止带方加减治疗慢性宫颈炎合并HPV感染LEEP术后观察

Clinical Observation of Add and Subtract Treatment of Zhidaifang on Chronic Cervicitis with Human Papillomavirus

目的:探讨止带方加减对慢性宫颈炎合并人类乳头瘤病毒(HPV)感染,高频电波刀宫颈电圈环切术后(LEEP)患者病毒阴转作用,及对重组人γ-干扰素(IFN-γ),白细胞介素-10(IL^(-1)0)和IL-4的影响。方法:将190例符合研究的中、重度患者,按SAS软件生成,随机分为观察组和对照组。两组患者均采用LEEP术。术后对照组89例患者给予治带片口服,5片/次,3次/d;术后观察组91例患者采用止带方加减内服,1剂/d。两组患者均连续治疗4个月经周期。进行治疗前后糜烂面积、糜烂类型、阴道清洁度、带下的量、带下性质、外阴痒痛、接触性出血,下腹或腰痛和湿热下注评分;检测人乳头瘤病毒脱氧核糖核酸(HPV-DNA),记录HPV-DNA阴转情况和HPV病毒载量。检测治疗前后IFN-γ,IL^(-1)0和IL-4水平。结果:经Ridit分析,治疗后观察组慢性宫颈炎疗效优于对照组(P<0.05);经Ridit分析,治疗后观察组中医临床证候疗效优于对照组(P<0.05);治疗后观察组糜烂面积、糜烂类型、阴道清洁度、带下的量、带下性质等临床症状、体征评分均低于对照组(P<0.01);治疗后观察组HPV病毒载量低于对照组(P<0.01),湿热下注证评分低于对照组(P<0.01);治疗后观察组HPV-DNA阴转率为79.12%,高于对照组的62.92%(P<0.05);治疗后两组患者IFN-γ水平均升高,观察组升高更为显著(P<0.01),两组患者IL-4和IL^(-1)0水平均下降,观察组下降更为明显(P<0.01)。结论:止带方加减治疗慢性宫颈炎合并HPV感染,能显著改善慢性宫颈炎症状、体征,降低HPV-DNA载量,促使HPV阴转,临床疗效明显,其作用机制可能与调节Th1/Th2的失衡有关。

Objective： To observe the negative conversion role to virus and clinical effect of add and subtract treatment of Zhidaifang in treating chronic cervicitis with HPV infection and investigate its regulation effect on levels of interferon-γ （IFN-γ） , interleukin-10 （IL-10） and interleukin-4. Method： One hundred and ninety patients were randomly divided into control group and observation group by random number table. Patients in both groups received of cervical loop electrosurgical excision procedure （LEEP）. After surgery, the patients in control group （89 cases） received Zhidaifang, 5 tablets/time, 3 times/day by oral. And the patients in observation group （91 cases） received add and subtract Zhidaifang, 1 dose/day. The treatment course was 4 menstrual cycles for both groups. Before and after treatment, scores of erosion area, erosion type, vaginal cleanliness, the amount of vaginal discharge, vulvar itching, contact bleeding, damp of abdominal or back pain were graded. Human papillomavirus DNA （HPV-DNA） was detected, and negative conversion conditions of HPV-DNA and viral load of HPV were recorded. Levels of IFN-γ, IL-10 and IL-4 in serum were detected both before and after treatment. Result： Ridit analysis showed that, the clinical efficacy and effect on traditional Chinese medicine （TCM） symptoms in observation group were better than those in control group after treatment （P 〈 0.05 ）. Scores of erosion area, erosion type, vaginal cleanliness, the amount of vaginal discharge, vulvar itching, contact bleeding and damp in observation group were lower than those in control group （P 〈 0.01 ）. Viral load of HPV in observation group was lower than that in control group （P 〈 0.01 ）. Negative conversion rate of HPV-DNA was 79.12% in observation group, higher than 62.92% in control group （P 〈 0.05）. The levels of IFN-γ were increased after treatment in both groups, and the increase was more obvious in observation group （P 〈 0.01 ）. Levels of IL-4 and IL-10 were decreased in both groups, and the decrease was more obvious in observation group （P 〈 0.01 ）. Conclusion： Add and subtract Zhidaifang can ameliorate symptoms and signs of chronic cervicitis, promote HPV negative conversion, and reduce HPV-DNA load, with obvious clinical efficacy, and the mechanism may be related to regulating imbalance of Thl/Th2.