内异停方治疗子宫腺肌病的疗效观察及对血清VEGF、在位内膜VEGFR-2的影响
发布时间：2018-11-18 20:39
【摘要】：目的:研究表明,子宫腺肌病(Adenomyosis,AM)的发生与"3A程序"—粘附、侵袭、血管生成密切相关,而血管生成对AM的发生、发展及预后至关重要。随着中医药在抗血管生成方面实验研究的不断深入,临床应用也愈显广泛。本次研究通过观察内异停方治疗AM患者的临床疗效变化,从抗血管生成的角度探讨内异停方对血清VEGF、在位内膜VEGFR-2的影响,观察AM与VEGF/VEGFR-2信号通路的相关性,阐明内异停方治疗AM的作用机理,为中医药治疗AM提供更充分的理论基础和更广阔的研究思路。方法:选取45例就诊于江苏省中医院妇科门诊的AM患者,其中治疗组25例口服内异停方,对照组20例口服桂枝茯苓胶囊。两组患者均于经后开始服药,经期停服,连服4个月经周期为一个疗程,于治疗前后对患者痛经程度、中医症状及体征进行评分,并观察CA125、血清VEGF及在位内膜VEGFR-2的变化。另选取58例选择手术治疗的AM患者,分为术前曾服药组23例和术前未服药组35例,研究内异停方对在位内膜VEGFR-2的作用。结果:治疗组治疗后痛经积分、中医症状及体征积分与治疗前比较,差异均存在统计学意义(P0.05);对照组治疗后痛经积分、中医症状及体征积分与治疗前比较,差异均存在统计学意义(P0.05);治疗后两组间比较痛经积分、中医症状及体征积分,差异均存在统计学意义(P0.05)。治疗组及对照组治疗后的总有效率分别为88.00%和70.00%,治疗后两组间综合疗效比较,差异存在统计学意义(P0.05)。治疗组治疗后血清CA125及VEGF水平与治疗前比较,差异均存在统计学意义(P0.05);对照组治疗后血清CA125及VEGF水平与治疗前比较,差均存在统计学意义(P0.05);治疗后两组间比较血清CA125及VEGF水平,差异均无统计学意义(P0.05)。治疗组治疗后在位内膜VEGFR-2与治疗前比较,差异无统计学意义(P0.05);对照组治疗后在位内膜VEGFR-2与治疗前比较,差异无统计学意义(P0.05);治疗后两组间比较在位内膜VEGFR-2水平,无显著性差异(P0.05)。术前曾服药组治疗后在位内膜VEGFR-2与术前未服药组比较,差异具有显著性(P0.05),术前曾服药组在位内膜VEGFR-2的表达明显下降。结论:1、内异停方可明显改善患者痛经程度、中医症状及体征,且优于桂枝茯苓胶囊。2、内异停方能够使血清CA125及VEGF水平下降,且与桂枝茯苓胶囊比较无统计学差异。3、内异停方及桂枝茯苓胶囊治疗前后患者在位内膜VEGFR-2变化均不明显,可能与样本量少有关。4、术前曾服药组治疗后的在位内膜VEGFR-2水平与术前未服药组相比,表达明显下降。说明内异停方可以降低在位内膜VEGFR-2水平。5、内异停方治疗子宫腺肌病临床疗效肯定,其分子作用机制之一可能与干扰VEGF/VEGFR-2信号通路而影响血管生成相关。
[Abstract]:Objective: studies have shown that the occurrence of adenomyosis (Adenomyosis,AM) is closely related to the "3A program"-adhesion, invasion, angiogenesis, and angiogenesis is crucial to the occurrence, development and prognosis of AM. With the deepening of experimental research on anti-angiogenesis of Chinese medicine, clinical application is becoming more and more extensive. In this study, we observed the changes of clinical efficacy of Neiyi stopping prescription in treating AM patients, discussed the effect of Neiyi stopping prescription on VEGFR-2 in eutopic endometrium of VEGF, from the angle of anti-angiogenesis, and observed the correlation between AM and VEGF/VEGFR-2 signal pathway. To elucidate the mechanism of the treatment of AM with Neiyi stopping prescription, and to provide a more theoretical basis and a broader research idea for the treatment of AM with traditional Chinese medicine. Methods: 45 patients with AM were selected from gynecological outpatient department of Jiangsu Provincial traditional Chinese Medicine Hospital. 25 patients in treatment group were treated with Neiyi decoction and 20 patients in control group were treated with Guizhi Fuling capsule. The patients in both groups began to take medicine after menstruation, stopped taking it during menstrual period, and took 4 menstrual cycles as a course of treatment. The degree of dysmenorrhea, symptoms and signs of TCM were evaluated before and after treatment, and the changes of VEGF in serum and VEGFR-2 in eutopic endometrium were observed. In addition, 58 patients with AM were divided into two groups: 23 patients who had been treated before operation and 35 patients who were not treated before operation. The effect of nifedipine on VEGFR-2 of eutopic endometrium was studied. Results: the scores of dysmenorrhea, symptoms and signs of traditional Chinese medicine in the treatment group were significantly different from those before treatment (P0.05). The scores of dysmenorrhea, symptoms and signs of traditional Chinese medicine in the control group were significantly different from those before treatment (P0.05). After treatment, the scores of dysmenorrhea, TCM symptoms and signs were significantly different between the two groups (P0.05). The total effective rate of the treatment group and the control group after treatment were 88.00% and 70.005% respectively. There was significant difference between the two groups after treatment (P0.05). The levels of serum CA125 and VEGF in the treatment group were significantly different from those before treatment (P0.05), and the levels of serum CA125 and VEGF in the control group were significantly different from those before treatment (P0.05). There was no significant difference in serum CA125 and VEGF levels between the two groups after treatment (P0.05). The VEGFR-2 of eutopic endometrium in the treatment group was not significantly different from that before treatment (P0.05), while that in the control group was not significantly different from that before treatment (P0.05). There was no significant difference in VEGFR-2 level between the two groups after treatment (P0.05). There was a significant difference in the VEGFR-2 of the eutopic endometrium between the pre-treated group and the pre-medication group (P0.05). The expression of VEGFR-2 in the pre-medication group was significantly lower than that in the pre-medication group. Conclusion: 1. Neiyi decoction can obviously improve the degree of dysmenorrhea, symptoms and signs of traditional Chinese medicine, and is superior to Guizhi Fuling capsule. 2. Neiyi decoction can decrease the levels of serum CA125 and VEGF, and has no statistical difference with Guizhi Fuling capsule. The changes of VEGFR-2 in eutopic endometrium of patients before and after treatment with Neiyi stopping prescription and Guizhi Fuling capsule were not obvious, which may be related to the sample size. 4. The VEGFR-2 level of eutopic endometrium after treatment in the group who had taken medicine before operation was higher than that in the group without taking the medicine before operation. The expression decreased obviously. The results suggest that Neiyidu decoction can decrease the level of VEGFR-2 in eutopic endometrium. The clinical efficacy of Neiyidu decoction in the treatment of adenomyosis is certain, and one of its molecular mechanisms may be related to the interference of VEGF/VEGFR-2 signal pathway and the influence of angiogenesis.
