内异方加减联合曲普瑞林治疗子宫内膜异位症疗效及对超声血流参数和血清FSH、AMH水平的影响

Efficacy of Using Modified Neiyi Decoction Combined with Triptorelin in the Treatment of Patients with Endometriosis and Its Influence on Ultrasound Blood Flow Parameters and Levels of Serum FSH and AMH

目的:分析内异方加减联合曲普瑞林治疗子宫内膜异位症的临床疗效。方法:选取2020年3月至2021年9月到我院就诊的136例子宫内膜异位症(气滞血瘀证)患者,随机数字表法分为观察组和对照组各68例。对照组接受曲普瑞林治疗,观察组在对照组的基础上接受内异方加减治疗。比较两组治疗3个月时的临床疗效;比较两组治疗前及治疗3个月时的中医证候积分、超声血流参数[阻力指数(RI)、脉搏指数(PI)、舒张末期流速(EDV)、收缩期峰值流速(PSV)]、血清卵巢功能指标[卵泡刺激素(FSH)、抗苗勒氏管激素(AMH)、黄体生成素(LH)]水平及血清相关因子[血清癌胚抗原125(CA125)、基质金属蛋白酶9(MMP-9)、细胞间黏附因子1(ICAM-1)]水平;记录两组用药不良反应发生情况。结果:观察组治疗3个月时的治疗有效率为85.29%,显著高于对照组的70.15%(P<0.05);两组治疗3个月时的经行腹痛、经血量少、胸闷不舒,乳房胀痛证候积分较治疗前明显降低,且观察组显著低于对照组(P<0.05);两组治疗3个月时的超声RI、PI值较治疗前明显降低,EDV、PSV值较治疗前明显升高,组间比较差异有统计学意义(P<0.05);两组治疗3个月时的血清FSH、AMH、LH、CA125、MM-9、ICAM-1水平较治疗前明显降低,且观察组显著低于对照组(P<0.05);观察组治疗期间用药不良反应发生率为10.29%,对照组为7.46%,组间比较差异无统计学意义(P>0.05)。结论:内异方加减联合曲普瑞林治疗子宫内膜异位症可有效缓解患者经行腹痛、经血量少等中医证候,改善卵巢功能,提高治疗有效率。

Objective:To analyze the clinical efficacy of using Modified Neiyi Decoction combined with Triptorelin in the Treatment of endometriosis.Methods:A total of 136 patients with endometriosis(Qi-stagnation and blood-stasis syndrome)who were treated in the hospital from March 2020 to September 2021 were selected and divided into an observation group and a controlled group with 68 cases in each group according to the random number table method.The controlled group received Triptorelin treatment,while the observation group was additionally given Modified Neiyi Decoction on the basis of the controlled group.The clinical efficacy after 3 months of treatment as well as TCM syndromes scores,ultrasound blood flow parameters[resistance index(RI),pulsatility index(PI),end-diastolic velocity(EDV),peak systolic velocity(PSV)],serum ovarian function indicators[follicle stimulating hormone(FSH),anti-Müllerian hormone(AMH),luteinizing hormone(LH)]and serum related factors[serum carcinoembryonic antigen 125(CA125),matrix metalloproteinase 9(MMP-9),intercellular adhesion molecule 1(ICAM-1)]before treatment and at 3 months of treatment were compared between the two groups.The occurrence of adverse drug reactions in the two groups were recorded.Results:The effective rate of treatment was 85.29%in the observation group at 3 months of treatment,which was significantly higher than 70.15%in the controlled group(P<0.05).At 3 months of treatment,the scores of syndromes such as menstrual abdominal pain,little menstrual blood volume,chest tightness and uneasiness and breast distending pain in both groups were significantly decreased compared to before treatment,and the scores in the observation group were significantly lower than those in the controlled group(P<0.05).The ultrasound RI and PI of the two groups at 3 months of treatment were significantly declined while the EDV and PSV were significantly elevated compared with those before treatment,and the differences were statistically significant between the groups(P<0.05).The levels of serum FSH,AMH,LH,CA125,MM-9 and ICAM-1 in the two groups were significantly lowered at 3 months of treatment compared to before treatment(P<0.05).And the levels were significantly lower in the observation group compared to the controlled group(P<0.05).The incidence rate of adverse drug reactions in the observation group during treatment was 10.29%and that in the controlled group was 7.46%(P>0.05).Conclusion:Modified Neiyi Decoction combined with Triptorelin is effective in the treatment of endometriosis,and can effectively relieve the TCM syndromes such as menstrual abdominal pain and little menstrual blood volume,improve the ovarian function and enhance the effective rate of treatment.