消痞止痛破瘀汤联合醋酸戈舍瑞林缓释植入剂对子宫内膜异位症腹腔镜术后激素水平及其标志物含量的影响

Observation of Xiaopi-Zhitong-Poyu decoction combined with gosserin sustained-release implant for the treatment of endometriosis after laparoscopy

目的探讨消痞止痛破瘀汤联合醋酸戈舍瑞林缓释植入剂对子宫内膜异位症腹腔镜术后激素水平及其标志物含量的影响.方法将符合入选标准的204例子宫内膜异位症患者采用随机数字表法分为2组,每组102例.在常规治疗基础上对照组于术后第5天在腹前壁处皮下注射醋酸戈舍瑞林缓释植入剂,观察组在对照组基础上加服消痞止痛破瘀汤.2组均治疗24周,随访3年.采用世界卫生组织生活质量测定量表(World Health Organization Quality of Life Scale-Brief Form Questionnaire,WHOQOL-BREF)评价患者生活质量;分别从经期腹痛、腰部酸胀、大便稀薄、头晕目眩及月经异常方面进行中医症状评分;采用全自动血清分析仪检测FSH、E2、黄体生成素(luteinizing hormone,LH)含量,采用酶标仪检测抗子宫内膜抗体(endomethal antibody,EMAb)、MMP-3、糖类抗原125(carbohydrate antigen-125,CA-125)含量;评价临床疗效,记录治疗期间的不良反应.结果观察组总有效率为93.1%(95/102)、对照组为80.4%(82/102),2组比较差异有统计学意义(χ^2=3.871,P=0.039).治疗后,观察组环境领域、生活领域、生理领域及社会关系领域评分均高于对照组(t值分别为4.725、4.930、4.259、4.571,P值均<0.05);经期腹痛、腰部酸胀、大便稀薄、头晕目眩、月经异常评分均低于对照组(t值分别为3.561、3.457、3.421、3.652、3.529,P值均<0.05).治疗后,观察组血清FSH[(1.48±0.15)U/L比(2.98±0.29)U/L,t=3.174]、E2[(52.17±5.25)pg/ml比(88.04±8.23)pg/ml,t=3.141]、LH[(1.82±0.18)U/L比(2.45±0.25)U/L,t=3.372]水平及血清EMAb[光密度值(0.23±0.02)OD450比(0.32±0.03)OD450,t=3.763]、MMP-3[(69.69±6.68)μg/L比(82.57±8.89)μg/L,t=3.890]、CA-125[(25.89±2.78)U/ml比(61.43±6.78)U/ml,t=3.652]水平均低于对照组(P<0.05).观察组1、2、3年复发率分别为4.2%(4/95)、7.4%(7/95)、12.6%(12/95),对照组分别为13.4%(11/82)、18.3%(15/82)、25.6%(21/82),2组比较差异有统计学意义(χ^2值分别为3.309、3.911、4.102,P值均<0.05).结论自拟消痞止痛破瘀汤联合醋酸戈舍瑞林缓释植入剂可有效降低子宫内膜异位症腹腔镜术后患者激素水平,降低子宫内膜异位症标志物含量,提高临床疗效,降低不良反应.

Objective To evaluate the efficacy of Xiaopi-Zhitong-Poyu decoction combined with gosserin sustained-release implant for the treatment of endometriosis after laparoscopy. Methods A total of 204 patients with endometriosis who met the inclusion criteria were divided into 2 groups by random number table methods, with 102 cases in each group. On the 5th day after the operation, the control group was subcutaneously injected with Gosserin sustained-release implant in the anterior abdominal wall on the basis of routine treatment, the observation group was added with Xiaopi-Zhitong-Poyu soup on the basis of the control group. Both groups were treated for 24 weeks and followed up for 3 years. The World Health Organization Quality of Life Scale-Brief Form Questionnaire (WHOQOL-BREF) was used to evaluate the quality of life of patients. The TCM symptom scores were used to evaluate the menstrual pain, waist sour bloated, thin stool, dizziness and abnormal menstruation. The FSH, E2 and LH was detected by full automatic serum analyzer, and the endomethal antibody (EMAb), matrix metalloproteinase-3 (mmp-3) and carbohydrate antigen 125(ca-125) were detected by enzyme labeling instrument. Clinical efficacy was evaluated and adverse reactions during treatment were recorded. Results The total effective rate was 93.1% (95/102) in the observation group and 80.4% (82/102) in the control group, with statistically significant differences (χ^2=3.871, P=0.039). After treatment, scores in environmental field, life field, physiological field and social relation field in the observation group were all significantly higher than those in the control group (t values were 4.725, 4.930, 4.259, 4.571, all Ps<0.05). Scores of menstrual pain, waist sour bloated, thin stool, dizziness and abnormal menstruation in the observation group were all significantly lower than those of the control group (t values were 3.561, 3.457, 3.421, 3.652, 3.529, all Ps<0.05). After treatment, the serum FSH (1.48 ± 0.15 U/L vs. 2.98 ± 0.29) U/L, t=3.174), E2 (52.17 ± 5.25 pg/ml vs. 88.04 ± 8.23 pg/ml, t=3.141), LH (1.82 ± 0.18 U/L vs. 2.45 ± 0.25 U/L, t=3.372) levels in the observation group were significantly lower ( P<0.05);Serum EMAb (0.23 ± 0.02 vs. 0.32 ± 0.03, t=3.763), MMP-3 (69.69 ± 6.68 μg/L vs. 82.57 ± 8.89 μg/L, t=3.890], the CA-125 (25.89 ± 2.78 U/ml vs. 61.43 ± 6.78 U/ml, t=3.652) levels in the observation group were significantly lower (P<0.05). The recurrence rates of the observation group were 4.2% (4/95), 7.4% (7/95), 12.6% (12/95) at 1, 2, and 3 years respectively, while those of the control group were 13.4% (11/82), 18.3% (15/82), 25.6% (21/82), respectively. The differences were statistically significant ( χ 2 values were 3.309, 3.911, 4.102, all Ps<0.05). Conclusions The Xiaopi-Zhitong-Poyu decoction combined with gosserin sustained-release implant can reduce the hormone level of patients with endometriosis after laparoscopic surgery, improve the content of markers of endometriosis, improve the quality of life and clinical efficacy of patients, and reduce adverse reactions.