益母逐瘀汤联合西药治疗宫腔粘连分解术后中重度宫腔粘连临床研究

李莉莉 周艳

摘要：目的 觀察益母逐瘀汤联合西药对宫腔粘连分解术后（TCRA）中重度宫腔粘连（IUA）的临床疗效及其对子宫内膜组织中转化生长因子（TGF）-β1/Smad3信号通路及炎性因子的影响。方法 采用随机数字表法将120例TCRA后中重度IUA患者分为研究组和对照组各60例。对照组予戊酸雌二醇片联合地屈孕酮片口服；研究组在对照组基础上予益母逐瘀汤，每日1剂，每日3次，餐前口服。连续治疗3个月经周期。观察2组临床疗效、分离粘连次数及妊娠情况；观察2组治疗前后子宫内膜厚度、子宫内膜螺旋动脉搏动指数（PI）、子宫内膜螺旋动脉阻力指数（RI）及子宫内膜穿支血流数，子宫内膜组织中TGF-β1、Smad3蛋白及肿瘤坏死因子（TNF）-α、白细胞介素（IL）-1及血管内皮生长因子（VEGF）水平。结果 研究组治疗后中度、重度IUA疗效及月经改善疗效显著高于对照组（P<0.05），研究组分离粘连次数显著少于对照组（P<0.05），研究组妊娠成功率显著优于对照组（P<0.05）。与本组治疗前比较，2组子宫内膜厚度、PI、RI显著改善，研究组子宫内膜穿支血流分级显著改善；研究组治疗后子宫内膜厚度、PI、RI及子宫内膜穿支血流分级显著优于对照组（P<0.05）。与本组治疗前比较，研究组治疗后TNF-α、VEGF水平显著降低，IL-1显著升高（P<0.05），TGF-β1及Smad3蛋白相对表达量显著降低（P<0.05）。结论 益母逐瘀汤联合西药治疗TCRA后中重度IUA临床疗效显著，可恢复子宫内膜形态，有效预防宫腔再粘连。

关键词：益母逐瘀汤；中重度宫腔粘连；术后；炎性细胞

DOI：10.3969/j.issn.1005-5304.2018.05.007

中图分类号：R271.91 文献标识码：A 文章编号：1005-5304（2018）05-0027-05

Clinical Study of Yimu Zhuyu Decoction Combined with Western Medicine in Treating Moderate or Severe Intrauterine Adhesion After Transcervical Resection of Adhesion

LI Li-li， ZHOU Yan

People's Liberation Army 169 Hospital， Hengyang 421000， China

Abstract： Objective To observe the effects of Yimu Zhuyu Decoction on intrauterine adhesion （IUA） after transcervical resection of adhesion （TCAR） and its effect on TGF-β1/Smad3 signaling pathway and inflammatory factor expression in endometrial tissue. Methods Totally of 120 patients with moderate to severe IUA after TCAR were randomly divided into study group and control group， with 60 cases in each group. The control group was treated with estradiol valerate treatment， and the study group was given Yimu Zhuyu Decoction on the basis of the above treatment， one dosage per day， three times a day before dinner， orally for three periods. The clinical efficacy， the number of adhesions and the situation of pregnancy， the thickness of endometrium before and after treatment， the spiral artery pulsatility index （PI） in the endometrium， endometrial helix artery resistance index （RI） and the expression of TGF-β1， Smad3 and TNF-α， IL-1 and VEGF in endometrial tissues were observed and analyzed. Results After treatment， the effects of intrauterine adhesions and menstrual improvement in moderate to severe IUA were significantly higher than those in the control group （P<0.05）. The number of adhesions in the study group was significantly less than the control group （P<0.05）. The success rate of pregnancy in the study group were significantly better than those in the control group （P<0.05）. Compared with the pretreatment， the endometrial thickness， PI and RI of the two groups were significantly improved， and the grading of endometrial perforating branch in the study group

基金项目：湖南省医学科技攻关计划项目（201702315）

was significantly improved. The thickness of the endometrium， PI， RI and endometrium branch blood flow was significantly better than the control group （P<0.05）. The levels of TNF-α and VEGF， IL-1 in the study group were significantly decreased （P<0.05）， and the relative expressions of TGF-β1 and Smad3 in the study group were significantly lower than those before treatment （P<0.05）. Conclusion Yimu Zhuyu Decoction combined with Western medicine can improve the clinical symptoms and restore the endometrial morphology of the patients with moderate to severe IUA， and effectively prevent the occurrence of intrauterine adhesions.

Keywords： Yimu Zhuyu Decoction； moderate to severe intrauterine adhesions； postoperative； inflammatory cells

宫腔粘连（intrauterine adhesion，IUA）是由宫腔创伤与感染等导致的子宫内膜基底层受损，导致宫颈管与宫腔肌壁粘连的疾病，临床表现为腹痛、月经量减少、习惯性流产，严重者可导致闭经、不孕。近年来，IUA的发病率随着女性流产率的升高而呈上升趋势。宫腔镜下宫腔粘连分解术（TCRA）可在宫腔镜直视下有效分离或切除宫腔粘连，改善患者生育功能，是目前临床诊治IUA的首选手段。虽然TCRA术后已将宫腔的各个侧壁充分分离，但由于宫腔内膜修复机制障碍及炎性因子的影响，可导致3.1%～23.5%患者出现粘连[1]。……