中医四联法治疗湿热瘀结型盆腔炎患者的临床效果及部分机制

Clinical Effect Observation of the Quadruple Therapy of Traditional Chinese Medicine on the Accumulation and Stasis of Damp-heat Type Pelvic Inflammation and Some Mechanisms Exploration

目的:观察中医四联法治疗湿热瘀结型盆腔炎患者的临床疗效,并研究其部分作用机制。方法:选取2014年5月至2016年5月攀枝花市中西医结合医院收治的湿热瘀结型盆腔炎患者86例,随机分为对照组(42例)及观察组(44例)。对照组患者接受左氧氟沙星及替硝唑抗菌处理,观察组采用中药内服、外敷、保留灌肠和远红外理疗四联疗法,2组均以30 d为1个疗程,并进行为期1年的随访,疗程结束后比较2组患者临床总有效率、后遗症发生率、中医证候积分、子宫血流动力学以及转化生长因子-β(TGF-β)。结果:观察组患者的治疗总有效率95.45%,明显高于对照组83.33%(P<0.05);1年后随访,观察组患者仅有1例月经紊乱及2例白带增多,对照组患者有4例月经紊乱、6例白带增多、1例异位妊娠,2组后遗症发生率比较,差异有统计学意义(P<0.05);2组患者下腹痛、腰骶疼痛、白带增多、月经异常候积分较治疗前减少(P<0.05),总症候积分亦较治疗前降低(P<0.05),其中观察组降低得更明显(P<0.05);治疗后观察组子宫内收缩期最大流速(PSV)明显高于对照组,搏动指数(PI)、血管阻力指数(RI)明显较对照组降低,差异有统计学意义(P<0.05)。2组经过治疗后外周血TGF-β水平均下降,且观察组低于对照组(P<0.05)。结论:中药四联疗法治疗湿热瘀结型盆腔炎患者的临床疗效显著,有利于减少后遗症的发生,其作用机制可能与降低TGF-β表达有关。

Objective： To observe the clinical curative effects of the Quadruple therapy of traditional Chinese medicine in the accumulation and stasis of damp-heat type pelvic inflammatory,and to study some of the action mechanism.Methods： A total of 86 cases of patients with accumulation and stasis of damp-heat type pelvic inflammatory who received and cured during May 2014 to May2016 in our hospital as the research object,were randomly divided into the control group（ 42 cases） and the observation group（ 44 cases）.The control group patients received levofloxacin and tinidazole for antimicrobial treatment,and the observation group had the quadruple therapy of traditional Chinese medicine oral and external application,retention enema and far-infrared physiotherapy on the basis of treatment of the control group.Both groups had 30 d for a course of treatment,and 1 year follow-up.Clinical total effective rate and the incidence of sequelae,TCM syndrome integrals,uterine blood flow dynamics and the concentration changes of transforming growth factor beta（ TGF-beta） of two groups were compared after treatment.Results： 1） The clinical total effective rate of 95.45% in the observation group patients was significantly higher than 83.33% of the control group（ P〈0.05）;After 1 years follow-up,only 1 case of patients with menstrual disorders and 2 cases of increased leucorrhoea in the observation group,4 cases of menstrual disorders,6 patients with increased leucorrhea,1 case of ectopic pregnancy in the control group.The sequela incidences between the two groups were statistically significant（ P〈0.05）; 2） Lower abdominal pain,lumbosacral pain and increased leucorrhea,menstrual abnormalities integrals of two groups were less than before treatment（ P〈0.05）.The total symptom integrals also reduced（ P〈0.05）,and the observation group reduced more significantly（ P〈0.05）; 3） Uterus peak systole velocity（ PSV） of the observation group were significantly higher than the control group after treatment,and the largest pulsation index（ PI）,vascular resistance index（ RI） reduced obviously than the control group.The differences were with statistical significance（ P〈0.05）.4） Peripheral blood TGF-beta level decreased in the two groups after treatment,and the observation group was lower than the control group.The differences were statistically significant（ P〈0.05）.Conclusion： The Quadruple therapy of traditional Chinese medicine has clinical curative effect in patients with the accumulation and stasis of damp-heat type pelvic inflammatory,which is beneficial to reduce the occurrence of sequelae.The mechanism may be associated with the lower expression of TGF-beta.