文献类型：期刊文献

中文题名：加味少腹逐瘀汤对子宫内膜异位症寒凝血瘀证盆腔疼痛神经血管生成的影响

英文题名：Effect of Modified Shaofu Zhuyutang on Neural Angiogenesis and Pelvic Pain of Endometriosis with Syndrome of Cold Congeal and Blood Stasis

作者：毛海燕[1,2];陈元欢[1];武权生[1];吉秀家[1];黄灿灿[1];窦艳猛[1];张小花[1]

第一作者：毛海燕

机构：[1]甘肃中医药大学,兰州730011;[2]甘肃省人民医院,兰州730000

第一机构：甘肃中医药大学

年份：2022

卷号：28

期号：12

起止页码：141

中文期刊名：中国实验方剂学杂志

外文期刊名：Chinese Journal of Experimental Traditional Medical Formulae

收录：CSTPCD;;北大核心:【北大核心2020】；CSCD:【CSCD2021_2022】；

基金：国家自然科学基金地区基金项目(81760879);甘肃省中药现代制药工程研究院项目(2305083302);甘肃省中医药管理局项目(GZK-2017-47);2021年度优秀研究生“创新之星”项目(2021CXZX-763)。

语种：中文

中文关键词：子宫内膜异位症;盆腔疼痛;寒凝血瘀证;加味少腹逐瘀汤;神经机制;血管生成

外文关键词：endometriosis;pelvic pain;syndrome of cold congeal and blood stasis;modified Shaofu Zhuyutang;neural mechanism;angiogenesis

摘要：目的:评价加味少腹逐瘀汤治疗子宫内膜异位症寒凝血瘀证盆腔疼痛的临床疗效及对神经血管生成的影响。方法:将110例符合标准的患者采用随机数字表法分为对照组(54例)和观察组(56例)。对照组口服艾附暖宫丸,6 g/次,2次/d;观察组口服加味少腹逐瘀汤,1剂/d。两组均连续治疗3个月经周期。治疗前后进行痛经、其他盆腔疼痛症状及盆腔疼痛体征评分;寒凝血瘀证和子宫内膜异位症患者生存质量量表(EHP-5)评分;检测治疗前后外周血神经生长因子(NGF)、P物质(SP)、降钙素基因相关肽(CGRP)、脑源性神经营养因子(BDNF)、血管内皮生长因子可溶性受体-1(sFlt-1)、血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)和胰岛素生长因子-1(IGF-1)水平;检测治疗前后前列腺素E_(2)(PGE_(2))、环氧化酶2(COX-2)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)等炎症因子水平。记录止痛药物使用量和复发情况。结果:观察组痛经、其他盆腔疼痛症状(非经期盆腔痛、性交痛、肛门坠痛、排便痛等)和盆腔疼痛体征(盆腔压痛、骶韧带触痛结节)评分均低于对照组(P<0.01);观察组患者痛经、盆腔压痛、骶韧带触痛结节的消失率分别为67.35%(33/49)、73.33%(33/45)、77.27%(34/44),均分别高于对照组的45.83%(22/48)、48.84%(21/43)和52.27%(23/44),差异有统计学意义(χ^(2)=4.571,χ^(2)=5.565,χ^(2)=6.026,P<0.05);观察组EHP-5和寒凝血瘀证评分低于对照组(P<0.01);观察组VEGF、MMP-9、IGF-1、NGF、SP、CGRP和BDNF水平低于对照组(P<0.01),sFlt-1水平高于对照组(P<0.01);观察组PGE_(2)、COX-2、TNF-α和IL-6水平低于对照组(P<0.01);观察组总有效率为92.45%(49/53),高于对照组的76.00%(38/50)(χ^(2)=5.307,P<0.05);进行6个月的随访,观察组复发率为30.61%(15/49),低于对照组的52.63%(20/38)(χ^(2)=4.315,P<0.05);对照组平均每个月经期服用布洛芬缓释胶囊高于观察组(P<0.01)。结论:加味少腹逐瘀汤治疗子宫内膜异位症盆腔疼痛寒凝血瘀证患者可调节神经血管生成机制,减轻疼痛,促进相关疼痛消失,提高了生活质量,临床疗效优于艾附暖宫丸,且复发率低。
Objective:To evaluate the clinical curative effect of modified Shaofu Zhuyutang on pelvic pain of endometriosis(EMT)with syndrome of cold congeal and blood stasis and the influence on neural angiogenesis.Method:A total of 110 cases were divided into a control group(54 cases)and an observation group(56 cases)by the random number table method.Patients in the control group took Aifu Nuangong pills with 6 g/time and 2 times/day.Patients in the observation group took modified Shaofu Zhuyutang with1 dose/day.Course of treatment continued for 3 menstrual cycles.Dysmenorrhea,other symptoms and signs of pelvic pain,and the EMT health profile-5(EHP-5)for patients with syndrome of cold congeal and blood stasis and EMT were scored before and after treatment.The levels of peripheral blood nerve growth factor(NGF),substance P(SP),calcitonin gene-related peptide(CGRP),brain-derived neurotrophic factor(BDNF),soluble Fms-like tyrosine kinase(sFlt-1),vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9),and insulin growth factor-1(IGF-1)were detected before and after treatment.The levels of prostaglandin E_(2)(PGE_(2)),cyclooxygenase-2(COX-2),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and other inflammatory factors were detected before and after treatment.The pain medication usage and recurrence were recorded.Result:The scores of dysmenorrhea,symptoms of pelvic pain symptoms(nonmenstrual pelvic pain,dyspareunia,anal falling pain,and defecation pain,etc.),and signs of pelvic pain(pelvic tenderness and sacral ligament tender nodules)in the observation group were lower than those in the control group(P<0.01).The disappearance rates of dysmenorrhea,pelvic tenderness,and sacral ligament tender nodules were 67.35%(33/49),73.33%(33/45),and 77.27%(34/44)in the observation group,which were all higher than 45.83%(22/48),48.84%(21/43),and 52.27%(23/44)in the control group.The difference was statistically significant(χ^(2)=4.571,χ^(2)=5.565,χ^(2)=6.026,P<0.05).The scores of EHP-5 and syndrome of cold congeal and blood stasis in the observation group were lower than those in the control group(P<0.01).The levels of VEGF,MMP-9,IGF-1,NGF,SP,CGRP,and BDNF in the observation group were lower than those in the control group(P<0.01),while the level of sFlt-1 was higher than that in the control group(P<0.01).The levels of PGE_(2),COX-2,TNF-α,and IL-6 in the observation group were lower than those in the control group(P<0.01).The total effective rate of the observation group was 92.45%(49/53),which was higher than 76.00%(38/50)of the control group(χ^(2)=5.307,P<0.05).After 6 months of follow-up,the recurrence rate in the observation group was 30.61%(15/49),which was lower than 52.63%(20/38)in the control group(χ^(2)=4.315,P<0.05).The average of taking ibuprofen sustained-release capsules in the control group was higher than that in the observation group per menstrual period(P<0.01).Conclusion:Modified Shaofu Zhuyutang treated pelvic pain of EMT with syndrome of cold congeal and blood stasis by regulating the mechanism of neural angiogenesis,reducing pain,and promoting the disappearance of related pains,thus improving the quality of life.Shaofu Zhuyutang has a better clinical effect than Aifu Nuangong pills and has a low recurrence rate.