益气化瘀通络法提高输卵管积液经微创疏通术后的临床疗效及抑制TGF-β1、CTGF的表达作用研究

Efficacy-Enhancing Effect of Therapy of Replenishing Qi,Removing Stasis and Unblocking Collaterals for Sactosalpinx Patients After Minimally Invasive Tubal Dredging Operation and Its Inhibition of Transforming Growth Factor β1 and Connective Tissue Growth Factor Expressions

【目的】探讨益气化瘀通络法对输卵管积液经微创疏通术(腹腔镜下输卵管伞端造口术)后的临床疗效及可能的作用机制。【方法】选取海口市中医医院2014年2月~2020年2月因不孕症经宫腔镜检查以及腹腔镜探查术确诊为双侧输卵管轻、中、重度积液患者各80例,分别设为A、B、C组,共计240例。根据治疗方式不同将A组患者分为A1、A2组,将B组患者分为B1、B2组,将C组患者分为C1、C2组,每组各40例。其中,A1、B1、C1为观察组,A2、B2、C2组为对照组。对照组患者单纯给予腹腔镜下输卵管伞端造口术治疗,观察组患者在对照组的基础上给予益气化瘀通络法治疗,每个月经周期服药半个月,共治疗3个月经周期并随访1年。比较观察组与对照组患者治疗后1年内的总妊娠率、活产率、异位妊娠率、流产率及复发率的差异,同时对比观察组与对照组患者术后7 d和术后3个月血清转化生长因子β1(TGF-β1)、结缔组织生长因子(CTGF)水平的变化情况。【结果】(1)术后随访1年,观察组的轻度(A1组)、中度(B1组)、重度(C1组)输卵管积液患者的总妊娠率、活产率分别高于相同程度的对照组(A2、B2、C2组)患者,复发率分别低于相同程度的对照组(A2、B2、C2组)患者,差异均有统计学意义(P<0.05或P<0.01),而2组不同程度输卵管积液患者间的异位妊娠率和流产率比较(A1&A2,B1&B2,C1&C2),差异均无统计学意义(P>0.05)。(2)术后7 d,观察组与对照组的不同程度输卵管积液患者的血清TGF-β1、CTGF水平比较(A1&A2,B1&B2,C1&C2),差异均无统计学意义(P>0.05)。术后3个月,2组患者的血清TGF-β1、CTGF水平均较术后7 d明显降低(P<0.05),且观察组的轻度(A1组)、中度(B1组)、重度(C1组)输卵管积液患者对血清TGF-β1、CTGF水平的降低作用均明显优于相同程度的对照组(A2、B2、C2组)患者,差异均有统计学意义(P<0.01)。【结论】益气化瘀通络法能提高输卵管积液经微创疏通术后的疗效,显著提高患者的妊娠率、活产率,降低患者的复发率,其作用机制可能与抑制血清TGF-β1、CTGF的表达有关。

Objective To investigate the clinical efficacy of therapy of replenishing qi,removing stasis and unblocking collaterals(shortened as Yiqi Huayu Tongluo method)for sactosalpinx patients after minimally invasive tubal dredging operation(laparoscopic salpingo-oophorectomy)and to exlore its possible therapeutic mechanism.Methods The analysis was carried out in the infertility patients with mild,moderate,and severe bilateral sactosalpinx,80 cases for each degree,a total of 240 cases,which were confirmed by hysteroscopy and laparoscopic exploration in Haikou Hospital of Traditional Chinese Medicine from February 2014 to February 2020.The infertility patients with mild,moderate,and severe bilateral sactosalpinx were allocated to groups A,B,and C separately,and then each group was divided into 2 subgroups according to the treatment method,namely groups A1,A2,B1,B2,C1,C2,with 40 cases in each group.Among them,groups A1,B1,and C1 were named as the observation groups,and groups A2,B2,and C2 served as the control groups.The patients in the control groups were treated with laparoscopic salpingo-oophorectomy alone,while the patients in the observation groups were treated with oral use of Chinese medicine with the action of Yiqi Huayu Tongluo method together with laparoscopic salpingo-oophorectomy.The oral medication of Chinese medicine lasted for half a month in each menstrual cycle and the medication was performed for a total of 3 menstrual cycles,and one year of postoperative follow-up was carried out.The total pregnancy rate,live birth rate,ectopic pregnancy rate,miscarriage rate and recurrence rate of the patients in the observation groups and the control groups were compared within one year after the treatment.Meanwhile,the changes in serum transforming growth factorβ1(TGF-β1)and connective tissue growth factor(CTGF)levels of the patients in the observation groups and the control groups were observed 7 days and 3 months after the operation.Results(1)The one-year postoperative follow-up showed that the total pregnancy rate and live birth rate of patients with mild(group A1),moderate(group B1),and severe(group C1)sactosalpinx in the observation groups were higher than those of patients with the corresponding degree of sactosalpinx in the control groups(groups A2,B2,and C2 respectively),and the recurrence rate was lower than that of patients with the corresponding degree of sactosalpinx in the control groups(groups A2,B2,and C2 respectively),and the differences were statistically significant(P<0.05 or P<0.01).However,no statistically significant differences of ectopic pregnancy rate and miscarriage rate(P>0.05)were shown in the patients with the same degree of sactosalpinx(A1 vs A2,B1 vs B2,C1 vs C2).(2)Seven days after the operation,the serum TGF-β1 and CTGF levels of the observation groups did not differ from those in the control groups(A1 vs A2,B1 vs B2,C1 vs C2),the differences being not statistically significant(P>0.05).Three months after the operation,the serum TGF-β1 and CTGF levels of patients in the observation groups and the control groups were significantly lower than those at postoperative day 7(P<0.05),and the reduction of serum TGF-β1 and CTGF levels in the patients with mild(A1 group),moderate(B1 group),and severe(C1 group)sactosalpinx in the observation groups was significantly superior to that of patients with the corresponding degree of sactosalpinx in the control groups(groups A2,B2,and C2 respectively),the differences being statistically significant(P<0.01).Conclusion Yiqi Huayu Tongluo method can improve the efficacy of minimally invasive tubal dredging operation for sactosalpinx,significantly increase the pregnancy rate and live birth rate and reduce the recurrence rate of patients.Its therapeutic mechanism may be related to the inhibition of the expression levels of serum TGF-β1 and CTGF.