【作者】 许明桃；

【导师】 梁雪芳；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2008， 硕士

【摘要】 研究目的本研究以回顾性分析术前应用中药治疗对盆腔子宫内膜异位症患者盆腔状况的影响作为研究背景,在此基础上进行前瞻性研究,通过观察莪棱胶囊治疗30例气滞血瘀型盆腔内异症患者的临床疗效,比较治疗前后患者血清中可溶性细胞间粘附分子-1(sICAM-1)、血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)、白细胞介素-6(IL-6)含量的变化,从“3A”(粘附、侵袭、血管形成)及免疫方面,探讨中药应用对盆腔子宫内膜异位症盆腔状况影响的作用机制,为今后围手术期应用中药提供初步理论依据。研究方法1.回顾性研究收集2005年1月1日～2007年12月31日在广东省中医院妇科住院行手术治疗的盆腔子宫内膜异位症(经手术治疗及病理证实)患者133例,根据术前治疗情况分为中药组和空白组,对其住院病历进行回顾性分析,按照美国生育协会修订的子宫内膜异位症分期(r-AFS)法标准,分别对两组患者进行r-AFS评分,了解术前中药应用对盆腔状况的影响。2.前瞻性研究收集2007年2月～2008年2月期间在我院内异症专科门诊就诊,并符合纳入标准的气滞血瘀型盆腔子宫内膜异位症病例30例,给予莪棱胶囊治疗3个月,观察莪棱胶囊治疗的临床疗效,比较治疗前后患者血清中可溶性细胞间粘附分子-1(sICAM-1)、血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)、白细胞介素-6(IL-6)的含量变化,从“3A”及免疫机制方面,探讨中药对盆腔子宫内膜异位症盆腔状况影响的作用机制。研究结果1.在回顾性研究中,手术中发现中药组患者r-AFS评分为41.94±25.62分,空白组55.79±31.67分,两组的r-AFS评分比较具有显著性差异(P＜0.05),表明中药组患者的r-AFS评分较空白组低。2.在前瞻性研究中,经莪棱胶囊治疗3个月后,气滞血瘀型盆腔内异症患者的痛经症状得到明显改善,痛经积分较前降低,治疗前后比较有显著性差异(P＜0.05);患者全身及局部的血瘀症状亦得到显著改善(P＜0.05);盆腔包块亦较治疗前缩小(P＜0.05),临床治疗总有效率达83.3%。3.莪棱胶囊治疗3个月后,能够降低气滞血瘀型盆腔内异症患者血清中的sICAM-1、MMP-9和IL-6水平,与治疗前同期比较,均有显著性差异(P＜0.05);治疗后患者血清中的VEGF水平与治疗前同期比较,差异无统计学意义(P＞0.05)。结论1.通过回顾性研究,发现术前应用中药治疗能够降低盆腔内异症患者的r-AFS评分,与术前没有经过药物治疗的空白组相比,中药疗法可使盆腔粘连与腹膜异位病灶减少,通过改善盆腔环境,使手术顺利进行。2.莪棱胶囊治疗气滞血瘀型盆腔内异症具有良好的临床疗效,不仅有效缓解患者的痛经症状、改善机体的瘀血状态,而且能够缩小卵巢子宫内膜异位囊肿,对控制疾病的进展起到重要作用。3.莪棱胶囊可降低气滞血瘀型盆腔内异症患者血清中slCAM-1、MMP-9及IL-6的水平,推测中药应用可通过调节患者的体液和细胞免疫功能、阻断EM发生的“3A(粘附、侵袭、血管形成)”病理环节,影响疾病的形成和进展,从而达到改善盆腔状况的作用。更多还原

【Abstract】 Objectives:The effect on pelvic cavities of patient with pelvic endometriosis treated with Traditional Chinese Medicine Virtual Screening before operation were analyzed retrospectively.In this research background,to study the clinical effect of TCM therapy,and the variation of sICAM-1,VEGF、MMP-9、IL-6 expression in serum of patients with pelvic endometriosis.Reasearch on the pelvic cavities of patients with pelvic endometriosis treated with TCM preoperatively and its mechanisms of"3A"and immunity.Methods:1.Background researchThere were 133 cases with pelvic endometriosis,which were confirmed by surgery and pathology,receiving surgical treatment in Guangdong provincial TCM hospital from 2005 to 2007.Reasearch on the pelvic cavities of patients with pelvic endometriosis treated with TCM preoperatively.2.prospective studyThere were 30 cases with pelvic endometriosis treated with TCM treatment in special clinic of endometriosis in Guangdong provincial TCM hospital from February of 2007 to February of 2008.To study the variation of sICAM-1, VEGF、MMP-9、IL-6 expression in serum of patients,who received TCM treatment for 3 months,and then used the statistical software SPSS13.0 editions for the statistical analysis. Results: @1.In Background research,we foud that r-AFS score in the TCM group is 41.94±25.62,lower than the group without treatment preoperative,which is 55.79±31.67.There was statistical difference between the r-AFS score. @2.The Painful menstruation and the blood stasis symptom of 30 patients with pelvic endometriosis were reduced after TCM treatment.The dysmenorrheal score is lower then before.There was significant statistical difference between the two(P＜0.05). @3.The expression of sICAM-1,VEGF、MMP-9、IL-6 in serum of patients with pelvic endometriosis were decreased after treatment with TCM for 3 months.There was statistical difference between the two(P＜0.05).But there was no statistical difference as compared with VEGF in the serum pre and post treatment(P＞0.05). @Conclusion: @1.The r-AFS score in the patients with pelvic endometriosis could be reduced by the treatment with Traditional Chinese Medicine Virtual Screening preoperatively,in these station,operation could be done successfully. @2.The Painful menstruation and the blood stasis symptom of the patients with pelvic endometriosis could be improved with the TCM treatment. @3.The expression of sICAM-1,VEGF,MMP-9,IL-6 in serum of patients with pelvic endometriosis were decreased after TCM treatment.We conjecture that mechanisms of TCM treatment on the patients with pelvic endometriosis,is concern with the 3A" and immunity.更多还原