血府逐瘀丸联合苁蓉益肾颗粒对腹腔镜术后子宫内膜异位症合并不孕症患者RANTES、CA125及性激素水平的影响

Effects of Xuefu Zhuyu Pills combined with Congrong Yishen Granules on the levels of RANTES,CA125 and sex hormones in patients with endometriosis and infertility after laparoscopic surgery

目的探讨血府逐瘀丸联合苁蓉益肾颗粒对腹腔镜术后子宫内膜异位症(EM)合并不孕症患者受激活调节正常T细胞表达和分泌因子(RANTES)、糖类抗原125(CA125)及性激素水平的影响。方法回顾性选取2019年1~4月首都医科大学附属北京潞河医院收治的200例子宫内膜异位症并不孕症患者作为研究对象,均接受腹腔镜手术治疗,按治疗方法不同分为两组,每组100例。对照组给予孕三烯酮辅助治疗,观察组在对照组基础上接受血府逐瘀丸联合苁蓉益肾颗粒。观察并记录两组临床疗效、治疗前后血清RANTES、CA125、雌二醇(E2)、孕酮(P)、卵泡刺激素(FSH)和黄体生成素(LH)水平、妊娠率、复发率及不良反应,并进行统计学分析。结果观察组临床总有效率为92.00%,显著高于对照组的81.00%,差异有统计意义(P <0.05)。治疗3个月后,两组患者血清RANTES及CA125水平均较治疗前明显下降,且观察组血清RANTES及CA125水平为(240.94±92.35)μg/L、(24.19±4.31) U/mL,显著低于对照组[(452.70±115.55)μg/L、(35.36±6.85) U/mL],差异均有统计意义(P <0.05)。两组治疗3个月后E2、P、FSH及LH水平均较治疗前明显下降,且观察组治疗3个月后E2、P、FSH及LH水平为(111.51±17.31) pmol/L、(124.71±23.13) nmol/L、(1.68±0.47) U/L、(1.80±0.59) U/L,显著低于对照组[(137.69±23.65) pmol/L、(187.85±39.55) nmol/L、(2.08±0.77) U/L、(2.24±0.88) U/L],差异均有统计意义(P <0.05)。观察组术后1年及2年妊娠率分别为46.00%和79.00%,显著高于对照组(23.00%和50.00%),差异均有统计意义(P <0.05)。观察组术后1年及2年复发率分别为5.00%和7.00%,显著低于对照组(14.00%和19.00%),差异均有统计意义(P <0.05);观察组不良反应总发生率为13.00%,对照组为21.00%,差异无统计意义(P> 0.05)。结论腹腔镜手术后,采用血府逐瘀丸联合苁蓉益肾颗粒治疗EM合并不孕症患者能够显著改善患者RANTES、CA125及性激素水平,提高妊娠率,降低复发率,值得临床予以推广应用。

Objective To investigate the effect of Xuefu Zhuyu Pills combined with Congrong Yishen Granules on the levels of regulated upon activation normal T cell expressed and secreted factor( RANTES),carbohydrate antigen 125( CA125) and sex hormones in patients with endometriosis( EM) combined with infertility after laparoscopic surgery. Methods A total of 200 patients with EM combined with infertility who were admitted to Beijing Luhe Hospital,Capital Medical University from January to April 2019 were retrospectively selected as the research objects. They all received laparoscopic surgery and were divided into two groups according to the treatment method,each with 100 cases. The control group received adjuvant treatment with gestrinone,and the observation group received Xuefu Zhuyu Pills combined with Congrong Yishen Granules on the basis of the control group. Observe and record the clinical efficacy of the two groups,RANTES,CA125,( estradiol( E2),progesterone( P),follicule-stimulating hormone( FSH) and luteinizing hormone( luteinizing hormone,LH) levels before and after treatment,pregnancy rate,recurrence rate and adverse reactions,and then perform statistical analysis. Results The total clinical effective rate of the observation group was92. 00%,which was significantly higher than 81. 00% of the control group,the difference was statistically significant( P < 0. 05). After 3 months of treatment,the serum RANTES and CA125 levels of the two groups were significantly lower than before treatment,and the serum RANTES and CA125 levels of the observation group were( 240. 94 ± 92. 35) μg/L and( 24. 19 ± 4. 31) U/mL,which were significantly lower than those in the control group [( 452. 70 ± 115. 55) μg/L,( 35. 36 ± 6. 85) U/mL],the differences were statistically significant( P < 0. 05). The levels of E2,P,FSH and LH in the two groups after 3 months of treatment were significantly lower than before treatment,and the levels of E2,P,FSH and LH in the observation group were( 111. 51 ± 17. 31) pmol/L,( 124. 71 ± 23. 13) nmol/L,( 1. 68 ± 0. 47) U/L,( 1. 80 ± 0. 59) U/L,which were significantly lower than those in the control group [( 137. 69 ± 23. 65) pmol/L,( 187. 85 ± 39. 55) nmol/L,( 2. 08 ± 0. 77) U/L,( 2. 24 ± 0. 88) U/L],the differences were statistically significant( P < 0. 05). The pregnancy rates of the observation group were 46. 00% and 79. 00% at 1 and 2 years,which were significantly higher than those in the control group( 23. 00% and 50. 00%),and the differences were statistically significant( P < 0. 05). The recurrence rates of the observation group were 5. 00% and 7. 00% in the observation group at 1 and 2 years,which were significantly lower than those in the control group( 14. 00% and 19. 00%),and the differences were statistically significant( P< 0. 05). The total incidence of adverse reactions was 13. 00% in the observation group and 21. 00% in the control group,and the difference was not statistically significant( P > 0. 05). Conclusion After laparoscopic surgery,the treatment of Xuefu Zhuyu Pills combined with Congrong Yishen Granules can significantly improve the levels of RANTES,CA125 and sex hormones,increase the pregnancy rate,and reduce the recurrence rate in the patients with EM combined with infertility. It is worthy of clinical application.