益气化瘀方治疗保守性手术后复发子宫内膜异位症的临床研究

Clinical Efficacy and Mechanism Research on Yiqi Huayu Decoction in Treatment of Recurrent Endometriosis After Conservative Surgery

目的探讨益气化瘀方治疗保守性手术后复发子宫内膜异位症的临床疗效及对患者血清CA125、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制因子-1(TIMP-1)水平的影响。方法 45例保守性手术后复发的子宫内膜异位症患者随机分成中药组(23例)和西药组(22例)。西药组口服孕三烯酮胶囊,2.5 mg/次,2次/周;中药组口服益气化瘀方每日1剂,2次/日。连续治疗3个月后,比较两组患者治疗前后临床疗效;血清CA125、MMP-9、TIMP-1水平;盆腔包块的最大径线及药物的不良反应。结果中药组和西药组临床疗效无明显差异(P>0.05);两组治疗后CA125、MMP-9水平下降、TIMP-1水平上升、MMP-9/TIMP-1比值下降,但治疗后中药组TIMP-1水平明显高于西药组(P<0.05),中药组MMP-9及MMP-9/TIMP-1比值明显低于西药组(P<0.05);中药组药物不良反应明显低于西药组(P<0.05)。结论益气化瘀方能有效治疗保守性手术后复发子宫内膜异位症,其机理可能与降低血清CA125、MMP-9水平,提高TIMP-1水平,降低MMP-9/TIMP-1比值有关。与孕三烯酮相比,益气化瘀方药物不良反应更小,值得临床应用推广。

Objective To investigate the efficacy of Yiqihuayu decoction（ YQHYD ）on patients with recurrent endometriosis after conservative surgery and observe its effects on levels of serum cancer antigen 125 （CA125）, matrix metalloproteinase-9 （MMP- 9） and tissue inhibitor ofmetalloproteinase- 1（TIMP- 1）. Methods 45 cases of patients with recurrent endometriosis after conservative surgery were randomly divided into YQHYD group （23 cases） and Gestrinone group （22 cases）. YQHYD group took Yiqi Huayu decoction, ldose/d, Gestrinone group took Gestrinone capsules, 2.5 mg/time, 2 times/week. Both groups took drugs continuingly for 3 months. The levels of serum CA 125, MMP- 9 and TIMP- 1 were detected before and after treatment. The maximum diameter of pelvic masses measured by ultrasonic and the adverse drug reactions were recorded before and after treatment. Results After treatment, the levels of CA125, MMP- 9 and the ratio of MMP- 9 to TIMP- lwere significantly lower while the levels of TIMP- 1 were significantly higher than those before treatment in both groups. The levels of MMP- 9 and the ratio ofMMP- 9 to TIMP- 1 in YQHYD group were significantly lower than those in Gestrinone group and the levels of TIMP - 1 in YQHYD group were significantly higher than that in Gestrinone group. There was no significant difference between the two groups in clinical efficacy after treatment, the adverse drug reactions in Gestrinone group were much more obvious than that in YQHYD group. Conclusion Yiqi Huayu decoction is effective in treatment of recurrent endometriosis after conservative surgery. It can obviously lower the levels of serum CA125, MMP- 9 and the ratio ofMMP- 9 to TIMP- 1 and elevate the levels of serum TIMP- 1 with fewer side effect.