补肾活血散瘀汤治疗子宫内膜异位症的疗效观察及作用机理初探
发布时间：2018-11-14 20:58
【摘要】：目的：1、通过观察补肾活血散瘀汤治疗肾虚血瘀型卵巢子宫内膜异位囊肿患者在治疗前后,其痛经程度、中医证候评分、异位囊肿大小及血清糖类抗原125(CA125)的变化,客观评价补肾活血散瘀汤治疗肾虚血瘀型卵巢子宫内膜异位囊肿的临床疗效,为中医药治疗卵巢子宫内膜异位囊肿提供临床依据。2、观察补肾活血散瘀汤对离体异位子宫内膜间质细胞增殖、凋亡的影响,初步探讨补肾活血散瘀汤治疗子宫内膜异位症的作用机制,为临床用药提供客观的理论依据。方法：1、选择50例肾虚血瘀型的卵巢子宫内膜异位囊肿患者,随机分为治疗组(口服补肾活血散瘀汤)30例和对照组(口服米非司酮片)20例,均治疗3个月。比较两组治疗前后痛经程度、中医证候评分、异位囊肿大小及血清CA125的变化。2、体外培养异位子宫内膜间质细胞,经不同浓度补肾活血散瘀汤处理后,观察细胞形态、数目的变化,以及caspase-8、caspase-9、caspase-3的活化水平。结果：1、临床研究：1)痛经疗效评定,两组患者治疗后痛经症状积分较治疗前均明显下降,比较有显著性差异(P0.01),但治疗后两组间比较无明显差异(P0.05)。2)两组患者治疗后中医证候总评分较治疗前均有明显下降,比较有显著性差异(P0.01),且治疗后两组间比较有明显差异(P0.05),治疗组优于对照组；3)50例患者治疗后,治疗组治愈0例(0%),好转20例(83.33%),无效5例(16..67%),总有效率83.33%。对照组治愈1例(5%),好转16例(80%),无效3例(15%),总有效率85%。两组间比较无明显差异(P0.05)。4)两组患者治疗后子宫内膜异位囊肿大小较治疗前略下降,比较均无明显差异(P0.05)。5)两组患者治疗后血清CA125值较治疗前明显下降,比较有明显差异(P0.05),治疗后两组间比较无明显差异(P0.05)。2、实验研究：空白对照组中,异位子宫内膜间质细胞生长状态良好,细胞数目多于接种时,而补肾活血散瘀汤对异位子宫内膜间质细胞的增殖有明显的抑制作用,且该作用呈现明显的时间依赖性和浓度依赖性。补肾活血散瘀汤可诱导异位子宫内膜间质细胞凋亡,且在此过程中发生了caspase级联活化。结论：采用补肾活血散瘀汤治疗肾虚血瘀型卵巢子宫内膜异位囊肿,患者的痛经、中医证候得到明显改善；子宫内膜异位囊肿较前缩小,血清CA125较前下降,可见补肾活血散瘀汤治疗肾虚血瘀型卵巢子宫内膜异位囊肿疗效确实肯定,无明显副作用及不良反应,其可能的机制是通过激活caspase-8、caspase-9、caspase-3,诱导异位子宫内膜间质细胞的凋亡。
[Abstract]:Objective: 1. To observe the changes of dysmenorrhea, TCM syndromes, size of ectopic cysts and serum glucose antigen 125 (CA125) in patients with endometriosis of ovarian endometriosis with kidney deficiency and blood stasis before and after treatment with Bushen Huoxue Sanyu decoction. Objective to evaluate the clinical effect of Bushen Huoxue Sanyu decoction in treating ovarian endometriosis cysts with kidney deficiency and blood stasis, and to provide the clinical basis for the treatment of ovarian endometriosis cysts with traditional Chinese medicine. To observe the effect of Bushen Huoxue Sanyu decoction on the proliferation and apoptosis of ectopic endometrial stromal cells in vitro, to explore the mechanism of Bushen Huoxue Sanyu decoction in treating endometriosis, and to provide an objective theoretical basis for clinical use of drugs. Methods: 1. Fifty patients with endometriosis of ovary with kidney deficiency and blood stasis were randomly divided into treatment group (30 cases) and control group (20 cases). All patients were treated for 3 months. The degree of dysmenorrhea, the score of TCM syndromes, the size of ectopic cysts and the changes of serum CA125 were compared between the two groups before and after treatment. 2. Ectopic endometrial stromal cells were cultured in vitro and treated with different concentrations of Bushen Huoxue Sanyu decoction. The number of changes, as well as the level of caspase-8,caspase-9,caspase-3 activation. Results: 1) Clinical study: 1) the scores of dysmenorrhea symptoms in the two groups were significantly lower than those before treatment (P0.01). However, there was no significant difference between the two groups after treatment (P0.05). 2) after treatment, the total score of TCM syndromes in the two groups was significantly lower than that before treatment (P0.01), and there was no significant difference between the two groups (P0.01). After treatment, there was significant difference between the two groups (P0.05), the treatment group was better than the control group; 3) in the treatment group, 0 cases (0%) were cured, 20 cases (83.33%) were improved, 5 cases (16.67%) were ineffective. The total effective rate was 83.33%. In the control group, 1 case (5%) was cured, 16 cases (80%) were improved, 3 cases (15%) were ineffective, the total effective rate was 85%. There was no significant difference between the two groups (P0.05). The size of endometriosis cysts in the two groups decreased slightly after treatment. There was no significant difference between the two groups (P0.05). The serum CA125 level of the two groups decreased significantly after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05). Experimental study: in the blank control group, the ectopic endometrial stromal cells grew well and the number of cells was more than when inoculated, while Bushen Huoxue Sanyu decoction had obvious inhibitory effect on the proliferation of ectopic endometrial stromal cells. Moreover, the effect was time-dependent and concentration-dependent. Bushen Huoxue Sanyu decoction could induce apoptosis of ectopic endometrial stromal cells and caspase cascade activation occurred during this process. Conclusion: Bushen Huoxue Sanyu decoction was used to treat ovarian endometriosis cyst with kidney deficiency and blood stasis. The dysmenorrhea and TCM syndrome of the patients were obviously improved. The effect of Bushen Huoxue Sanyu decoction on treating ovarian endometriosis cysts with kidney deficiency and blood stasis was confirmed, and there were no obvious side effects and adverse reactions. The possible mechanism is to activate caspase-8,caspase-9,caspase-3, to induce the apoptosis of ectopic endometrial stromal cells.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71
