清热化湿散结灌肠方对盆腔炎性疾病后遗症湿热瘀结型患者MCP-1、TGF-β_(1)、IL-6及T淋巴亚群水平的影响

Effect of Qingre Huashi Sanjie Enema Prescription on MCP-1,TGF-β_(1),IL-6,and T Lymphoid Subsets in Patients with Sequelae of Pelvic Inflammatory Disease with Syndrome of Combined Dampness,Heat,and Stasis

目的:探讨清热化湿散结灌肠方在盆腔炎性疾病后遗症湿热瘀结型患者治疗中的应用价值,观察其对炎性因子及T淋巴亚群的影响。方法:研究纳入2022年5月至2023年8月,经辨证属于湿热瘀结型的盆腔炎性疾病后遗症患者,将其随机分为两组,每组各79例,对照组采用西医常规治疗,观察组在西医常规治疗基础上联合清热化湿散结灌肠方治疗,两组均治疗12周。采用酶联免疫吸附测定法(ELISA)测定两组治疗前后血清巨噬细胞趋化蛋白-1(MCP-1)、转化生长因子-β_(1)(TGF-β_(1))、白细胞介素-6(IL-6)水平;采用全自动血液流变分析仪测定两组治疗前后红细胞沉降率(ESR)、纤维蛋白原(FIB)水平;流式细胞仪检测两组治疗前后血清CD4^(+)、CD4^(+)/CD8^(+)水平;评估两组治疗前后中医证候积分及健康状况调查简表(SF-36)评分;采用多普勒仪测定两组治疗前后子宫动脉阻力指数(RI)、子宫动脉搏动指数(PI),子宫动脉收缩期血流峰值速度(PSV)水平;比较两组治疗后的临床疗效与不良反应发生情况。结果:与本组治疗前比较,两组患者MCP-1、TGF-β_(1)、IL-6、ESR、FIB水平均显著降低(P<0.01);与对照组治疗后比较,观察组上述指标均改善更明显(P<0.05,P<0.01)。与本组治疗前比较,两组患者血清CD4^(+)、CD4^(+)/CD8^(+)显著升高(P<0.01);与对照组治疗后比较,观察组上述指标均改善更明显(P<0.05,P<0.01)。与本组治疗前比较,两组患者治疗后中医证候积分、中医体征积分显著降低,SF-36显著升高(P<0.01);与对照组治疗后比较,观察组上述指标均改善更明显(P<0.05,P<0.01);治疗后两组RI、PI显著降低,PSV显著升高(P<0.01),治疗后,与对照组比较上述指标均改善更显著(P<0.01)。观察组总有效率93.67%(74/79),高于对照组的79.75%(63/79),差异具有统计学意义(χ^(2)=6.645,P<0.05);两组治疗后不良反应发生情况差异无统计学意义。结论:盆腔炎性疾病后遗症(湿热瘀结型)联合清热化湿散结灌肠方治疗有助于减轻炎症反应,改善高凝状态及血流动力学,调节免疫功能,提高临床疗效。

Objective:To investigate the application value of Qingre Huashi Sanjie enema prescription in the treatment of the patients with sequelae of pelvic inflammatory disease(syndrome of combined dampness,heat,and stasis)and the effects of this prescription on inflammatory mediators and T lymphocyte subsets.Method:The patients with sequelae of pelvic inflammatory disease(syndrome of combined dampness,heat,and stasis)treated from May 2022 to August 2023 were included in this study and randomized into two groups(79 cases).The control group was treated with conventional Western medicine,and the observation group was treated with Qingre Huashi Sanjie enema prescription on the basis of the therapy in the control group.Both groups were treated for 12 weeks.The serum levels of monocyte chemoattractant protein-1(MCP-1),transforming growth factor-β_(1)(TGF-β_(1)),and interleukin-6(IL-6)were measured by enzyme linked immunoserbent assay(ELISA)before and after treatment in both groups.The erythrocyte sedimentation rate(ESR)and fibrinogen(FIB)were measured by an automatic blood rheology analyzer before and after treatment in both groups.The serum levels of CD4^(+),CD4^(+)/CD8^(+)before and after treatment in both groups were measured by flow cytometry.The traditional Chinese medicine(TCM)symptom score and the 36-item short form survey(SF-36)score were assessed before and after treatment.The uterine artery resistance index(RI),uterine artery pulsatility index(PI),and uterine artery peak systolic velocity(PSV)were measured by Doppler before and after treatment.The clinical efficacy and the occurrence of adverse reactions were compared between the two groups.Result:After treatment,the levels of MCP-1,TGF-β_(1),IL-6,ESR,and FIB decreased in both groups(P<0.01),and the decreases were larger in the observation group than in the control group(P<0.05,P<0.01).After treatment,the serum levels of CD4^(+)and CD4^(+)/CD8^(+)elevated in both groups(P<0.01)and the observation group had higher levels of CD4^(+)and CD4^(+)/CD8^(+)than the control group(P<0.05,P<0.01).The treatment in both groups decreased the TCM symptom score and TCM sign score and increased the SF-36 score(P<0.01),and the changes were more significant in the observation group than in the control group(P<0.05,P<0.01).In addition,the treatment lowered RI and PI and elevated PSV(P<0.01),and the changes in these indicators were more significant in the observation group than in the control group(P<0.01).The total response rate in the observation group was 93.67%(74/79),which was higher than that(79.75%,63/79)in the control group(χ^(2)=6.645,P<0.05).There was no significant difference in the occurrence of adverse reactions between the two groups.Conclusion:For the patients with sequelae of pelvic inflammatory disease(syndrome of combined dampness,heat,and stasis),Qingre Huashi Sanjie enema prescription can reduce inflammation,attenuate hypercoagulability,improve hemodynamics,and regulate the immune function,demonstrating a definite therapeutic effect.