【作者】 张烨；

【导师】 尤昭玲；

【作者基本信息】 湖南中医学院 ， 中医诊断学， 2003， 博士

【摘要】 目的：探讨宫环出血病病理生理机制，阐明宫环出血病的中医病证特点；探讨宫环Ⅱ号胶囊（以下称GHⅡ）干预作用研究及其机理；寻求中医药治疗宫环出血的有效方法。 方法：1、60例气虚血瘀型宫环出血患者完全随机分为GHⅡ治疗组和吲哚美辛对照组，7日为1疗程，1疗程结束后填写临床观察表。临床研究结果采用治疗前后症状积分、临床有效率、治疗依从性等各项指标进行统计分析。2、采用光镜、PCR、放射免疫等方法观察宫环出血患者治疗前后子宫内膜形态学改变、阴道念珠菌转阴率、子宫内膜及月经血中ET-1、CGRP、NO、NOS、t-PA、免疫五项的改变。3、采用大鼠阴道炎模型，观察GHⅡ在体抑菌及离体抑菌作用。4、采用气虚血瘀证宫环出血家兔模型，观察GHⅡ对模型子宫内膜形态学的影响。结果：1、GHⅡ能明显改善宫环出血患者临床症状，其临床有效率明显高于对照组，治疗依从性亦明显优于对照组；2、GHⅡ能增加宫环出血伴念珠菌阳性患者细菌转阴率，减少宫环出血患者炎症细胞、炎性渗出，改善子宫内膜充血、水肿，促进内膜修复。 3、GHⅡ能降低子宫内膜组织CGRP含量，升高ET-1水平；降低宫环出血患者月经血中NO水平；降低宫环出血患者月经血中C3、C4 、IgG、IgA水平。4、GHⅡ对加特纳杆菌、念珠菌有明显抑制作用；5、GHⅡ对加特纳杆菌腹腔感染小鼠及SD阴道感染大鼠模型有明显保护作用；6、GHⅡ能明显改善气虚血瘀证宫环出血家兔模型子宫内膜形态学。结论：1、GHⅡ能明显改善宫环出血患者的临床症状，是治疗宫环出血的有效方药； 2、GHⅡ的作用机制在于：a.抑制与宫环出血相关的病原体生长；b.抑制置IUD后子宫局部无菌性炎症，改善子宫内膜形态学<WP=6>使之趋于正常； c.调整局部血管舒缩因子（如ET-1、CGRP、NO、NOS）水平，使血管舒缩状态趋于正常；d.调整局部免疫状态（如降低C3及 IgG、IgA、IgM水平）。3、毒、虚、瘀是宫环出血病的中医病证实质更多还原

【Abstract】 Objective：To discuss pathophysiological mechanism of bleeding after IUD placement. To Clarificate pathophysiological behavior of TCM. To study intervention effect of GongHuanⅡ capsule(GHⅡ)and to seek methods of TCM on bleeding after IUD placement.Methods: 1、 60 bleeding after IUD placement patients were randomly divided into two group including GHⅡ treated group(n=30) and western medicine control group(n=30). GHⅡ were orally taken at dose of 16g/d(8g,Bid) in GHⅡ treated group, 1 course including one week. Indomethacin were orally taken at dose of 0.5/d(0.25,Bid) in western medicine control group and the treatment course was same as GHⅡ treated group. Lists of clinical observation were full in after one course. The results of clinical observation were described by clinical symptom number and rates of utility and compliance of therapy. 2、Microscope and PCR and radio-immunity were adopted to observe alteration of endometrium morpholog and rates of negative colpo-monilia, while alteration of ET-1、CGRP、NO、C3、C4、IgG、IgA、IgM in menorrhea or endometrium were<WP=8>observed. 3、Vaginitis rats model were adopted to observe role of GHⅡ in restraining bacteria. 4、QiXuXueYu bleeding after IUD placement rabbits model were adopted to observe effect of GHⅡon endometrium morpholog in animal model.Results:1、The clinical symptom of patients were ameliorated after treated by GHⅡ; 2、Rates of negative monilia in vaginal were increased after treated by GHⅡ, while inflammation cells and bleeding in endometrium were decreased. 3、Level of CGRP、NO、NOS in patients’ or rabitts’ endometrium were decreased, while level of ET-1 was increased. Level of C3、C4、IgG、IgA in blood of menorrhea were decreased. 4、GHⅡ can inhibit activity of monilia and Gatana’s Bacillus. 5、Protection actions of GHⅡ were observed in mice that were infected by Gatana’s Bacillus via abdominal cavity and SD-rats that were infected by monilia via vagina. 6、Endometrium morpholog and level of ET-1、CGRP、NO、C3、C4、IgG、IgA in menorrhea or endometrium were ameliorated after treated by GHⅡ in QiXuXueYu bleeding after IUD placement rabbits model.Conclusion:1、GHⅡ was an effective drug which could ameliorate the clinical symptom of IUD placement patients；2、The mechanism of GHⅡ maybe conclude: a. Inhibits growing up of monilia and Gatana’s Bacillus;b. Endometrium morphology in uterine were ameliorated by treating with GHⅡ;c.Level of ET-1、CGRP、NO、C3、C4、IgG、IgA in menorrhea or endometrium were ameliorated after treated by GHⅡ. 3、Pathophysiological behavior of TCM on bleeding after IUD placement maybe "Du、Xu、Yu更多还原