【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】：2017
【分类号】：R271.9
本文编号：2341158
[Abstract]:Objective: studies have shown that the occurrence of adenomyosis (Adenomyosis,AM) is closely related to the "3A program"-adhesion, invasion, angiogenesis, and angiogenesis is crucial to the occurrence, development and prognosis of AM. With the deepening of experimental research on anti-angiogenesis of Chinese medicine, clinical application is becoming more and more extensive. In this study, we observed the changes of clinical efficacy of Neiyi stopping prescription in treating AM patients, discussed the effect of Neiyi stopping prescription on VEGFR-2 in eutopic endometrium of VEGF, from the angle of anti-angiogenesis, and observed the correlation between AM and VEGF/VEGFR-2 signal pathway. To elucidate the mechanism of the treatment of AM with Neiyi stopping prescription, and to provide a more theoretical basis and a broader research idea for the treatment of AM with traditional Chinese medicine. Methods: 45 patients with AM were selected from gynecological outpatient department of Jiangsu Provincial traditional Chinese Medicine Hospital. 25 patients in treatment group were treated with Neiyi decoction and 20 patients in control group were treated with Guizhi Fuling capsule. The patients in both groups began to take medicine after menstruation, stopped taking it during menstrual period, and took 4 menstrual cycles as a course of treatment. The degree of dysmenorrhea, symptoms and signs of TCM were evaluated before and after treatment, and the changes of VEGF in serum and VEGFR-2 in eutopic endometrium were observed. In addition, 58 patients with AM were divided into two groups: 23 patients who had been treated before operation and 35 patients who were not treated before operation. The effect of nifedipine on VEGFR-2 of eutopic endometrium was studied. Results: the scores of dysmenorrhea, symptoms and signs of traditional Chinese medicine in the treatment group were significantly different from those before treatment (P0.05). The scores of dysmenorrhea, symptoms and signs of traditional Chinese medicine in the control group were significantly different from those before treatment (P0.05). After treatment, the scores of dysmenorrhea, TCM symptoms and signs were significantly different between the two groups (P0.05). The total effective rate of the treatment group and the control group after treatment were 88.00% and 70.005% respectively. There was significant difference between the two groups after treatment (P0.05). The levels of serum CA125 and VEGF in the treatment group were significantly different from those before treatment (P0.05), and the levels of serum CA125 and VEGF in the control group were significantly different from those before treatment (P0.05). There was no significant difference in serum CA125 and VEGF levels between the two groups after treatment (P0.05). The VEGFR-2 of eutopic endometrium in the treatment group was not significantly different from that before treatment (P0.05), while that in the control group was not significantly different from that before treatment (P0.05). There was no significant difference in VEGFR-2 level between the two groups after treatment (P0.05). There was a significant difference in the VEGFR-2 of the eutopic endometrium between the pre-treated group and the pre-medication group (P0.05). The expression of VEGFR-2 in the pre-medication group was significantly lower than that in the pre-medication group. Conclusion: 1. Neiyi decoction can obviously improve the degree of dysmenorrhea, symptoms and signs of traditional Chinese medicine, and is superior to Guizhi Fuling capsule. 2. Neiyi decoction can decrease the levels of serum CA125 and VEGF, and has no statistical difference with Guizhi Fuling capsule. The changes of VEGFR-2 in eutopic endometrium of patients before and after treatment with Neiyi stopping prescription and Guizhi Fuling capsule were not obvious, which may be related to the sample size. 4. The VEGFR-2 level of eutopic endometrium after treatment in the group who had taken medicine before operation was higher than that in the group without taking the medicine before operation. The expression decreased obviously. The results suggest that Neiyidu decoction can decrease the level of VEGFR-2 in eutopic endometrium. The clinical efficacy of Neiyidu decoction in the treatment of adenomyosis is certain, and one of its molecular mechanisms may be related to the interference of VEGF/VEGFR-2 signal pathway and the influence of angiogenesis.
【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】：2017
【分类号】：R271.9
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