琥珀散加减辨治子宫内膜异位症疼痛(血瘀证)的疗效作用机制

Effect and Mechanism of Add and Subtract Dialectics of Huposan on Endometriosis with Blood Stasis Syndrome

目的:探讨琥珀散加减辨治子宫内膜异位症(EMs)疼痛(血瘀证)的临床疗效及对致炎细胞因子水平的影响。方法:将138例符合要求的EMs疼痛患者,采用随机区组分化,按数字表法分为对照组和观察组各69例。对照组采用口服米非司酮片治疗,12.5 mg/次,1次/d。观察组采用琥珀散加减辨证治疗,1剂/d。两组疗程均为连续治疗6个月。经期疼痛情况采用视觉模拟评分(VAS)评分,并对非经期的盆腔痛、性交疼痛、盆腔压痛、骶韧带触痛结节和血瘀证进行治疗前后评分;检测治疗前后血清血栓素B2(TXB2),6-酮前列腺素F1α(6-Keto-PGF1α),癌抗原125(CA125),雌激素(E2),肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),白细胞介素-8(IL-8)水平。结果:观察组临床总有效率为95.38%,对照组为81.25%,观察组高于对照组(χ~2=6.269,P<0.05);经重复测量的方差分析,两组患者在6个月经周期的治疗过程VAS评分均呈下降趋势(F对照组=6.903,F观察组=7.632,P<0.05),经配对t检验,观察组在第3,4,5,6个月经周期VAS评分均低于对照组(P<0.01);治疗后观察组非经期的盆腔痛、性交疼痛、盆腔压痛、骶韧带触痛结节评分和血瘀证评分均低于对照组(P<0.01);观察组患者血清CA125,E2,TXB2和6-Keto-PGF1α水平均低于对照组(P<0.01);治疗后观察组血清TNF-α,IL-6,IL-8水平均低于对照组(P<0.01)。结论:采用琥珀散加减辨证治疗EMs疼痛(血瘀证)患者,能明显缓解患者的疼痛症状,并能降低雌激素、前列腺素和血清TNF-α,IL-6,IL-8等因子水平,起到改善EMs病情的作用。

Objective： To discuss the clinical efficacy of add and subtract dialectics of Huposan on endometriosis （EMs） with blood stasis syndrome and investigate its effect on inflammation factors. Method： One hundred and thirty-eight patients with EMs were randomly divided into control group 69 cases and observation group 69 cases by random number table. The control group adopted mifepristone, 12.5 mg/time, 1 time/day. In observation group, the patients received add and subtract dialectics of Huposan, 1 dose/day. The treatment course was 6 months in both groups. Score of pain in menstrual period was graded by visual simulation score （VAS） , and scores of pelvic pain, sexual intercourse pain, pelvic tenderness, sacral ligament tenderness nodules and blood stasis syndrome were graded at non-menstrual period both before ans after treatment. In addition, the levels of serum thromboxane-2 （ TXB2 ） , 6-Keto prostaglandins F1α （6-Keto-PGF1α）, cancer antigen 125 （ CA125 ）, estrogen （ E2） , tumor necrosis factor-α （TNF-α） , interleukin-6 （IL-6） , and interleukin-8 （IL-8） were detected both before and after treatment. Result： The total effective rate was 95.38% in observation group, higher than 81.25% in control group （x^2 = 6. 269, P 〈 0.05）. In the variance analysis of repeated measurements, during 6 menstrual cycles, scores of VAS were decreased （F 1 = 6. 903, Fobservation = 7. 632, P 〈 0.05）. In paired t-test, at the 3th, dth, 5th and 6th menstrual cycles, scores of VAS in observation group were lower than those in control group （P 〈 0.01 ）. After treatment, scores of pelvic pain, pain in intercourse, pelvic tenderness, tenderness of the sacral ligament, and blood stasis scores, and levels of CA125, E2, TXB2 and 6-Keto-PGF1α, TNF-α, IL-6, and IL-8 in observation group were all lower than those in control group （P 〈 0.01 ）. Conclusion： Add and subtract dialectics of Huposan can ameliorate pain and decrease levels of estrogen, TNF-α, IL-6, and IL-8 to ameliorate conditions in patients with endometriosis pain （blood stasis syndrome）.