补肾活血方对肾虚血瘀型不明原因月经过少患者血清中VEGF、TGF-β1的影响

Effect of Bushen Huoxue Decoction(补肾活血方)on Serum VEGF and TGF-β_(1)in Patients with Kidney Deficiency and Blood Stasis of Unexplained Oligomenorrhea

目的补肾活血方治疗肾虚血瘀型不明原因月经过少患者临床疗效并探讨其对患者血清中血管内皮生长因子(vascular endothelial growth factor,VEGF)、转化生长因子β1(transforming growth factor-β1,TGF-β1)的影响。方法对收集2019年6月—2021年6月南京市中西医结合医院门诊诊治肾虚血瘀型不明原因月经过少患者60例,随机分为观察组和对照组。对照组给予戊酸雌二醇联合黄体酮胶囊序贯治疗,观察组在此基础上给予补肾活血汤口服,疗程为3个月经周期。同时收集月经正常的30例妇女作为正常组,观察两组治疗前后分泌晚期血清中VEGF、TGF-β1及子宫内膜厚度、月经失血图积分、中医证候积分的变化,并与正常组比较。结果(1)观察组脱落2例,剔除1例,对照组脱落3例,剔除1例,最终观察组共27例,对照组26例。(2)观察组、对照组分泌晚期血清中VEGF、TGF-β1均低于正常组(P<0.05);治疗后两组VEGF、TGF-β1较前均明显升高(P<0.05);观察组上升趋势明显,优于对照组(P<0.05),且与正常组无明显差异(P>0.05)。子宫内膜厚度比较,治疗前观察组与对照组内膜厚度均明显低于正常组(P<0.05);治疗后,两组子宫内膜厚度较前均明显增厚(P<0.05),但观察组优于对照组(P<0.05)。对于中医证候积分的改善及月经失血图评分的评估,观察组优于对照组(P<0.05)。结论不明原因月经过少的发病机制可能与分泌晚期血清中的VEGF、TGF-β1水平下降有关,补肾活血方可通过提高分泌晚期血清中VEGF及TGF-β1水平,使得子宫内膜增厚、增加月经量,明显改善患者的中医证候,临床疗效显著,优于单用雌孕激素序贯治疗。

Objective To observe the clinical efficacy of Bushen Huoxue Decoction(补肾活血方)in the treatment of patients with kidney deficiency and blood stasis of unexplained oligomenorrhea,and to explore the effects of Bushen Huoxue Decoction on serum vascular endothelial growth factor and transforming growth factor-β_(1).Methods A total of 60 patients with kidney deficiency and blood stasis of unexplained oligomenorrhea were collected from outpatient department of Nanjing hospital of integrated traditional Chinese and Western medicine from June 2019 to June 2021,and were randomly divided into observation group and control group.The control group received treatment of estradiol valerate combined with progesterone capsules.The observation group was given Bushen Huoxue Decoction based on the treatment plan of the control group.The treatment period was 3 months.At the same time,30 women with normal menstruation were collected as the normal group.The changes of VEGF,TGF-β_(1),endometrial thickness,blood loss map score and TCM syndrome score in late secreted serum of 2 groups before and after treatment were observed,and compared with normal group.Results(1)In the observation group,2 cases were detached and 1 case was removed,and in the control group,3 cases were detached and 1 case was removed.Finally,there were 27 cases in the observation group and 26 cases in the control group.(2)The serum levels of VEGF and TGF-β_(1)in the observation group and control group were lower than those in the normal group(P<0.05).VEGF and TGF-β_(1)in both groups were significantly increased after treatment(P<0.05).The observation group had an obvious upward trend,which was better than the control group(P<0.05),and there was no significant difference between the observation group and the normal group(P>0.05).Endometrial thickness of the observation group and the control group was significantly lower than that of the normal group before treatment(P<0.05).After treatment,endometrial thickness was significantly increased in both groups(P<0.05),but the observation group was better than the control group(P<0.05).The observation group was better than the control group in the improvement of TCM syndrome score and the evaluation of menstrual blood loss map score(P<0.05).Conclusion The pathogenesis of unexplained oligomenorrhea may be related to the decreased levels of VEGF and TGF-β_(1)in late serum secretion.Bushen Huoxue Decoction can significantly improve the TCM symptoms of patients as well as the endometrium thickens and increase the menstrual volume by increasing the levels of VEGF and TGF-β_(1)in serum at late secretion stage.The clinical effect is better than sequential therapy of estrogen and progesterone alone.