益肾散结祛瘀方治疗肾虚血瘀证子宫腺肌病的临床研究

Clinical Study of Yishen Sanjie Quyu Decoction in the Treatment of Adenomyosis Caused by Kidney Deficiency and Blood Stasis

目的探讨益肾散结祛瘀方治疗肾虚血瘀证子宫腺肌病的临床疗效。方法选取我院2014年6月-2016年6月收治的中医辨证分型为肾虚血瘀证子宫腺肌病患者102例,将其按照随机数字法随机分为观察组和对照组,每组51例,对照组给予散结镇痛胶囊治疗,观察组给予益肾散结祛瘀方治疗,观察治疗前后2组痛经症状及中医证候改善情况、子宫体积、CA125值、免疫学指标的变化。结果治疗后2组痛经积分和中医证候积分均显著下降(P<0.01),但观察组下降更为明显(P<0.01)。治疗后观察组总有效率为96.1%,显著高于对照组的78.4%(P<0.01)。治疗后观察组中医证候总有效率为94.1%,显著高于对照组的78.4%(P<0.05)。治疗后2组子宫体积及CA125值均较治疗前显著降低(P<0.01),但观察组降低更为明显(P<0.01)。治疗后2组Th17细胞比率、Th17/Treg均较治疗前显著下降,Treg细胞比率较治疗前显著上升(P<0.01),但观察组Th17细胞比率、Th17/Treg下降更为明显,Treg细胞比率上升更为明显(P<0.01)。治疗后2组IL-6、IL-10、IL-17、TGF均较治疗前显著下降(P<0.01),但观察组下降更为明显(P<0.01)。结论益肾散结祛瘀方可显著改善肾虚血瘀证子宫腺肌病患者痛经症状及中医证候,临床疗效好,安全性高,其作用机制可能与改善机体的Th17/Treg细胞免疫失衡状态有关。

OBJECTIVE To investigate the clinical curative effects of Yishen Sanjie Quyu decoction in the treatment of adenomyosis caused by kidney deficiency and blood stasis. METHODS 102 patients in our hospital who were diagnosed as adenomyosis caused by kidney deficiency and blood stasis from June, 2014 to June 2016 were randomly divided into the observation group and the control group according to random number method, with 51 cases in each group. The control group was treated by Sanjie Zhentong Capsule, and the observation group was given Yishen Sanjie Quyu Decoction. Symptoms of dysmenorrhea, TCM syndrome improvements, uterine volume changes, CA125 value changes and immunological indexes of the two groups were compared before and after treatment. RESULTS Dysmenorrhea scores and TCM syndrome scores of the two groups were decreased significantly after the treatment （P〈0.01）, but the observation group decreased more significantly（P〈0.01）. After the treatment, the total effective rate of the observation group was 96.1%, which was significantly higher than 78.4% of the control group（P〈0.01）. After treatment, TCM syndrome total effective rate of the observation group was 94.1% which was significantly higher than 78.4% of the control group（P〈0.05）. After the treatment, uterine volumes and CA125 values of two groups were both decreased significantly than that of the pre-treatment （P〈0.01）, but the observation group decreased more significantly （P〈0.01）. After the treatment, Th17 cell ratios and Th17/Treg of two groups were both decreased significantly than that of the pre-treatment, Treg cell ratio increased significantly than that of the pre-treatment （P 〈0.01）, but Th17 cell ratio and Th17/Treg of the observation group decreased more significantly, and Treg cell ratio of the observation group increased more significantly （P〈0.01）. After the treatment, IL-6, IL-10, IL-17 and TGF of two groups were de- creased significantly than pre-treatment （P〈0.01）, but the observation group decreased more significantly （P〈0.01）. CONCLUSION Yishen Sanjie Quyu decoction can significantly improve the dysmenorrhea symptoms and TCM syndromes of patients with adenomyosis caused by kidney deficiency and blood stasis. It has good clinical effects and high safety, and its action mechanism may correlate with improving the imbalance of Th17/Treg ceils which can strengthen the body.