宫瘤消胶囊对子宫内膜异位症气滞血瘀证血管生成机制的影响

Mechanism of Gongliuxiao Capsules on Angiogenesis in Patients with Endometriosis with Qi Stagnation and Blood Stasis Syndrome

目的:探讨宫瘤消胶囊治疗子宫内膜异位症(EMs)气滞血瘀证的临床疗效及对血管内皮生长因子(VEGF),基质金属蛋白酶(MMP),碱性成纤维细胞生长因子(b FGF),转化生长因子-β1(TGF-β1)和肿瘤坏死因子-α(TNF-α)等促血管生成因子水平的影响。方法:将128符合EMs气滞血瘀证患者,采用SAS软件生成的,随机按数字表法分为对照组和观察组各64例。两组患者均服用孕三烯酮胶囊,2.5 mg/次,2次/周,于月经第1天开始,每周固定时间服药。观察组加服宫瘤消胶囊,4粒/次,3次/d。两组疗程均连续治疗6个月经周期。经期疼痛情况采用视觉模拟评分(VAS)评分,进行治疗前后非月经期的盆腔痛、性交疼痛、盆腔压痛、骶韧带触痛结节和气滞血瘀证评分;检测治疗前后血清癌抗原125(CA125),CA199,VEGF,MMP-2,MMP-9,b FGF,TGF-β1和TNF-α水平。结果:观察组临床总有效率为91.67%,高于对照组的76.27%(χ2=5.255,P<0.05);观察组在第4,5,6个月经周期VAS评分均低于对照组(P<0.01);治疗后观察组非月经期的盆腔痛、性交疼痛、盆腔压痛、骶韧带触痛结节评分均低于对照组(P<0.01),观察组气滞血瘀证评分低于对照组(P<0.01);观察组患者血清CA125和CA199水平均低于对照组(P<0.01);观察组患者血清VEGF,MMP-2,MMP-9,b FGF,TGF-β1和TNF-α水平均低于对照组(P<0.01)。结论:宫瘤消胶囊治疗子宫内膜异位症气滞血瘀证患者,能显著缓解患者的疼痛相关症状,提高临床疗效,并能降低VEGF等促血管生成因子水平,从不同靶点抑制新生血管的形成,起到控制病情的作用。

Objective： To discuss the clinical efficacy of Gongliuxiao capsules on endometriosis （EMs） with Qi stagnation and blood stasis syndrome and investigate their effect on levels of vascular endothelial growth factor （VEGF） , matrix metalloproteinases （MMP）, basic fibroblast growth factor （bFGF） , transforming growth factor-β （TGF-β） and tumor necrosis factor-α （TNF-α）. Method： One hundred and twenty-eight patients with Ems were randomly divided into control group and observation group by random number table, 64 cases in each group. Two groups of patients were treated with Gestrinone capsules, 2.5 mg/ times, 2 times / week, first days after menstruation, weekly fixed time medication. Patients in observation group got Gongliuxiao capsules, 4 capsules/time, 3 times/day. 6 menstrual cycles were course of treatment in both groups. Menstrual pain was recorded by visual simulation score （VAS） , and scores of non-menstrual pelvic pain, sexual intercourse pain,pelvic tenderness, sacral ligament tenderness nodules and blood stasis syndrome were graded before and after treatment. In addition, levels of carcinoembryonic antigen 125 （CA125）, CA199, VEGF, MMP-2, MMP-9, bFGF, TGF-β1 and TNF-α were detected before and after treatment. Result： The total effective rate was 91.67% in observation group, higher than 76.27% in control group （X2 = 5. 255, P 〈 0. 05 ）. At the 4th, 5th, 6th menstrual cycle, VAS in observation group was lower than that in control group （P 〈 0. 01 ）. Scores of non-menstrual pelvic pain, sexual intercourse pain, pelvic tenderness, sacral ligament tenderness nodules and blood stasis syndrome in observation group were all lower than those in control group after treatment （P 〈 0.01 ） , and scores of CA125, CA199, VEGF, MMP-2, MMP-9, bFGF, TGF-βl and TNF-α were all lower than those in control group （P 〈 0.01 ）. Conclusion： Gongliuxiao capsules can ameliorate pain-related symptoms, improve clinical efficacy, reduce levels of proinflammatory cytokines such as VEGF, and promote the formation of neovascularization from different targets to control the condition.