门氏消瘤汤辅助射频消融术治疗子宫肌瘤临床疗效研究

Clinical efficacy of Menshi Xiaoliu decoction-assisted radiofrequency ablation in the treatment of uterine fibroids

目的研究门氏消瘤汤辅助射频消融术治疗子宫肌瘤的临床效果。方法选取2021年12月至2022年5月河南中医药大学第三附属医院妇产科收治的90例子宫肌瘤患者为研究对象,按照单双数分配原则分为观察组、对照1组和对照2组各30例。观察组予以门氏消瘤汤+射频消融术治疗,对照1组予以射频消融术治疗,对照2组予以门氏消瘤汤治疗。比较三组患者治疗3个月经周期后的临床疗效及治疗前后中医证候积分、子宫肌瘤体积、月经量和月经周期;比较三组患者治疗前后的性激素[卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)、孕酮]水平、血清微小RNA-34a(miR-34a)和微小RNA Let-7(Let-7)水平;同时比较三组患者随访6个月时的子宫肌瘤复发率和不良反应发生率。结果观察组患者的治疗总有效率为93.33%,明显高于对照1组的63.33%和对照2组的53.33%,差异有统计学意义(P<0.05);治疗后,观察组患者的中医证候积分、子宫肌瘤体积、月经量明显低于对照1组、对照2组,月经周期明显短于对照1组、对照2组,差异均有统计学意义(P<0.05);治疗后,观察组患者的FSH、LH、E2、孕酮水平分别为(16.11±3.01)μg/L、(14.03±2.34)μg/L、(136.62±25.54)pmol/L、(7.34±1.44)μg/L,明显低于对照1组的(20.16±4.07)μg/L、(19.51±3.21)μg/L、(223.21±44.40)pmol/L、(15.03±3.01)μg/L和对照2组的(21.03±3.85)μg/L、(19.24±3.18)μg/L、(220.18±44.06)pmol/L、(15.18±3.07)μg/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的血清miR-34a、Let-7水平分别为2.03±0.16、2.11±0.22,明显高于对照1组的1.55±0.12、1.63±0.18和对照2组的1.52±0.14、1.61±0.20,差异均有统计学意义(P<0.05);随访6个月,观察组患者的复发率为0,低于对照1组的13.79%和对照2组的21.43%,差异均有统计学意义(P<0.05),但三组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论门氏消瘤汤辅助射频消融术治疗子宫肌瘤疗效显著且具有一定安全性,其不仅可改善临床症状,缩小子宫肌瘤体积,抑制激素分泌,还可降低复发率,其作用机制可能与促进miR-34a、Let-7表达有关。

Objective To study the clinical efficacy of Menshi Xiaoliu decoction-assisted radiofrequency ablation in the treatment of uterine fibroids.Methods Ninety patients with uterine fibroids admitted to the Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from December 2021 to May 2022 were selected as the research objects.According to the principle of single and double number,they were divided into an observation group,control group 1,and control group 2,with 30 patients in each group.The patients in the observation group were treated with Menshi Xiaoliu decoction+radiofrequency ablation,the patients in the control group 1 were treated with radiofrequency ablation,and the patients in the control group 2 were treated with Menshi Xiaoliu decoction.The clinical efficacy of three groups of patients after treatment for three menstrual cycles,as well as the TCM syndrome scores,uterine fibroid volume,menstrual volume,and menstrual cycle before and after treatment were compared among the three groups.The levels of sex hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),progesterone],serum microRNA-34a(miR-34a),and microRNA Let-7(Let-7)before and after treatment were compared among the three groups.At the same time,the recurrence rate of uterine fibroids and the incidence of adverse reactions were compared among the three groups at 6 months of follow-up.Results The total effective rate in the observation group was 93.33%,which was higher than 63.33% in the control group 1 and 53.33% in the control group 2(P<0.05).After treatment,the TCM syndrome score,uterine fibroid volume,menstrual volume,and menstrual cycle of the observation group were significantly lower than those of the control group 1 and control group 2,and the menstrual cycle was significantly shorter than that in the control group 1 and control group 2,with statistically significant differences(P<0.05).After treatment,the levels of FSH,LH,E2,and progesterone in the observation group were(16.11±3.01)μg/L,(14.03±2.34)μg/L,(136.62±25.54)pmol/L,and(7.34±1.44)μg/L,respectively,which were significantly lower than(20.16±4.07)μg/L,(19.51±3.21)μg/L,(223.21±44.40)pmol/L,and(15.03±3.01)μg/L in the control group 1,as well as(21.03±3.85)μg/L,(19.24±3.18)μg/L,(220.18±44.06)pmol/L,and(15.18±3.07)μg/L in the control group 2(P<0.05).After treatment,the serum levels of miR-34a and Let-7 in the observation group were 2.03±0.16 and 2.11±0.22,respectively,which were significantly higher than 1.55±0.12 and 1.63±0.18 in the control group 1,as well as 1.52±0.14 and 1.61±0.20 in the control group 2(P<0.05).After 6 months of follow-up,the recurrence rate of the observation group was 0,which was significantly lower than 13.79% of the control group 1 and 21.43% of the control group 2(P<0.05),and there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Menshi Xiaoliu Decoction-assisted RF ablation has significant efficacy and certain safety in the treatment of uterine fibroids,which can improve clinical symptoms,reduce the size of uterine fibroids,inhibit hormone secretion,and reduce the recurrence rate.The mechanism of action may be related to the promotion of miR-34a and Let-7 expression.