己酮可可碱联合炔雌醇环丙孕酮片对子宫内膜异位症患者Th1/Th2漂移及血清抗子宫内膜抗体、血管内皮生长因子水平的影响探讨

Effects of pentoxifylline combined with ethinylestradiol and cyproterone tablets on Th1/Th2 drift and serum EMAb and VEGF levels in patients with endometriosis

目的探讨己酮可可碱联合炔雌醇环丙孕酮片治疗子宫内膜异位症(EM)的效果。方法选取于海南省妇女儿童医学中心就诊的136例EM患者作为研究对象,以区组随机分组法分为研究组(n=68)、对照组(n=68)。两组均经腹腔镜保守手术治疗,对照组术后口服炔雌醇环丙孕酮片,研究组在对照组基础上联合己酮可可碱。治疗前后评估患者的痛经程度,检测血液流变学指标及血清白介素(IL)-2、干扰素-γ(IFN-γ)、IL-4、IL-10、血管内皮生长因子(VEGF)、细胞间黏附分子-1(ICAM-1),统计抗子宫内膜抗体(EMAb)转阴情况及治疗期间不良反应发生情况。结果治疗后研究组痛经程度低于对照组(P<0.05);治疗后研究组血浆黏度、红细胞聚集指数、纤维蛋白原降低,且较对照组低(P<0.05);治疗后两组血清IL-2、IFN-γ水平均较治疗前提高,IL-4、IL-10水平均较治疗前降低,且研究组变化幅度大于对照组(P<0.05);研究组血清EMAb转阴率48.00%(24/50)高于对照组的27.08%(13/48)(P<0.05);治疗后两组血清VEGF、ICAM-1水平降低,且较对照组低(P<0.05);研究组不良反应发生率8.82%(6/68)与对照组4.41%(3/68)比较,差异无统计学意义(P>0.05)。结论采用己酮可可碱联合炔雌醇环丙孕酮片治疗EM患者,可缓解痛经症状,调节免疫功能及血管内皮功能,改善血液流变学,提高EMAb转阴率,安全性高。

Objective To investigate the effect of pentoxifylline combined with ethinylestradiol and cyproterone tablets in the treatment of endometriosis(EM).Methods A total of 136 EM patients in Hainan Women and Children′s Medical Center were collected and divided into the study group(n=68)and the control group(n=68)by block randomization.Both groups were treated by laparoscopic conservative surgery.The control group was given ethinylestradiol and cyproterone tablets orally after operation,and the study group was given pentoxifylline on the basis of the control group.Before and after treatment,the degree of dysmenorrhea was evaluated,and hemorheological indexes,serum interleukin(IL)-2,interferon-γ(IFN-γ),IL-4,IL-10,vascular endothelial growth factor(VEGF),intercellular adhesion molecule-1(ICAM-1)were detected.Anti-endometrial antibody(EMAb)negative conversion and adverse reactions during treatment were counted.Results After treatment,the degree of dysmenorrhea in the study group was lower than that in the control group(P<0.05).After treatment,Plasma viscosity,erythrocyte aggregation index,fibrinogen in the study group decreased,and they were lower than those in the control group(P<0.05).After treatment,the levels of serum IL-2 and IFN-γin the two groups were higher than those before treatment,while the levels of IL-4 and IL-10 were lower than those before treatment,and the changes in the study group were greater than those in the control group(P<0.05).The negative rate of serum EMAb in the study group of 48.00%(24/50)was higher than that of 27.08%(13/48)in the control group(P<0.05).After treatment,the levels of serum VEGF and ICAM-1 in the two groups were lower than those before treatment,and the study group was lower than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions 8.82%(6/68)in the study group and 4.41%(3/68)in the control group(P>0.05).Conclusions Pentoxifylline combined with ethinylestradiol and cyproterone tablets in the treatment of EM patients can relieve dysmenorrhea symptoms,regulate immune function and vascular endothelial function,improve blood rheology,and increase the negative rate of EMAb,with high safety.