柴胡疏肝散加减结合他莫昔芬片治疗乳腺增生患者的临床疗效及对其超声指标的影响

Clinical Efficacy of Chaihu Shugan Powder Combined with Tamoxifen Tablets in Treatment of Breast Hyperplasia and its Influence on Ultrasound Indicators

目的探讨柴胡疏肝散加减结合他莫昔芬片治疗乳腺增生患者的临床疗效及对其超声指标的影响。方法选取2023年1月—2023年10月期间淄博市妇幼保健院收治的乳腺增生患者120例,采用随机抽签法分为观察组和对照组,每组各60例。对照组接受他莫昔芬片治疗,观察组在对照组基础上加用柴胡疏肝散加减。治疗3个月经周期后,观察比较两组患者临床疗效、不良反应发生率及复发率,治疗前后临床症状及体征(乳房疼痛、肿块大小、肿块质地、肿块分布范围)、中医证候积分(乳房胀痛或窜痛、乳房肿块、烦躁易怒、抑郁失眠、两胁胀满、月经失调或痛经)、乳腺超声征象(乳腺导管最粗管径、乳腺腺体厚度、肿块直径、低回声直径)变化,并检测血清性激素[垂体促卵泡刺激素(Follicle stimulating hormone,FSH)、雌二醇(Estrogen,E2)、黄体生成素(Luteinizing hormone,LH)、孕酮(Progesterone,P)、催乳素(Prolactin,PRL)]、血管生长因子[碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)]水平。结果治疗后观察组总有效率95.00%(57/60)明显高于对照组81.67%(49/60),差异有统计学意义(χ2=8.622,P<0.003)。治疗后两组患者临床症状及体征评分均较治疗前降低,差异有统计学意义(P<0.05),且观察组临床症状及体征评分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者中医证候积分均较治疗前降低,差异有统计学意义(P<0.05),且观察组中医证候积分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者超声指标均较治疗前明显降低,差异有统计学意义(P<0.05),且观察组超声指标低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清LH、E2、PRL、bFGF及VEGF水平均较治疗前降低,FSH和P水平均较治疗前升高,差异有统计学意义(P<0.05);且观察组LH、E2、PRL、bFGF、VEGF低于对照组,FSH和P高于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应率比较,差异无统计学意义(χ2=0.199,P=0.656);随访3个月,观察组复发率3.33%(2/60),对照组复发率16.67%(10/60),两组患者复发率比较,差异有统计学意义(χ2=9.886,P=0.002)。结论柴胡疏肝散结合他莫昔芬片能减轻乳腺增生患者临床症状和体征,改善乳腺超声征象及血清性激素水平,下调bFGF、VEGF水平,疗效显著。

Objective To explore the clinical efficacy of modified Chaihu Shugan Powder combined with Tamoxifen tablets in treating patients with breast hyperplasia and its effect on ultrasound indicators.Methods A total of 120 patients with breast hyperplasia admitted to Zibo Maternal and Child Health Hospital from January 2023 to October 2023 were selected and randomly divided into an observation group and a control group by random drawing,with 60 cases in each group.The control group received Tamoxifen tablets,while the observation group was additionally treated with modified Chaihu Shugan Powder.After three menstrual cycles of treatment,clinical efficacy,adverse reaction rates,recurrence rates,changes in clinical symptoms and signs(breast pain,lump size,lump texture,lump distribution),traditional Chinese medicine(TCM)syndrome scores(breast distention or scurrying pain,breast lumps,irritability,depression and insomnia,fullness in the flanks,menstrual disorders or dysmenorrhea),and ultrasound findings(largest duct diameter,gland thickness,lump diameter,hypoechoic diameter)before and after treatment in both groups were compared.Serum hormone levels[follicle-stimulating hormone(FSH),estrogen(E_2),luteinizing hormone(LH),progesterone(P),prolactin(PRL)]and levels of vascular growth factors[basic fibroblast growth factor(bFGF),vascular endothelial growth factor(VEGF)]were detected.Results After treatment,the total effective rate in the observation group was 95.00%(57/60),significantly higher than 81.67%(49/60)in the control group(χ~2=8.622,P<0.003).Both groups showed significant reductions in clinical symptom and sign scores after treatment compared to those before treatment(P<0.05),with the observation group showing lower scores than the control group(P<0.05).TCM syndrome scores also significantly decreased in both groups(P<0.05),with the observation group showing lower scores than the control group(P<0.05).Ultrasound indicators were significantly reduced in both groups after treatment(P<0.05),with the observation group showing lower values(P<0.05).Serum levels of LH,E_2,PRL,bFGF,and VEGF decreased after treatment,while FSH and P levels increased(P<0.05).The observation group had lower LH,E_2,PRL,bFGF,and VEGF levels,and higher FSH and P levels than the control group(P<0.05).The adverse reaction rates between the two groups were not significantly different(χ~2=0.199,P=0.656).At a three-month follow-up,the recurrence rate was 3.33%(2/60)in the observation group and 16.67%(10/60)in the control group(χ~2=9.886,P=0.002).Conclusion Modified Chaihu Shugan Powder combined with Tamoxifen tablets significantly alleviates clinical symptoms and signs in patients with breast hyperplasia,improves ultrasound findings,and regulates serum hormone levels,with notable reductions in bFGF and VEGF levels.