摘要
目的:观察祛湿活血组合方法联合输卵管加压再通术治疗输卵管阻塞性不孕症的临床疗效。方法:本研究纳入2019年8月—2022年10月苏州大学附属张家港医院收治的输卵管阻塞性不孕症(湿热瘀阻型)患者80例,按照患者是否采用祛湿活血组合方法指导用药将80例患者分成对照组和祛湿活血组,每组40例。两组均于输卵管造影过程中行加压再通术治疗,术后均口服罗红霉素3 d预防感染,对照组术后未采取祛湿活血组合方法指导用药,祛湿活血组术后采用祛湿活血组合方法指导用药。评估两组中医症状评分,检测两组卵巢动脉阻力指数(RI)、搏动指数(PI)及前列腺素E2(PGE2)、白细胞介素-6(IL-6)等相关因子的差异,比较两组人绒毛膜促性腺激素(HCG)日子宫内膜厚度和卵巢直径,统计两组停药半年妊娠率。结果:祛湿活血组治疗结束后下腹疼痛、带下量多、神疲乏力、腰骶酸痛、经期腹痛加重、月经不调、纳呆、大便溏或燥结、小便黄评分较治疗前下降,差异有统计学意义(P<0.05);对照组周期结束后中医症状评分与治疗前比较,差异未见统计学意义(P>0.05);祛湿活血组周期结束后中医症状评分低于对照组,差异有统计学意义(P<0.05)。祛湿活血组周期结束后卵巢动脉RI、PI均较治疗前下降,差异有统计学意义(P<0.05);对照组周期结束后卵巢动脉RI、PI与治疗前比较,差异未见统计学意义(P>0.05);祛湿活血组周期结束后卵巢动脉RI、PI低于对照组,差异有统计学意义(P<0.05)。祛湿活血组周期结束后HCG日子宫内膜厚度、卵巢直径均较治疗前升高,差异有统计学意义(P<0.05);对照组周期结束后子宫内膜厚度、卵巢直径与治疗前比较,差异未见统计学意义(P>0.05);祛湿活血组周期结束后HCG日子宫内膜厚度、卵巢直径高于对照组,差异有统计学意义(P<0.05)。两组周期结束后PGE2、干扰素-γ(IFN-γ)、白细胞介素-6(IL-6)较治疗前下降,差异有统计学意义(P<0.05);祛湿活血组周期结束后PGE2、IFN-γ、IL-6低于对照组,差异有统计学意义(P<0.05)。祛湿活血组停药半年妊娠率为67.5%(27/40),高于对照组的37.50%(15/40),差异有统计学意义(P<0.05)。结论:祛湿活血组合方法联合输卵管再通术治疗输卵管阻塞性不孕症可抑制炎症因子的表达,改善输卵管周围的血液供应,提高输卵管的通畅性,从而提高妊娠率。
Objective:To observe the clinical efficacy of the dampness-expelling and blood-activating combination therapy combined with fallopian tube recanalization in treating fallopian tube obstructive infertility.Methods:This study included 80 patients diagnosed with fallopian tube obstructive infertility(damp-heat obstructive type)who were treated at Zhangjiagang Hospital Affiliated to Soochow University from August 2019 to October 2022.Patients were randomly divided into two groups based on whether they received the dampness-expelling and blood-activating combination therapy:the control group and the dampness-expelling and blood-activating group,with 40 patients in each group.Both groups underwent compression recanalization of fallopian tube during hysterosalpingography,followed by 3 days of oral roxithromycin to prevent infection.The control group did not receive the dampness-expelling and blood-activating combination therapy,while the dampness-expelling and blood-activating group received this therapy post-operatively.The two groups were evaluated for traditional Chinese medicine(TCM)symptom scores,differences in ovarian arterial resistance index(RI),pulsatility index(PI),prostaglandin E2(PGE2),interleukin-6(IL-6),and other related factors.Additionally,uterine endometrial thickness and ovarian diameter were compared on the day of human chorionic gonadotropin(HCG)administration,and pregnancy rates after six months of treatment were statistically analyzed.Results:After treatment,the dampness-expelling and blood-activating group showed significant reductions in symptoms such as lower abdominal pain,increased leucorrhea,fatigue,sacral pain,worsened menstrual pain,irregular menstruation,poor appetite,loose or hard stools,and yellow urine,with statistically significant differences(P<0.05).In contrast,the control group did not show significant changes in TCM symptom scores(P>0.05).The dampness-expelling and blood-activating group had significantly lower TCM symptom scores compared to the control group(P<0.05).The ovarian arterial RI and PI were significantly reduced in the dampness-expelling and blood-activating group compared to before treatment(P<0.05),while there was no significant change in the control group(P>0.05).Furthermore,the dampness-expelling and blood-activating group had significantly lower RI and PI compared to the control group(P<0.05).Endometrial thickness and ovarian diameter on the day of HCG administration were significantly increased in the dampness-expelling and blood-activating group(P<0.05),whereas no significant changes were observed in the control group(P>0.05).The dampness-expelling and blood-activating group had significantly higher endometrial thickness and ovarian diameter compared to the control group(P<0.05).After treatment,PGE2,interferon-gamma(IFN-γ),and IL-6 levels decreased significantly in both groups(P<0.05),with the dampness-expelling and blood-activating group showing lower levels compared to the control group(P<0.05).The pregnancy rate six months after stopping treatment was 67.5%in the dampness-expelling and blood-activating group,which was significantly higher than 37.50%in the control group(P<0.05).Conclusion:The combination of dampness-expelling and blood-activating therapy with compression recanalization of fallopian tube can inhibit the expression of inflammatory factors,improve blood supply around the fallopian tubes,enhance tubal patency,and increase pregnancy rates.
作者
孙叶
顾银银
彭静微
曹丹丹
SUN Ye;GU Yinyin;PENG Jingwei;CAO Dandan(Department of Traditional Chinese Medicine,Zhangjiagang Hospital Affiliated to Soochow University,Suzhou 215600,China)
出处
《中医药学报》
CAS
2024年第11期77-82,共6页
Acta Chinese Medicine and Pharmacology
基金
江苏省自然科学基金项目(BK20201080)。
关键词
祛湿活血
输卵管再通术
输卵管阻塞性不孕症
炎症因子
妊娠
Dampness-expelling and blood-activating
Fallopian tube recanalization
Fallopian tube obstructive infertility
Inflammatory factors
Pregnancy
作者简介
孙叶(1985-),女,副主任中医师,主要从事中医妇科相关研究工作;通讯作者:顾银银(1987-),女,硕士,副主任中医师,主要从事中医妇科相关研究工作。
