补肾活血汤治疗中重度宫腔粘连TCRA术后患者及对纤维化因子的影响

目的:评价补肾活血汤用于中重度宫腔粘连(IUA)宫腔镜宫腔粘连分离术(TCRA)术后恢复的效果及对纤维化因子的影响.方法 :将110例患者随机分为观察组和对照组,各55例.两组均行TCRA治疗,术后给予戊酸雌二醇片+黄体酮胶囊.对照组口服金凤丸,10 g/次,2次/d,饭前服用;观察组以补肾活血汤辨证治疗,1 剂/d....

Efficacy of Bushen Huoxue Decoction for Patients with Intra Uterine Adhesions After Trans Cervical Resection Adhesions Operation and Effect on Fibrotic Factors

Objective:To discuss the efficacy of Bushen Huoxue decoction for recovery in patients with intra uterine adhesions(IUA)after trans cervical resection adhesions(TCRA)operation,and to investigate its effect on fibrosis factor.Method:The 110 patients were randomly divided into two groups by random number table(55 cases for control group and 55 cases for observation group).The patients in both groups got TCRA,and after the operation,they got estradiol valerate tablets+progesterone capsules.The patients in control group additionally got Jinfengwan before meals,10 g/time,2 times/day.Patients in observation additionally got syndrome differentiation and treatment by Bushen Huoxuetang,1 dose/day.The treatment course was 3 months in both groups,and 6 months’follow-up was recorded.Before and after treatment,menstrual volume,period and cycle were recorded.During the follow-up,pregnancy,ectopic pregnancy and abortion were also recorded.Endoscopy and vagina color Doppler ultrasound were conducted to detect endometrial thickness,uterine volume,resistance index(RI),pulsation index(PI)and blood flow index(FI).Scores of IUA and syndrome of kidney deficiency and blood stasis were graded.At the 6^thmonths after treatment,rate of intrauterine re-adhesion was recorded.Levels of transforming growth factor-β₁(TGF-β₁),connective tissue growth factor(CTGF),matrix metalloproteinase inhibitor-1(TIMP-1),platelet-derived growth factor(PDGF),insulin-like growth factor-1(IGF-1)and matrix metalloproteinase-9(MMP-9)were detected,and safety was evaluated.Result:Total effective rate of clinical efficacy was 96.36%(53/55)in observation group,higher than 83.64%(46/55)in control group(χ²=4.959,P<0.05).Recovery rate of menstrual volume,period and cycle were 92.73%(51/55),90.91%(50/55),and 94.55%(52/55)in observation group,higher than 72.73%(40/55),76.36%(42/55),and 76.36%(42/55)in control group(χ²=7.698,χ²=4.245,χ²=7.313,P<0.05,P<0.01).During the follow-up,rate of intrauterine re-adhesions was 23.64%(13/55)in observation group,lower than 43.64%(24/55)in control group(χ²=4.927,P<0.05).Pregnancy rate was 45.45%(25/55),higher than 25.45%(14/55)in control group(χ²=4.807,P<0.05).Score of syndrome of kidney deficiency and blood stasis and IUA scores in observation group were lower than those in control group(P<0.01).Endometrial thickness,uterine volume,and FI were higher than those in control group(P<0.01).Levels of RI,PI,TGF-β₁,CTGF,PDGF,IGF-1 and TIMP-1 were lower than those in control group(P<0.01),while level of MMP-9 was higher than that in control group(P<0.01).No adverse reactions related to traditional Chinese medicine were found.Conclusion:Bushen Huoxue decoction can promote the recovery of menstruation,increase the thickness of endometrium,improve the blood circulation of uterus,regulate the expression of fibrogenic factors in vivo,prevent and treat intrauterine adhesions,reduce the rate of intrauterine re-adhesions,and improve the rate of pregnancy,with a good comprehensive effect and high safety for clinical use.