摘要
目的观察在宫腔粘连分解术(TCRA)治疗基础上,温针灸联合雌孕激素序贯疗法治疗宫腔粘连(IUA)的临床疗效。方法将100例肾虚血瘀型IUA患者随机分为治疗组和对照组,每组50例。对照组采用宫腔镜下粘连松解联合口服雌-孕激素序贯治疗,治疗组在此治疗基础上行温针灸治疗。观察宫腔镜下IUA程度评分、阴道超声监测子宫内膜厚度和子宫内膜血流参数[阻力指数(RI)和搏动指数(PI)]、子宫内膜血流分型、炎症因子[肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)]、纤维化相关分子[纤维蛋白原(FIB)、转化生长因子(TGF-β)和血管内皮生长因子(VEGF)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和凝血酶时间(TT)]以及术后感染指标[白细胞计数(WBC)和白带常规]的变化。结果治疗组总有效率为92.0%,显著高于对照组的76.0%,差异有统计学意义(P<0.05)。治疗后,两组IUA程度评分较治疗前降低(P<0.05),治疗组低于对照组(P<0.05);两组子宫内膜厚度较治疗前增加(P<0.05),且治疗组子宫内膜厚度及增加幅度均优于对照组(P<0.05)。治疗后,两组RI和PI优于治疗前,治疗组优于对照组,差异有统计学意义(P<0.05)。治疗后,两组子宫内膜血流分型较治疗前改善,治疗组优于对照组,差异有统计学意义(P<0.05)。治疗后,两组血清TNF-α和IL-6水平较治疗前降低,治疗组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组血清TGF-β、FIB和VEGF水平较治疗前降低(P<0.05);治疗组血清TGF-β和FIB水平低于对照组(P<0.05);两组血清VEGF水平比较,差异无统计学意义(P>0.05)。治疗后,两组血浆PT和TT水平降低,APTT水平上升,差异有统计学意义(P<0.05);治疗组血浆PT和APTT水平优于对照组(P<0.05),两组TT水平比较,差异无统计学意义(P>0.05)。治疗后,两组血浆WBC水平和白带异常率较治疗前改善(P<0.05),组间比较差异无统计学意义(P>0.05)。结论在TCRA治疗基础上,温针灸联合雌孕激素序贯疗法在治疗IUA、改善子宫内膜厚度及血流等方面具有良好的疗效。
Objective To observe the clinical efficacy of needle-warming moxibustion plus estrogen and progestin sequential therapy based on transcervical resection of adhesion(TCRA)in treating intrauterine adhesion(IUA).Method One hundred patients with IUA due to kidney deficiency and blood stasis were randomized into a treatment group and a control group,with 50 cases in each group.The control group underwent hysteroscopic TCRA plus oral estrogen and progestin sequential treatment,and the treatment group received additional needle-warming moxibustion.The IUA was scored using hysteroscopy,and transvaginal ultrasonography was used to measure endometrial thickness,blood flow parameters[resistance index(RI)and pulsatility index(PI)]and blood flow classification.Changes in the inflammatory factors[tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)],fibrosis-related molecules[fibrinogen(FIB),transforming growth factor-β(TGF-β),and vascular endothelial growth factor(VEGF)],coagulation indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),and thrombin time(TT)],and postoperative infection indicators[white blood cell count(WBC)and leucorrhea routine]were also observed.Result The total effective rate was 92.0%in the treatment group,significantly higher than 76.0%in the control group(P<0.05).After the intervention,the IUA score dropped in both groups(P<0.05)and was lower in the treatment group than in the control group(P<0.05);the endometrial thickness increased in both groups(P<0.05),and the thickness was greater in the treatment group than in the control group,so was the change in the thickness(P<0.05).After the treatment,the RI and PI improved in the two groups,and the treatment group was superior to the control group,showing statistical significance(P<0.05).The endometrial blood flow classification also improved after the intervention in both groups,and the treatment group surpassed the control group,showing statistical significance(P<0.05).After the treatment,the serum TNF-αand IL-6 levels declined in both groups and were lower in the treatment group than in the control group with statistical significance(P<0.05).After the intervention,The serum levels of TGF-β,FIB,and VEGF decreased in the two groups(P<0.05);the serum TGF-βand FIB levels were lower in the treatment group than in the control group(P<0.05);there was no significant between-group difference in the serum level of VEGF(P>0.05).After the treatment,the plasma PT and TT levels declined and the APTT level elevated in the two groups,showing statistical significance(P<0.05);the treatment group showed advantages over the control group in comparing the plasma levels of PT and APTT(P<0.05);the between-group difference in the TT level was statistically insignificant(P>0.05).The plasma WBC and abnormal rate of leucorrhea improved after the treatment in both groups(P<0.05),while the between-group differences were statistically insignificant(P>0.05).Conclusion Based on TCRA,needle-warming moxibustion plus estrogen and progestin sequential therapy can produce satisfactory results in treating IUA and improving endometrial thickness and blood flow.
作者
马娟娟
詹逸珺
裴建
吴胜男
翁晓晨
帅文
MA Juanjuan;ZHAN Yijun;PEI Jian;WU Shengnan;WENG Xiaochen;SHUAI Wen(Longhua Hospital Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Shanghai First Maternity and Infant Hospital,Tongji University,Shanghai 201203,China)
出处
《上海针灸杂志》
2022年第11期1077-1083,共7页
Shanghai Journal of Acupuncture and Moxibustion
基金
上海市中医药新型交叉学科资助计划项目(shxxjcxk201709)
国家自然科学基金青年项目(81804129)
上海市卫生健康委员会中医药科研项目(2020LQ015)
上海市综合医院中西医结合专项(ZHYY-ZXYJHZX-202106)
。
关键词
温针疗法
针药并用
宫腔粘连
宫腔粘连分解术
雌-孕激素序贯疗法
子宫内膜
不育
女性
Needle-warming therapy
Acupuncture medication combined
Intrauterine adhesion
Transcervical resection of adhesion
Estrogen-progestin sequential therapy
Endometrium
Infertility,female
