清热解毒方联合补肾祛瘀阶梯治疗改善宫腔粘连分离术后肾虚血瘀证妊娠结局的疗效及对TNF-α和TGF-β水平的影响

Efficacy of Qingrei Jiedu Decoction and Kidney-tonifying and Stasis-resolving Step Therapy Improving Pregnancy Outcome Cases after Separation of Intrauterine Adhesions with Kidney Deficiency and Blood Stasis Syndrome and Its Effect on Levels of TNF-α and

目的:探讨清热解毒方联合补肾祛瘀阶梯治疗改善宫腔粘连分离术后肾虚血瘀证患者妊娠结局的疗效及对血清肿瘤坏死因子(TNF)-α和转化生长因子(TGF)-β水平的影响。方法:筛选在医院就诊的宫腔粘连患者98例,按数字表法随机分为对照组和治疗组,每组49例。两组给予宫腔镜下宫腔粘连分离术。对照组术后第2天采取雌孕激素人工周期治疗。治疗组在对照组基础上于术后第2天予清热解毒中药灌肠治疗,1剂/d,连续2周。月经复潮后至月经前半周期内服补肾祛瘀方,1剂/d,2次/d,连续治疗3月。比较两组子宫动脉搏动指数(PI)和血流阻力指数(RI)、子宫内膜厚度、宫腔粘连复发、妊娠率及临床疗效。检测两组血清TNF-α和TGF-β水平。结果:治疗后,治疗组RI和PI显著低于对照组,子宫内膜厚度明显大于对照组(P<0.01)。治疗组总有效率为93.88%,显著高于对照组为77.55%(P<0.05)。治疗组患者的宫腔粘连复发率12.24%,显著低于对照组为30.61%(P<0.05)。治疗组患者的妊娠率63.27%,明显高于对照组为38.76%(P<0.05)。治疗后,治疗组血清TNF-α和TGF-β水平明显低于对照组(P<0.01)。结论:清热解毒方联合补肾祛瘀阶梯治疗干预宫腔粘连分离术后肾虚血瘀证患者可提高疗效、妊娠率,降低宫腔粘连复发率,调节体内TNF-α和TGF-β水平可能是其发挥疗效的途径之一。

Objective:To investigate the efficacy of Qingrei Jiedu Decoction and kidney-tonifying and stasis-resolving step therapy improving pregnancy outcome cases after separation of intrauterine adhesions with kidney deficiency and blood stasis syndrome and its effect on serum levels of tumor necrosis factor-α(TNF-α)and transforming growth factor-β(TGF-β).Methods:Ninety-eight cases with intrauterine adhesions were selected and randomly divided them into control group and treatment group with 48 cases in each group.Both groups received hysteroscopic separation of intrauterine adhesions.Control group was given estrogen and progesterone artificial cycle therapy 2 days after operation.Based on control group,cases of treatment group were given with enema treatment of Qingrei Jiedu Decoction(1 dose/d and for 2 weeks)and kidney-tonifying and stasis-resolving step therapy for 3 months after menorrhagia to the first half of menstruation(1 dose/d and twice a day).Blood flow resistance index(RI)and pulsatility index of the uterine artery(PI)of the uterine artery,the endometrial thickness,the recurrence of intrauterine adhesions,the pregnancy rate and the efficacy were compared for both groups.Serum levels of TNF-αand TGF-βwere detected.Results:After treatment,RI and PI of treatment group were obviously lower while the endometrial thickness was higher than those of the control group(P<0.01).The total effective rate was 93.88%of the treatment group,which was evidently higher than 75.55%of the control group(P<0.05).The recurrence rate of the treatment group was 12.24%,which was obviously lower than 30.61%in the control group(P<0.05).The pregnancy rate was 63.27%in the treatment group,which was remarkably higher than 38.76%in the control group(P<0.05).Serum levels of TNF-αand TGF-βof the treatment group were evidently lower than those of the control group(P<0.01).Conclusion:Qingrei Jiedu Decoction and kidney-tonifying and stasis-resolving step therapy improving pregnancy outcome cases after separation of intrauterine adhesions with kidney deficiency and blood stasis syndrome can increase the efficacy and the pregnancy rate,reduce the recurrence rate of intrauterine adhesions and regulating serum levels of TNF-αand TGF-βmay be one of ways for the efficacy.