化湿解毒汤对高级别CIN高危型HPV感染者LEEP术后湿热下注证患者转归的影响

发布时间：2018-03-14 15:04

本文选题：宫颈上皮内瘤变　切入点：人类乳头状瘤病毒　出处：《中国实验方剂学杂志》2017年16期 　论文类型：期刊论文

【摘要】：目的:探讨化湿解毒汤对高级别CIN高危型HPV感染者LEEP术后湿热下注证患者的临床疗效,并从凋亡抑制基因即生存素(Survivin)和增殖细胞核抗原(Ki67)表达及HPV病毒载量等方面探讨了其对转归的影响。方法:将160例CIN高危型HPV感染者,采用SAS软件生成,随机按1∶1比例分为观察组和对照组。两组患者均给予LEEP术治疗。术后对照组给予重组人干扰素α-2 b凝胶宫颈外涂,连续10 d为1个疗程,共使用3个月经周期。观察组在对照组治疗的基础上加用化湿解毒汤内服,1剂/d。连续服用3个月经周期,再行3个月经周期随访。检测术前和术后6个月患者Survivin,Ki67水平阳性表达情况和人乳头瘤病毒(HPV)DNA基因(HPV-DNA)病毒载量;进行术前和术后3个月慢性宫颈炎和湿热下注证的评价;检测术前和术后3个月宫颈局部灌洗液γ-干扰素(IFN-γ),白细胞介素-10(IL-10),白细胞介素-12(IL-12),白细胞介素-2(IL-2)和白细胞介素-4(IL-4)水平。结果:观察组临床疗效总有效率为94.52%,对照组为81.69%,观察组高于对照组(χ~2=6.691,P0.05);治疗后观察组中医证候疗效总有效率为95.89%,对照组为78.87%,观察组高于对照组(χ~2=9.529,P0.01);术后6个月,观察组高危型人乳头瘤病毒(hr-HPV)阴转率为91.78%,对照组为77.46%,观察组高于对照组(χ~2=5.699,P0.05);观察组患者在术后6个月hr-HPV病毒载量低于对照组(P0.01);术后6个月,观察组Survivin和Ki67阳性表达情况弱于对照组(P0.05),观察组Survivin阴转率为73.97%,高于对照组的56.34%(χ~2=4.938,P0.05),观察组Ki67阴转率为80.82%,高于对照组的59.15%(χ~2=8.067,P0.01);术后3个月观察组IFN-γ,IL-2和IL-12水平均高于对照组,IL-4和IL-10水平均低于对照组(P0.01)。结论:采用化湿解毒汤干预CIN高危型HPV感染LEEP术后患者,能提高患者的临床治疗效果,能促使hr-HPV阴转,降低病毒载量,能降低Survivin和Ki67阳性表达,并调节Th1/Th2平衡,从而起到控制CIN向宫颈癌转变,改善其预后。
[Abstract]:Objective: to investigate the clinical effect of Huashi jiedu decoction (Huishjiedu decoction) on the patients with damp and heat betting syndrome after LEEP operation in high grade CIN patients with high risk of HPV infection. The effects of apoptosis suppressor gene (survivin), proliferating cell nuclear antigen (PCNA) Ki67) and HPV viral load on prognosis were discussed. Methods: 160 cases of high risk HPV infected with CIN were generated by SAS software. The patients in the two groups were divided into observation group and control group randomly according to the ratio of 1: 1. The patients in both groups were treated with LEEP. The control group was treated with recombinant human interferon 伪 -2 b gel for 10 days as a course of treatment. Three menstrual cycles were used altogether. The observation group was treated with Huashi jiedu decoction on the basis of the treatment in the control group. The positive expression of survivin Ki67 and the HPV-DNAvirus load of human papillomavirus (HPV-HPV-DNA) gene were detected before and 6 months after the operation, and the evaluation of chronic cervicitis and damp-heat betting syndrome were performed before and 3 months after the operation. The levels of IFN- 纬, IL-10, IL-12, IL-2) and IL-4IL-4 were measured before and 3 months after operation. Results: the total effective rate was 94.52 in the observation group and 94.52 in the control group. 81.69, which was higher in the observation group than in the control group (蠂 ~ (2) 2) 6.691n (P0.05), the total effective rate of TCM syndrome in the observation group was 95.89 and 78.87 in the control group, which was higher than that in the control group (蠂 ~ (2) 2) 9.529 (P0.01); 6 months after operation, the total effective rate of TCM syndromes in the observation group was 95.89 and 78.87, respectively. The negative conversion rate of high-risk human papillomavirus (HPV) was 91.78 in the observation group and 77.46 in the control group, which was higher in the observation group than in the control group (蠂 ~ (2 +) 5.699) P0.05.The hr-HPV viral load in the observation group was lower than that in the control group at 6 months after operation (P 0.01), and at 6 months after operation, the viral load of hr-HPV in the observation group was lower than that in the control group. The positive expression of Survivin and Ki67 in the observation group was weaker than that in the control group (P 0.05). The negative conversion rate of Survivin in the observation group was 73.97, which was higher than that in the control group (56.34%) (蠂 ~ 2 = 4.938, P 0.05), and the negative conversion rate of Ki67 in the observation group was 80.82%, which was higher than that in the control group (59.15%) (蠂 ~ (28.067) P 0.01). The levels of IL-2 and IL-12 in the observation group were higher than those in the control group 3 months after operation. Conclusion: Huashi jiedu decoction is used to treat the patients with CIN high risk HPV infection after LEEP operation, and the level of IL-10 is lower than that of the control group (P 0.01). It can improve the clinical therapeutic effect of patients, promote the negative conversion of hr-HPV, reduce the viral load, decrease the positive expression of Survivin and Ki67, and regulate the balance of Th1/Th2, so as to control the transition of CIN to cervical cancer and improve its prognosis.
【作者单位】：河南大学淮河医院;
【基金】：河南省高等学校重点科研计划项目(17A320023)
【分类号】：R737.33

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