消癥饮治疗子宫内膜异位症临床观察及机制探讨

Clinical Efficacy and Mechanism of Xiaozheng Yin in Treatment of Endometriosis

目的:探讨消癥饮治疗子宫内膜异位症(EMS)疼痛(气滞血瘀证)的疗效及对基质金属蛋白酶(MMP)-3,MMP-9,血管内皮生长因子(VEGF)和肿瘤坏死因子-α(TNF-α)水平的影响。方法:108例患者随机分成对照组(53例)和观察组(55例)。两组均口服孕三烯酮胶囊,2.5 mg/次,2次/周,连续服用6个月。对照组口服散结镇痛胶囊,4粒/次,3次/d。观察组口服消癥饮,每日1剂。两组每月服药28 d,连续治疗6个月,经期不停药。检测治疗前后血清癌抗原125(CA125)和CA199水平,检测治疗前后血清MMP-3,MMP-9,VEGF和TNF-α水平;进行治疗前后疼痛症状、体征评分和子宫内膜异位症生存质量量表(EHP-5)评分。结果:治疗后观察组视模拟(VAS)、痛经、盆腔痛、盆腔压痛、骶韧带触痛结节评分均显著低于对照组(P<0.01);治疗后观察组CA125和CA199水平明显低于对照组(P<0.05);治疗后观察组血清MMP-3,MMP-9,VEGF,TNF-α水平明显低于对照组(P<0.05,P<0.01);治疗后观察组EHP-5量表疼痛、情绪状态、控制感、性生活、不孕和治疗效果评分显著低于对照组(P<0.01);观察组临床疗效总有效率高于对照组(P<0.05)。结论:消癥饮能显著改善EMS患者疼痛,提高患者生活质量,降低血清CA125,CA199,MMP-3,MMP-9,VEGF和TNF-α水平,从而促进疾病的康复。

Objective： To investigate the efficacy of Xiaozheng Yin for the pain in endometriosis（ EMS）with Qi stagnation and blood stasis and observe its effects on levels of matrix metalloproteinase（ MMP）-3,MMP-9,vascular endothelial growth factor（ VEGF） and tumor necrosis factor-α（ TNF-α）. Method： One hundred and eight patients were randomly divided into control group（ 53 cases） and observation group（ 55 cases）. Patients in both groups took Gestrinone capsules,2. 5 mg / time,2 times / week,continuing for six months. Patients in control group also took Sanjie Zhentong capsule,4 pieces / time,3 times / day,while patients in observation group orally took Xiaozheng Yin,1 dose / day. Both groups took drugs 28 days a month,continuing for 6 months. Medicines were not withdrawn in menstrual cycle period. The levels of serum cancer antigen 125（ CA125） and CA199,levels of serum MMP-3,MMP-9,VEGF and TNF-α were detected before and after treatment. Scores of pain,symptoms and endometriosis health profile-5（ EHP-5） were graded before and after treatment. Result： After therapy,scores of visual analogue scale（ VAS）,dysmenorrhea,pelvic pain,pelvic tenderness,and sacral ligament tenderness nodules in observation group were significantly lower than those in control group（ P 〈 0. 01）.After treatment,levels of CA125 and CA199 in observation group were lower than those in control group（ P 〈0. 05）,levels of serum MMP-3,MMP-9,VEGF and TNF-α in observation group were less than those in control group（ P 〈 0. 05,P 〈 0. 01）,the scores of pain,emotional state,control,sexual life,infertility and treatment effects at EHP-5 in observation group were significantly lower than those in control group（ P 〈 0. 01）. The total effective rate in treatment group was superior to that in control group（ P 〈 0. 05）. Conclusion： Xiaozheng Yin can obviously improve pain for EMS patients,enhance their quality of life,reduce levels of serum CA125,CA199,MMP-3,MMP-9,VEGF and TNF-α. Therefore,it can promote disease recovery.