加味少腹逐瘀汤治疗盆腔炎性疾病后遗症-慢性盆腔痛寒湿凝滞证的临床分析

Effect of Modified Shaofu Zhuyutang on Pelvic Inflammatory Disease-chronic Pelvic Pain with Cold Damp Stagnation Syndrome

目的：探讨加味少腹逐瘀汤治疗盆腔炎性疾病后遗症-慢性盆腔痛（SPID-CPP）寒湿凝滞证的止痛效应及对血栓素B2（TXB2）/6-酮-前列环素Flα（6-Keto-PGFlα）和促炎因子的影响。方法：将符合要求的118例患者,按数字表法随机分为对照组和观察组各58例。考虑有感染者给予盐酸左氧氟沙星胶囊,0.2 g/次,3次/d,连续治疗14 d。对照组口服桂枝茯苓丸,6 g/次,2次/d;观察组内服加味少腹逐瘀汤,1剂/d。两组患者均连续治疗3个月经周期,经期不停服。主观疼痛程度采用视觉模拟评分（VAS）评分,客观体征评分采用Mc Cormack量表,寒湿凝滞证评分,均于治疗前后各评价1次;进行治疗前后焦虑自评量表（SAS）和抑郁自评量表（SDS）评分;记录治疗后下腹痛等8个症状转归情况;检测治疗前后肿瘤坏死因子-α（TNF-α）,白细胞介素-6（IL-6）,IL-8和细胞间黏附分子-1（ICAM-1）,TXB2和水平6-Keto-PGFlα。结果：治疗后观察组患者VAS评分、寒湿凝滞证评分和Mc Cormack评分均低于对照组（P〈0.01）;观察组患者SAS和SDS评分均低于对照组（P〈0.01）;观察组下腹痛、痛经、性交痛、肛门坠胀、白带增多、腹胀等症状的改善情况均优于对照组（P〈0.05）;观察组TXB2水平和TXB2/6-Keto-PGF1α均低于对照组,6-Keto-PGF1α水平高于对照组（P〈0.01）;观察组患者血清TNF-α,IL-6,IL-8和ICAM-1水平均低于对照组（P〈0.01）;观察组临床疗效总有效率为94.55%,高于对照组的为81.48%（χ~2=4.427,P〈0.05）。结论：采用加味少腹逐瘀汤治疗SPID-CPP寒湿凝滞证患者,可缓解疼痛,减轻临床症状,改善患者的抑郁、焦虑状态,抑制促炎因子表达,调节TXB2/6-Keto-PGF1α,有明显的临床疗效。

Objective：To discuss the analgesia effect of modified Shaofu Zhuyutang on pelvic inflammatory disease-chronic pelvic pain（SPID-CPP） with cold damp stagnation syndrome and the effect on levels of thromboxane B2（TXB2）/6-keto prostacyclin-Flα（6-Keto-PGFlα） and proinflammatory factors.Method：A total of 118 patients were randomly divided into control group and observation group by random number table.Patients with infection were given levofloxacin hydrochloride capsules for 14 days,0.2 g/time,3 times/days.Patients in control group got Guizhi Fulin pills,6 g/time,2 times/days.Patients in observation group got modified Shaofu Zhuyutang,1 dose/day.The treatment lasted for 3 menstrual cycles.Before and after treatment,degree of subjective pain was scored by visual analogue scale（VAS）,objective signs were scored by Mc Cormack,and cold damp stagnation syndrome was also scored.And self-rating anxiety scale（SAS） and self-rating depression scale（SDS） were also scored.And 8 symptoms,such as lower abdominal pain,were recorded.And levels of tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,IL-8,intercellular adhesion molecule-1（ICAM-1）,TXB2 and6-Keto-PGFlαwere detected.Result：Scores of VAS,cold damp stagnation syndrome,Mc Cormack,SAS and SDS in observation group were lower than those in control group（P〈0.01）.The ameliorations of abdominal pain,dysmenorrheal,algopareunia,anal bulge,leukorrhagia,abdominal distention were better than those in control group（P〈0.05）.And levels of TXB2 and TXB2/6-Keto-PGF1αwere higher than those in control group（P〈0.01）.And levels of TNF-α,IL-6,IL-8 and ICAM-1 were lower than those in control group（P〈0.01）.The total clinical effect rate in observation group was 94.55%,which was higher than 81.48% in control group（χ~2=4.427,P〈0.05）.Conclusion：Modified Shaofu Zhuyutang can relieve the pain and clinical symptoms,ameliorate depression and anxiety,inhibit expression of proinflammatory factors and regulate TXB2/6-Keto-PGF1α,with an obvious clinical effect.