【作者】 宋玮炜；

【导师】 刘瑞芬；

【作者基本信息】 山东中医药大学 ， 中医妇科学， 2007， 硕士

【摘要】 目的:探讨宫宁颗粒调控IUD(宫内节育器)出血副反应子宫内膜剥脱/修复相关机制。方法:在临床试验研究中,对IUD出血副反应患者进行宫宁颗粒和消炎痛两种药物干预,并设未放置宫内节育器的空白对照组,在观察疗效的同时,采用宫腔镜对子宫内膜的IUD压迫区、移行区和远器区进行观察并定点取材,比较各区治疗前后及与空白对照组在常规组织形态学的变化,并检测ER(雌激素受体)及PR(孕激素受体)的表达情况。结果:宫宁颗粒的临床疗效、中医证候改善率明显优于消炎痛组(P<0.05)。形态学观察表明,IUD出血副反应患者子宫内膜存在明显的病理学组织损伤,其组织损伤程度与距离IUD的远近成反比,距离越远,损伤越轻,且表现为明显的内膜发育不同步和剥脱/修复障碍;较之正常对照组,ER、PR表达在子宫内膜压迫区、移行区明显降低,在远器区明显升高(P<0.05),且内膜不同部位的各项指标表达均不一致(P<0.05或P<0.01)。IUD出血副反应患者治愈或好转后,内膜病理损伤明显减轻,内膜剥脱修复障碍消失或减轻;内膜ER、PR的表达有上升的趋势,且表达不同步现象消失或好转。在改善内膜病理损伤和内膜ER、PR表达不同步方面,宫宁颗粒明显优于消炎痛(P<0.05)。结论:IUD出血副反应患者明显存在子宫内膜周期性剥脱/修复的障碍,宫宁颗粒通过减轻子宫内膜的组织形态学损伤,调整和恢复内膜ER及PR的表达,从而纠正IUD出血副反应的子宫内膜剥脱/修复紊乱,且宫宁颗粒的临床疗效、中医证候疗效和对子宫内膜剥脱/修复紊乱相关指标的改善明显优于消炎痛。更多还原

【Abstract】 Objective: To discuss the endometria’s peeling and recovery mechanism concerning control of the side reaction of bleeding after IUD placement by Gongning granula.Method: In the clinical experimental investigation, Gongning granula and Indometacin are used for the patients suffered by side reaction of bleeding, and it is assumed that without IUD blank group is placed; while observing herapeutic effect,uterine cavity is also adopted to observe pressure area,transition area and distant area, and sample is taken at a certain point. changes of different parts prior to and after the treatment are compared, those parts and the blank control groups are also compared in terms of conventional organization morphology, and the empress of ER and PR are examined.Results: The clinical curative effect and the improvement rate of traditional Chinese medicine of Gongning granula obviously better than Indometacin group(P<0.05)。The observation of morphology indicate that, the endometria’s of the patients that the adverse reaction of bleeding after IUD placement exist obviously patho-damagement in histological anatomy, it’s degree of the patho-damagement inverse proported with the distance to IUD, the farther distance the slighter pain, as well it appears the obviously derangement of endometria’s and the disturbance of stripping or recovery. Compare to normal control. After the patients that the adverse reaction of bleeding after IUD placement healing well or improved, the patho-damagement of the endometria’s obviously relieved, the disturbance of stripping or recovery endometria’s vanished or lightened; although the empress of ER and PR appears the tendency of height or degrade,but out of synchronia vanished or improved. In the directions to the improvement endometria’s patho-damagement and the empress of ER, PR Gongning granula obviously better than Indometacin(P<0.05).Conclusion: The patients who have IUD bleeding side reaction have an obvious hindrance of endometria peeling and recovery periodically, Gongning granula adjusts and recovers the delivery of endometrium ER and PR the abnormal construction of uterus vessels, by relieving the impair of endometrium tectology, so as to adjust peeling and recovery endometrium foul-up of IUD bleeding side reaction. Gongning granula’s clinical effect、effect on traditional medical syndrome and improvement of relative indexes of endometrium exfoliating/repairing foul-up excels to Indometacin obviously.更多还原