文献类型：期刊文献

中文题名：少腹逐瘀汤加减联合郑氏“热补针法”治疗子宫腺肌病相关疼痛的临床观察

英文题名：Clinical Efficacy of Modified Shaofu Zhuyutang Combined with Zheng’s Rebuzhen Therapy on Pain Caused by Adenomyosis

作者：丁海霞[1];彭凤娣[2];张小花[2];王玉泉[3]

第一作者：丁海霞

机构：[1]甘肃中医药大学附属医院,兰州730020;[2]甘肃中医药大学中医临床学院,兰州730000;[3]甘肃省中医院,兰州730050

第一机构：甘肃中医药大学第二附属医院

年份：2019

卷号：0

期号：15

起止页码：142

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2017】；CSCD:【CSCD2019_2020】；

基金：甘肃省中医药管理局科研项目(GZK-2018-1)

语种：中文

中文关键词：子宫腺肌病;寒凝血瘀证;郑氏“热补针法”;少腹逐瘀汤;疼痛

外文关键词：adenomyosis;cold coagulation and blood stasis syndrome;Zheng’s Rebuzhen therapy;Shaofu Zhuyutang;pain

摘要：目的:观察少腹逐瘀汤加减联合郑氏'热补针法'治疗子宫腺肌病(AM)相关疼痛(寒凝血瘀证)的疗效及对血管内皮生长因子(VEGF),基质金属蛋白酶-9(MMP-9),基质金属蛋白酶组织抑制剂-1(TIMP-1),前列腺素等因子的影响。方法:将140例符合要求的患者随机分为对照组和观察组各70例。对照组口服去氧孕烯炔雌醇片,1粒/次,1次/d,于月经来潮第1天开始服药,连续服用21 d,停药7 d;并给予郑氏'热补针法',1次/d,每月经周期连续10 d。观察组在对照组治疗的基础上,加用少腹逐瘀汤加减,1剂/d。疗程为3个月经周期。进行治疗前后COX痛经症状评分量表(CMSS),痛经视觉模拟(VAS)评分和慢性盆腔痛评分;进行治疗前后月经量评分(PBAC)和寒凝血瘀证评分;采用B超评价治疗前后子宫体积和子宫内膜厚度;检测治疗前后VEGF,MMP-9,TIMP-1,前列腺素E2(PGE2),前列腺素F2α(PGF2α)和癌抗原125(CA125)水平。结果:观察组临床疗效优于对照组(Z=2. 445,P <0. 05);治疗后观察组患者痛经VAS,COX痛经时间,COX痛经程度和慢性盆腔痛评分均低于对照组(P <0. 01);治疗后观察组患者PBAC评分和寒凝血瘀证评分均低于对照组(P <0. 01),子宫体积和子宫内膜厚度小于对照组(P <0. 01),治疗后观察组患者血清VEGF,MMP-9水平均低于对照组(P <0. 01),TIMP-1水平高于对照组(P <0. 01),MMP-9/TIMP-1低于对照组(P <0. 01);治疗后观察组患者血清PGF2α和CA125水平均低于对照组(P <0. 01),PGE2高于对照组(P <0. 01)。结论:在去氧孕烯炔雌醇片联合郑氏'热补针法'治疗的基础上,采用少腹逐瘀汤加减治疗AM寒凝血瘀证患者,可进一步的减轻疼痛等相关症状,减少月经量,提高临床疗效,其作用机制可能与调节VEGF,MMP-9,TIMP-1和前列腺素等因子表达有关。
Objective:To observe the effect of modified Shaofu Zhuyutang combined with Zheng’s Rebuzhen therapy on pain caused by adenomyosis(cold coagulation and blood stasis syndrome)and levels of vascular endothelial growth factor(VEGF),matrix metalloproteinases-9(MMP-9),tissue inhibitors of matrix metalloproteinases(TIMP-1)and prostaglandin.Method:One hundred and twenty-eight patients were randomly divided into control group(63 cases)and observation group(65 cases)by random number table.Patients in control group got desogestrel and ethinylestradiol tablets since the first day of menstruation for consecutive 21 days,1 granule/time,1 time/day,and Zheng’s Rebuzhen therapy for consecutive 10 days during the menstruation,1 time/day.In addition to the therapy of control group,patients in observation group were also given Shaofu Zhuyutang,1 dose/day.A course of treatment was 3 menstrual cycles.Before and after treatment,cox menstrual symptom scale(CMSS)of COX,visual simulation of dysmenorrheal(VAS),chronic pelvic pain,pictorial blood loss assessment chart(PBAC)and cold coagulation and blood stasis syndrome were scored.And uterine volume and endometrial thickness were evaluated by B-mode ultrasonography.And levels of VEGF,MMP-9,TIMP-1,prostaglandin E2(PGE2),prostaglandin F2α(PGF2α)and cancer antigen were detected.Result:After treatment,the clinical efficacy in observation group was superior to that in control group(Z=2.445,P<0.05).After treatment,scores of VAS,dysmenorrhea time of COX,dysmenorrheal of COX,chronic pelvic pain,PBAC and cold coagulation and blood stasis syndrome were lower than those in control group(P<0.01).And uterine volume and endometrial thickness were lower than those in control group(P<0.01).And levels of VEGF,MMP-9,MMP-9/TIMP-1,PGF2αand CA125 were lower than those in control group(P<0.01),while levels of TIMP-1 and PGE2 were higher than those in control group(P<0.01).Conclusion:In addition to desogestrel and ethinylestradiol tablets combined with Zheng’s Rebuzhen therapy,modified Shaofu Zhuyutang can relieve pain and hemorrhage and improve the clinical efficacy.The mechanism may be correlated with the regulation of expression levels of VEGF,MMP-9,TIMP-1 and prostaglandin.