滋肾凉血调周法对内异症性不孕症患者子宫内膜ER、PR、VEGF表达的影响及其与子宫内膜容受性的关系

Effects of TCM Zishen Liangxue cycle therapy on the expression of ER,PR and VEGF in endometrium of patients with endometriosis-related infertility and the correlation with endometrial receptivity

目的子宫内膜异位症性不孕症的低妊娠率是医学研究焦点,如何提高子宫内膜容受性,改善妊娠率是关键所在。本课题通过观察滋肾凉血调周法对子宫内膜雌、孕激素受体(ER、PR)和血管内皮生长因子(VEGF)表达的影响,探讨其改善内膜容受性,提高妊娠率方面的作用。方法选取宁波市中医院2015年7月—2016年9月经腹腔镜确诊为内异症性不孕症患者130例,轻度组60例,随机分为中药组和空白组,中药组服用滋肾凉血调周中药3个月经周期,观察3个月经周期,空白组不予治疗,观察6个月经周期;中重度组70例,随机分为治疗组和西药组,均予术后月经第1天皮下注射促性腺激素释放激素激动剂(GnRH-a),每4周一针,共3个疗程,治疗组续服滋肾凉血调周中药3个月经周期,采用免疫组化法检测各组治疗前后子宫内膜ER、PR及VEGF表达并观察妊娠结局。结果 (1)轻度组:治疗后中药组子宫内膜ER和VEGF表达较空白组下降,差异有统计学意义(P<0.05);PR表达未见显著性变化(P>0.05);(2)中重度组:治疗后治疗组子宫内膜ER、PR和VEGF表达较西药组均有显著性下降(P<0.05);(3)中药干预的2组患者与对照组比较,妊娠率均提高,差异有统计学意义(P<0.05)。结论滋肾凉血调周法能有效下调子宫内膜中ER和VEGF表达;该方法与GnRH-a针联合使用后对PR也有显著性下调作用;其提高妊娠率可能与改善子宫内膜容受性相关的激素受体和细胞因子表达有关。

Objective Many study focus on the low pregnancy rate in patients with endometriosis-related infertility. The key treatment for increasing the pregnancy rate is to improve the endometrial receptivity. The aim of this study is to ob- serve the effect of TCM Zishen Liangxue cycle therapy on the the expression of ER, PR and VEGF in endometrium of pa- tients with endometriosis-related infertility, and explore the clinical efficacy of TCM Zishen Liangxue cycle therapy in im- proving the pregnancy rate and the endometrial receptivity. Methods Total 130 patients with endometriosis-induced in- fertility in our hospital from July, 2015 to September, 2016 were enrolled into this study. Among them, 60 patients were defined as mild group, and other 70 cases were assigned into moderate-to-severe group. The patients in the mild group were randomly divided into TCM group （TCM Zishen Liangxue cycle therapy for continuous three months） and control group （without treatment） , the clinical efficacy was observed for six menstrual cycles. The patients in the moderate-to- severe group were randomly divided into treatment group and western medicine group. All the patients in both groups re- ceived GnRH-a injection on the first day of menstruation after the operation, one injection every 4 weeks for three cour- ses, then the treatment group continuous received treatment of TCM Zishen Liangxue cycle decoction for three menstrual cycles, while the western medicine group was only treated with GnRH-a. The expression of ER, PR and VEGF in endometrium before and after the treatment in all groups was tested by immunohistochemistry. Thee pregnancy rate were also observed. Results （1）in the mild group ： there were significantly lower expression of ER and VEGF in endometrium after treatment in TCM group as compared with the control group （ P 〈 0.05 ）. There were no significantly change in the expression of PR（ P 〈 0.05 ）. （2）in moderate-to-severe group ： significantly lower expression of ER, PR and VEGF in endometrium in the treatment group were observed after the treatment （ P 〈 0.05 ）. （3）Significant increase of pregnancy rate were found in both TCM group and treatment group when compared with the contrast groups, the difference was statistical significant （P 〈 0.05 ）. Conclusion TCM Zishen Liangxue cycle therapy can improve the expression of ER, PR and VEGF in endometrium and increase the pregnancy rate of patients with endometriosis-related infertility. It has a close relationship with the improvement of the endometrial receptivity.