活血通络方配合子宫输卵管通液术治疗输卵管性不孕的临床观察

Clinic Observation of Huoxue Tongluo Decoction Cooperated Hydrotubation in Tubal Infertility Treatment

目的:观察活血通络方配合子宫输卵管通液术治疗输卵管性不孕的临床疗效及对肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和血液流变学的影响。方法:将94例患者随机按数字表分为对照组45例和观察组49例。对照组采用子宫输卵管通液术,观察组在对照组治疗的基础上加用活血通络方,根据病症辨证加减治疗,1剂/d,常规水煎,每次约200 mL,分早晚服用。两组均连续治疗2个月。随访1年记录妊娠情况(宫内妊娠率、异位妊娠率、妊娠流产率);进行治疗前后子宫输卵管造影评价输卵管通畅度;检测治疗前后血清TNF-α和IL-6水平;检测治疗前后血液流变学。结果:观察组宫内妊娠率40.8%优于对照组的20.0%(P<0.05),两组异位妊娠率和妊娠流产率比较差异无统计学意义;观察组输卵管通畅率63.3%优于对照组的42.2%(P<0.05);治疗后两组血清TNF-α和IL-6水平均较治疗前下降,观察组下降更为显著(P<0.01);治疗后观察组全血黏度(低、中、高切)、全血还原黏度(低、中、高切)、红细胞聚集指数和血浆黏度改善均优于对照组(P<0.01)。结论:活血通络方配合子宫输卵管通液术能促进输卵管再通,提高宫内妊娠率,近期和远期疗效均显著,其作用机制可能与减轻炎性损伤,促进炎症吸收,改善盆腔局部微循环有关。

Objective： The purpose is to observe the clinical curative effect of Huoxue Tongluo decoction in the cooperation with uterine hydrotubation in the tubal infertility and its influence on tumor necrosis factor-α （TNF-α）, interleukin-6 （IL-6） and blood rheology. Method： Ninety-four cases of patients were randomly divided into control group （45 cases） and observation group （49 cases） according to the digital method. Patients in the control group adopted the uterine Hydrotubation. based on this, patients in the observation group took Huoxue Tongluo decoction with add and subtract treatment, 1 dose/day, conventional water decoction, about 200 mL/ time, taking in the morning and the night, the treatment course of two groups is two months. The patients took one year follow-up, recording pregnancies condition （including rate of intrauterine pregnancy, ectopic pregnancy rate and pregnancy abortion rate）. The uterus oviduct images were taken to evaluate the tubal patency before and after treatment. The levels of TNF-α and IL-6 and blood rheology before and after the treatment were detected. Result：The intrauterine pregnancy rate of observation group is 40. 8% , which is better than 20.0% of control group （P 〈 0.05）. The comparison of ectopic pregnancy rate and pregnancy abortion rate of two groups does not have statistically significant differences, the tubal patency rate of observation group is 63.3% , which is better than 42.2% of control group （P 〈 0.05）. the levels of serum TNF-α and IL-6 was decreased after treatment, while the more significant decline occurred in the observation group （P 〈 0.01 ）. the improvements of whole blood viscosity （low, medium, high）, whole blood reductive viscosity （low, medium and high shear）, erythrocyte aggregation index and plasma viscosity of observation group after treatment were all better than control group （P 〈 0.01 ）. Conclusion： Huoxue Tongluo decoction cooperated with uterine hydrotubation can promote the fallopian tube recanalization, increase intrauterine pregnancy rate. The immediate and long-term efficacy is significant. The mechanism may be related to reduce inflammatory damage, promote inflammation absorption, and improve microcirculation in the pelvic region.