化瘀散结法对子宫内膜息肉患者雌孕激素及其受体表达的影响

目的 子宫内膜息肉(endometrial polyp,EP)是妇科常见疾病,宫腔镜下子宫内膜息肉切除术(transcervical resection of polyps,TCRP)能有效治疗子宫内膜息肉,但其术后复发率较高,因此,如何预防子宫内膜息肉复发是本课题研究的目的。本课题通过不同治疗方案对TCRP术后患者进行治疗,观察治疗前后患者血清雌二醇(E2)、孕酮(P)及子宫内膜中子宫内膜雌激素受体(ER)、孕激素受体(PR)表达的变化,从而探讨化瘀散结法治疗子宫内膜息肉的可能作用机制。 方法 选择2015年6月—2016年6月在宁波市中医院妇科住院符合血瘀型诊断、宫腔镜及病理确诊为子宫内膜息肉的患者147例,随机分为中药组、西药组、对照组,每组49例,行TCRP后分别给予中药化瘀散结法、西药妈富隆及术后不予用药3种治疗方法,疗程3个月,比较治疗前后各组患者血清E2、P及子宫内膜中ER、PR表达的变化及差异。 结果 治疗后,3组患者血清E2、P及子宫内膜ER无明显变化,中药组及西药组均可上调患者子宫内膜中PR表达,中药组PR表达上调最明显(P<0.05)。 结论 化瘀散结法可能通过改善子宫内膜血流情况,调控PR在子宫内膜的分布均衡,有效上调子宫内膜息肉患者内膜中PR的表达,促进内膜周期性完整脱落,从而抑制子宫内膜息肉复发。 

Effects of Huayu Sanjie therapy on the expression of E2,P,ER and PR in patients with endometrial polyp

Objective Endometrial polyp is a common gynecological disease.Transcervical resection of polyps (TCRP) is an effective treatment for endometrial polyp;however, the recurrence rate was higher.Therefore, how to prevent the recurrence of endometrial polyp was the purpose of this research.The aim of this paper is to investigate the changes of E2 and P levels in blood, and ER and PR in endometrium before and after the Huayu Sanjie therapy in in patients with endometrial polyp after TCRP. Methods Total 147 cases of endometrial polyp (blood stasis type by TCM, confirmed by hysteroscopy and histopathologic examination) undergoing TCRP in our hospital between June, 2015 and June, 2016 were randomly divided into traditional Chinese medicine group, western medicine group and control group with 49 cases in each group.The traditional Chinese medicine group received Huayu Sanjie therapy and the western medicine group received Marvelon therapy for 3 months.The changes of E2 and P levels in blood, and ER and PR levels in endometrium before and after treatment were compared. Results There was no obvious change in the levels of E2, P and ER in all three groups after the treatment.The expression of PR was up-regulated both in the Chinese medicine group and the western medicine group, and especially obvious in the Chinese medicine treatment group (P < 0.05). Conclusion Huayu Sanjie therapy may improve the endometrial blood flow, and regulate the distribution of PR in endometrium, and up-regulate the expression of PR in patients with endometrial polyp, promote the uterine lining to shed completely and periodically, then to inhibit the recurrence of endometrial polyp.