腹腔镜术后中药治疗对盆腔炎性不孕患者肿瘤坏死因子-α、白细胞介素-6的影响

Effect of Chinese Medicine on Tumor Necrosis Factor Alpha and Interleukin 6 in Patients with Infertility Induced by Pelvic Inflammatory Disease After Laparoscopic Operation

【目的】观察腹腔镜术后中药治疗对不同程度盆腔炎性不孕患者肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的影响。【方法】收集因盆腔炎性不孕行腹腔镜手术治疗的患者85例,采用分层随机方法分为4组:手术组(轻度)20例,手术+中药组(轻度)22例,手术组(中度)21例,手术+中药组(中度)22例。收集同期因单纯性卵巢囊肿行腹腔镜手术患者20例作为非炎症对照组。比较治疗前后各组患者临床症状、体征的改善情况,采用酶联免疫吸附法测定各组患者治疗前后血清TNF-α、IL-6水平。【结果】(1)治疗后除手术组(轻度)的症状积分与治疗前比较差异无统计学意义(P>0.05)外,其余3组均较治疗前显著下降(P<0.05)。治疗后各组的体征积分均较治疗前显著降低(P<0.05)。治疗后,症状积分、体征积分手术+中药组(中度)显著低于手术组(中度)(P<0.05);而手术+中药组(轻度)与手术组(轻度)比较,差异无统计学意义(P>0.05)。(2)治疗后,血清TNF-α水平除手术组(轻度)与治疗前比较差异无统计学意义(P>0.05)外,其他3治疗组较治疗前显著降低,差异均有统计学意义(P<0.05)。治疗后相同粘连程度的2组比较,手术+中药组(中度)的血清TNF-α水平显著低于手术组(中度),差异有统计学意义(P<0.01);而手术+中药组(轻度)与手术组(轻度)比较,差异无统计学意义(P>0.05)。治疗后与非炎症对照组比较,除手术+中药组(轻度)差异无统计学意义(P>0.05)外,其他3组的血清TNF-α水平仍显著高于非炎症对照组,差异均有统计学意义(P<0.05或P<0.01)。(3)治疗后,血清IL-6水平除手术组(中度)较治疗前有降低趋势,但差异无统计学意义(P>0.05)外,其他3治疗组均较治疗前显著降低,差异均有统计学意义(P<0.05或P<0.01)。治疗后相同粘连程度的2组比较,无论轻度还是中度,手术+中药组显著低于手术组,差异均有统计学意义(P<0.05或P<0.01)。治疗后与非炎症对照组比较,各治疗组的血清IL-6水平仍显著高于非炎症对照组,差异均有统计学意义(P<0.05或P<0.01)。【结论】中药联合腹腔镜手术是治疗盆腔炎性不孕的有效方法,能明显改善患者的临床症状及体征;可降低盆腔炎性不孕患者血清TNF-α、IL-6水平,抑制盆腔炎性不孕患者炎症因子的过度升高及所致的机体过度免疫应答,恢复输卵管功能,改善盆腔的病理状态。

Objective To observe the effect of Chinese medicine（CM） on tumor necrosis factor alpha（TNF-α） and interleukin 6（IL-6） in patients with infertility induced by pelvic inflammatory disease（PID） after laparoscopic operation.Methods By adopting the method of stratification randomization,85 PID-induced infertility patients after laparoscopic operation were divided into 4 groups,i.e.,mild PID group（N=20）,mild PID＋CM group（N=22）,moderate PID group（N=21）,and moderate PID＋CM group（N=22）.Twenty simultaneous patients which had received laparoscopic operation for simple ovarian cyst served as the non-inflammation control group.The clinical symptoms and signs were observed in all of the groups before and after the treatment.Enzyme-linked immunoassay was used for the detection of serum TNF-α and IL-6 levels in all of the groups before and after the treatment.Results（1）Symptom scores were decreased in all of the infertility patients except those in mild PID group（P0.05 compared with those before treatment）,and the sign scores were also decreased in all of the infertility patients（P0.05）.After treatment,the scores of symptoms and signs were decreased in all of the infertility patients receiving CM,the difference being significant only between moderate PID group and moderate PID＋CM group（P0.05）.（2）Serum TNF-α level was decreased in all of the infertility patients except those in mild PID group（P0.05 compared with those before treatment）,and the difference of TNF-α level was significant between moderate PID group and moderate PID＋CM group after treatment（P0.05）,while was insignificant between mild PID group and mild PID＋CM group（P0.05）.After treatment,TNF-α level was still higher in all of the infertility patients except those in mild PID＋CM group than that in non-inflammation control group（P0.05 or P0.01）.（3）Serum IL-6 level was decreased in all of the infertility patients except those in moderate PID group（P0.05 or P0.01 compared with those before treatment）,and the difference of IL-6 level was significant between PID groups and PID＋CM groups after treatment（P0.05 or P0.01）.After treatment,IL-6 level was still higher in all of the infertility patients than that in non-inflammation control group（P0.05 or P0.01）.Conclusion Application of CM after laparoscopic operation is effective for the treatment of PID-induced infertility patients by relieving the symptoms and signs,and its therapeutic mechanism may be related with the decrease of serum TNF-α and IL-6 levels,through which the hyperactive immune response is inhibited and the pelvic pathological state is improved.