本文编号：2332287
[Abstract]:Objective: 1. To observe the changes of dysmenorrhea, TCM syndromes, size of ectopic cysts and serum glucose antigen 125 (CA125) in patients with endometriosis of ovarian endometriosis with kidney deficiency and blood stasis before and after treatment with Bushen Huoxue Sanyu decoction. Objective to evaluate the clinical effect of Bushen Huoxue Sanyu decoction in treating ovarian endometriosis cysts with kidney deficiency and blood stasis, and to provide the clinical basis for the treatment of ovarian endometriosis cysts with traditional Chinese medicine. To observe the effect of Bushen Huoxue Sanyu decoction on the proliferation and apoptosis of ectopic endometrial stromal cells in vitro, to explore the mechanism of Bushen Huoxue Sanyu decoction in treating endometriosis, and to provide an objective theoretical basis for clinical use of drugs. Methods: 1. Fifty patients with endometriosis of ovary with kidney deficiency and blood stasis were randomly divided into treatment group (30 cases) and control group (20 cases). All patients were treated for 3 months. The degree of dysmenorrhea, the score of TCM syndromes, the size of ectopic cysts and the changes of serum CA125 were compared between the two groups before and after treatment. 2. Ectopic endometrial stromal cells were cultured in vitro and treated with different concentrations of Bushen Huoxue Sanyu decoction. The number of changes, as well as the level of caspase-8,caspase-9,caspase-3 activation. Results: 1) Clinical study: 1) the scores of dysmenorrhea symptoms in the two groups were significantly lower than those before treatment (P0.01). However, there was no significant difference between the two groups after treatment (P0.05). 2) after treatment, the total score of TCM syndromes in the two groups was significantly lower than that before treatment (P0.01), and there was no significant difference between the two groups (P0.01). After treatment, there was significant difference between the two groups (P0.05), the treatment group was better than the control group; 3) in the treatment group, 0 cases (0%) were cured, 20 cases (83.33%) were improved, 5 cases (16.67%) were ineffective. The total effective rate was 83.33%. In the control group, 1 case (5%) was cured, 16 cases (80%) were improved, 3 cases (15%) were ineffective, the total effective rate was 85%. There was no significant difference between the two groups (P0.05). The size of endometriosis cysts in the two groups decreased slightly after treatment. There was no significant difference between the two groups (P0.05). The serum CA125 level of the two groups decreased significantly after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05). Experimental study: in the blank control group, the ectopic endometrial stromal cells grew well and the number of cells was more than when inoculated, while Bushen Huoxue Sanyu decoction had obvious inhibitory effect on the proliferation of ectopic endometrial stromal cells. Moreover, the effect was time-dependent and concentration-dependent. Bushen Huoxue Sanyu decoction could induce apoptosis of ectopic endometrial stromal cells and caspase cascade activation occurred during this process. Conclusion: Bushen Huoxue Sanyu decoction was used to treat ovarian endometriosis cyst with kidney deficiency and blood stasis. The dysmenorrhea and TCM syndrome of the patients were obviously improved. The effect of Bushen Huoxue Sanyu decoction on treating ovarian endometriosis cysts with kidney deficiency and blood stasis was confirmed, and there were no obvious side effects and adverse reactions. The possible mechanism is to activate caspase-8,caspase-9,caspase-3, to induce the apoptosis of ectopic endometrial stromal cells.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71
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