內(nèi)異停方治療子宮腺肌病的療效觀察及對血清VEGF、在位內(nèi)膜VEGFR-2的影響
發(fā)布時間：2018-11-18 20:39
【摘要】：目的:研究表明,子宮腺肌病(Adenomyosis,AM)的發(fā)生與"3A程序"—粘附、侵襲、血管生成密切相關(guān),而血管生成對AM的發(fā)生、發(fā)展及預(yù)后至關(guān)重要。隨著中醫(yī)藥在抗血管生成方面實驗研究的不斷深入,臨床應(yīng)用也愈顯廣泛。本次研究通過觀察內(nèi)異停方治療AM患者的臨床療效變化,從抗血管生成的角度探討內(nèi)異停方對血清VEGF、在位內(nèi)膜VEGFR-2的影響,觀察AM與VEGF/VEGFR-2信號通路的相關(guān)性,闡明內(nèi)異停方治療AM的作用機(jī)理,為中醫(yī)藥治療AM提供更充分的理論基礎(chǔ)和更廣闊的研究思路。方法:選取45例就診于江蘇省中醫(yī)院婦科門診的AM患者,其中治療組25例口服內(nèi)異停方,對照組20例口服桂枝茯苓膠囊。兩組患者均于經(jīng)后開始服藥,經(jīng)期停服,連服4個月經(jīng)周期為一個療程,于治療前后對患者痛經(jīng)程度、中醫(yī)癥狀及體征進(jìn)行評分,并觀察CA125、血清VEGF及在位內(nèi)膜VEGFR-2的變化。另選取58例選擇手術(shù)治療的AM患者,分為術(shù)前曾服藥組23例和術(shù)前未服藥組35例,研究內(nèi)異停方對在位內(nèi)膜VEGFR-2的作用。結(jié)果:治療組治療后痛經(jīng)積分、中醫(yī)癥狀及體征積分與治療前比較,差異均存在統(tǒng)計學(xué)意義(P0.05);對照組治療后痛經(jīng)積分、中醫(yī)癥狀及體征積分與治療前比較,差異均存在統(tǒng)計學(xué)意義(P0.05);治療后兩組間比較痛經(jīng)積分、中醫(yī)癥狀及體征積分,差異均存在統(tǒng)計學(xué)意義(P0.05)。治療組及對照組治療后的總有效率分別為88.00%和70.00%,治療后兩組間綜合療效比較,差異存在統(tǒng)計學(xué)意義(P0.05)。治療組治療后血清CA125及VEGF水平與治療前比較,差異均存在統(tǒng)計學(xué)意義(P0.05);對照組治療后血清CA125及VEGF水平與治療前比較,差均存在統(tǒng)計學(xué)意義(P0.05);治療后兩組間比較血清CA125及VEGF水平,差異均無統(tǒng)計學(xué)意義(P0.05)。治療組治療后在位內(nèi)膜VEGFR-2與治療前比較,差異無統(tǒng)計學(xué)意義(P0.05);對照組治療后在位內(nèi)膜VEGFR-2與治療前比較,差異無統(tǒng)計學(xué)意義(P0.05);治療后兩組間比較在位內(nèi)膜VEGFR-2水平,無顯著性差異(P0.05)。術(shù)前曾服藥組治療后在位內(nèi)膜VEGFR-2與術(shù)前未服藥組比較,差異具有顯著性(P0.05),術(shù)前曾服藥組在位內(nèi)膜VEGFR-2的表達(dá)明顯下降。結(jié)論:1、內(nèi)異停方可明顯改善患者痛經(jīng)程度、中醫(yī)癥狀及體征,且優(yōu)于桂枝茯苓膠囊。2、內(nèi)異停方能夠使血清CA125及VEGF水平下降,且與桂枝茯苓膠囊比較無統(tǒng)計學(xué)差異。3、內(nèi)異停方及桂枝茯苓膠囊治療前后患者在位內(nèi)膜VEGFR-2變化均不明顯,可能與樣本量少有關(guān)。4、術(shù)前曾服藥組治療后的在位內(nèi)膜VEGFR-2水平與術(shù)前未服藥組相比,表達(dá)明顯下降。說明內(nèi)異停方可以降低在位內(nèi)膜VEGFR-2水平。5、內(nèi)異停方治療子宮腺肌病臨床療效肯定,其分子作用機(jī)制之一可能與干擾VEGF/VEGFR-2信號通路而影響血管生成相關(guān)。
[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.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R271.9
本文編號：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.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R271.9
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