【摘要】：目的：1、通過觀察補腎活血散瘀湯治療腎虛血瘀型卵巢子宮內膜異位囊腫患者在治療前后,其痛經程度、中醫(yī)證候評分、異位囊腫大小及血清糖類抗原125(CA125)的變化,客觀評價補腎活血散瘀湯治療腎虛血瘀型卵巢子宮內膜異位囊腫的臨床療效,為中醫(yī)藥治療卵巢子宮內膜異位囊腫提供臨床依據。2、觀察補腎活血散瘀湯對離體異位子宮內膜間質細胞增殖、凋亡的影響,初步探討補腎活血散瘀湯治療子宮內膜異位癥的作用機制,為臨床用藥提供客觀的理論依據。方法：1、選擇50例腎虛血瘀型的卵巢子宮內膜異位囊腫患者,隨機分為治療組(口服補腎活血散瘀湯)30例和對照組(口服米非司酮片)20例,均治療3個月。比較兩組治療前后痛經程度、中醫(yī)證候評分、異位囊腫大小及血清CA125的變化。2、體外培養(yǎng)異位子宮內膜間質細胞,經不同濃度補腎活血散瘀湯處理后,觀察細胞形態(tài)、數目的變化,以及caspase-8、caspase-9、caspase-3的活化水平。結果：1、臨床研究：1)痛經療效評定,兩組患者治療后痛經癥狀積分較治療前均明顯下降,比較有顯著性差異(P0.01),但治療后兩組間比較無明顯差異(P0.05)。2)兩組患者治療后中醫(yī)證候總評分較治療前均有明顯下降,比較有顯著性差異(P0.01),且治療后兩組間比較有明顯差異(P0.05),治療組優(yōu)于對照組；3)50例患者治療后,治療組治愈0例(0%),好轉20例(83.33%),無效5例(16..67%),總有效率83.33%。對照組治愈1例(5%),好轉16例(80%),無效3例(15%),總有效率85%。兩組間比較無明顯差異(P0.05)。4)兩組患者治療后子宮內膜異位囊腫大小較治療前略下降,比較均無明顯差異(P0.05)。5)兩組患者治療后血清CA125值較治療前明顯下降,比較有明顯差異(P0.05),治療后兩組間比較無明顯差異(P0.05)。2、實驗研究：空白對照組中,異位子宮內膜間質細胞生長狀態(tài)良好,細胞數目多于接種時,而補腎活血散瘀湯對異位子宮內膜間質細胞的增殖有明顯的抑制作用,且該作用呈現(xiàn)明顯的時間依賴性和濃度依賴性。補腎活血散瘀湯可誘導異位子宮內膜間質細胞凋亡,且在此過程中發(fā)生了caspase級聯(lián)活化。結論：采用補腎活血散瘀湯治療腎虛血瘀型卵巢子宮內膜異位囊腫,患者的痛經、中醫(yī)證候得到明顯改善；子宮內膜異位囊腫較前縮小,血清CA125較前下降,可見補腎活血散瘀湯治療腎虛血瘀型卵巢子宮內膜異位囊腫療效確實肯定,無明顯副作用及不良反應,其可能的機制是通過激活caspase-8、caspase-9、caspase-3,誘導異位子宮內膜間質細胞的凋亡。
[Abstract]:Objective: 1. To observe the changes of dysmenorrhea, TCM syndromes, size of ectopic cysts and serum glucose antigen 125 (CA125) in patients with endometriosis of ovarian endometriosis with kidney deficiency and blood stasis before and after treatment with Bushen Huoxue Sanyu decoction. Objective to evaluate the clinical effect of Bushen Huoxue Sanyu decoction in treating ovarian endometriosis cysts with kidney deficiency and blood stasis, and to provide the clinical basis for the treatment of ovarian endometriosis cysts with traditional Chinese medicine. To observe the effect of Bushen Huoxue Sanyu decoction on the proliferation and apoptosis of ectopic endometrial stromal cells in vitro, to explore the mechanism of Bushen Huoxue Sanyu decoction in treating endometriosis, and to provide an objective theoretical basis for clinical use of drugs. Methods: 1. Fifty patients with endometriosis of ovary with kidney deficiency and blood stasis were randomly divided into treatment group (30 cases) and control group (20 cases). All patients were treated for 3 months. The degree of dysmenorrhea, the score of TCM syndromes, the size of ectopic cysts and the changes of serum CA125 were compared between the two groups before and after treatment. 2. Ectopic endometrial stromal cells were cultured in vitro and treated with different concentrations of Bushen Huoxue Sanyu decoction. The number of changes, as well as the level of caspase-8,caspase-9,caspase-3 activation. Results: 1) Clinical study: 1) the scores of dysmenorrhea symptoms in the two groups were significantly lower than those before treatment (P0.01). However, there was no significant difference between the two groups after treatment (P0.05). 2) after treatment, the total score of TCM syndromes in the two groups was significantly lower than that before treatment (P0.01), and there was no significant difference between the two groups (P0.01). After treatment, there was significant difference between the two groups (P0.05), the treatment group was better than the control group; 3) in the treatment group, 0 cases (0%) were cured, 20 cases (83.33%) were improved, 5 cases (16.67%) were ineffective. The total effective rate was 83.33%. In the control group, 1 case (5%) was cured, 16 cases (80%) were improved, 3 cases (15%) were ineffective, the total effective rate was 85%. There was no significant difference between the two groups (P0.05). The size of endometriosis cysts in the two groups decreased slightly after treatment. There was no significant difference between the two groups (P0.05). The serum CA125 level of the two groups decreased significantly after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05). Experimental study: in the blank control group, the ectopic endometrial stromal cells grew well and the number of cells was more than when inoculated, while Bushen Huoxue Sanyu decoction had obvious inhibitory effect on the proliferation of ectopic endometrial stromal cells. Moreover, the effect was time-dependent and concentration-dependent. Bushen Huoxue Sanyu decoction could induce apoptosis of ectopic endometrial stromal cells and caspase cascade activation occurred during this process. Conclusion: Bushen Huoxue Sanyu decoction was used to treat ovarian endometriosis cyst with kidney deficiency and blood stasis. The dysmenorrhea and TCM syndrome of the patients were obviously improved. The effect of Bushen Huoxue Sanyu decoction on treating ovarian endometriosis cysts with kidney deficiency and blood stasis was confirmed, and there were no obvious side effects and adverse reactions. The possible mechanism is to activate caspase-8,caspase-9,caspase-3, to induce the apoptosis of ectopic endometrial stromal cells.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R711.71

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