温经汤对寒凝血瘀型原发性痛经的疗效及部分机制探讨
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摘要
目的:分析温经汤对寒凝血瘀型原发性痛经患者临床疗效,及对患者炎性反应因子、子宫动脉血流动力学、内分泌指标的影响,为寒凝血瘀型原发性痛经治疗方案选择提高参考。方法:选取2014年9月至2017年11月北京市回民医院收治的寒凝血瘀型原发性痛经患者84例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组42例。2组患者均采用常规西药解痉、镇痛药及前列腺素合成酶抑制剂治疗,观察组在常规治疗基础上加用温经汤治疗。2组患者均连续治疗3个月经周期为1个疗程。比较2组患者治疗前、后疼痛评分、炎性反应因子(肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6、)、单核细胞趋化蛋白-1(MCP-1)、高敏C-反应蛋白(hs-CRP)、子宫动脉血流动力学(子宫动脉搏动指数、阻力指数、收缩期峰值/舒张期峰值)及内分泌指标(前列腺素(PGs)、催产素(OT)、雌二醇(E2)、血管加压素(AVP))。对2组患者完成治疗后进行临床疗效判定并比较总有效率。收集治疗过程中2组患者药物不良反应情况并比较。结果:1)完成治疗后对照组、观察组痛经积分分别为(9. 66±2. 14)分、(8. 73±1. 93)分,均明显低于治疗前(11. 27±2. 31)分、(11. 31±2. 28)分,且观察组明显低于对照组,观察组临床总有效率明显高于对照组(P <0. 05); 2)完成治疗后,2组患者TNF-α、IL-6、MCP-1、hs-CRP较治疗前均明显降低,且观察组明显低于对照组(P <0. 05); 3)完成治疗后2组患者子PI、RI、S/D均较治疗前明显降低,且观察组低于对照组(P <0. 05); 4)完成治疗后,2组患者OT、E2、AVP均较治疗前明显降低,且观察组低于对照组,PGE_2较治疗前明显升高,且观察组高于对照组(P <0. 05); 5) 2组患者治疗过程中药物不良反应率比较,差异无统计学意义(P> 0. 05)。结论:温经汤可有效改善寒凝血瘀型原发性痛经患者的疼痛程度,降低患者炎性反应状态,促进内分泌趋向平衡,促进子宫动脉血流动力学水平,达到减轻疼痛的临床效果,且安全性高,具有较高的临床价值。
Objective: To analyze the clinical effects of Wenjing Decoction on primary dysmenorrhea of cold blood coagulation and stasis syndrome,and its influence on inflammatory factors,uterine artery hemodynamics and endocrine indexes,so as to improve the reference for the treatment of primary dysmenorrhea of cold blood coagulation and stasis type. Methods: From September 2014 to November 2017,84 patients with primary dysmenorrhea of cold coagulation and blood stasis syndrome were selected as subjects.They were randomly divided into a control group and an observation group,with 42 cases in each group. Two groups of patients were treated with conventional western medicine spasmolysis,analgesics and prostaglandin synthase inhibitors,the observation group added Wenjing Decoction treatment on the basis of conventional treatment. Two groups of patients were treated for 3 consecutive menstrual cycles for a course of treatment. The pain scores,inflammatory factors( tumor necrosis factor-alpha( TNF-alpha),interleukin-6( IL-6,),monocyte chemoattractant protein-1( MCP-1),high-sensitivity C-reactive protein( hs-CRP),uterine artery hemodynamics( uterine artery pulsation index,resistance index,systolic peak/diastolic peak) and endocrine indexes(( prostaglandin( PGs),oxytocin( OT),estradiol( E2),vasopressin( AVP)) were compared between the 2 groups before and after treatment. The clinical efficacy of the 2 groups of patients after completion of treatment was determined,and the total effective rate was compared. The adverse drug reactions of the 2 groups were collected and compared. Results: 1) After treatment,the dysmenorrhea scores of the control group and the observation group were( 9. 66 ± 2. 14) and( 8. 73 ± 1. 93) respectively,which were significantly lower than those before treatment( 11. 27 ± 2. 31) and( 11. 31 ± 2. 28). The total effective rate of the observation group was significantly higher than that of the control group( P < 0. 05). 2) After treatment,TNF-α,IL-6,MCP-1,hs-CRP in both groups were significantly decreased than before treatment,and the observation group was significantly lower than the control group( P < 0. 05). 3) After completion of treatment,the PI,RI and S/D of the 2 groups were significantly decrased than those before treatment,and the observation group was lower than the control group( P < 0. 05). 4) After completion of treatment,OT,E2 and AVP were significantly decreased in the 2 groups than before treatment. The observation group was lower than the control group. PGE2 was significantly increased than that before treatment,and the observation group was higher than the control group( P < 0. 05). 5) There was no significant difference in the adverse drug reactions between the 2 groups( P > 0. 05). Conclusion: Wenjing Decoction can effectively improve the degree of pain in patients with primary dysmenorrhea of cold coagulation and stasis syndrome,reduce inflammation,promote endocrine balance,promote uterine artery hemodynamics,and achieve the clinical effect of relieving pain. It has high safety and high clinical value.
Objective: To analyze the clinical effects of Wenjing Decoction on primary dysmenorrhea of cold blood coagulation and stasis syndrome,and its influence on inflammatory factors,uterine artery hemodynamics and endocrine indexes,so as to improve the reference for the treatment of primary dysmenorrhea of cold blood coagulation and stasis type. Methods: From September 2014 to November 2017,84 patients with primary dysmenorrhea of cold coagulation and blood stasis syndrome were selected as subjects.They were randomly divided into a control group and an observation group,with 42 cases in each group. Two groups of patients were treated with conventional western medicine spasmolysis,analgesics and prostaglandin synthase inhibitors,the observation group added Wenjing Decoction treatment on the basis of conventional treatment. Two groups of patients were treated for 3 consecutive menstrual cycles for a course of treatment. The pain scores,inflammatory factors( tumor necrosis factor-alpha( TNF-alpha),interleukin-6( IL-6,),monocyte chemoattractant protein-1( MCP-1),high-sensitivity C-reactive protein( hs-CRP),uterine artery hemodynamics( uterine artery pulsation index,resistance index,systolic peak/diastolic peak) and endocrine indexes(( prostaglandin( PGs),oxytocin( OT),estradiol( E2),vasopressin( AVP)) were compared between the 2 groups before and after treatment. The clinical efficacy of the 2 groups of patients after completion of treatment was determined,and the total effective rate was compared. The adverse drug reactions of the 2 groups were collected and compared. Results: 1) After treatment,the dysmenorrhea scores of the control group and the observation group were( 9. 66 ± 2. 14) and( 8. 73 ± 1. 93) respectively,which were significantly lower than those before treatment( 11. 27 ± 2. 31) and( 11. 31 ± 2. 28). The total effective rate of the observation group was significantly higher than that of the control group( P < 0. 05). 2) After treatment,TNF-α,IL-6,MCP-1,hs-CRP in both groups were significantly decreased than before treatment,and the observation group was significantly lower than the control group( P < 0. 05). 3) After completion of treatment,the PI,RI and S/D of the 2 groups were significantly decrased than those before treatment,and the observation group was lower than the control group( P < 0. 05). 4) After completion of treatment,OT,E2 and AVP were significantly decreased in the 2 groups than before treatment. The observation group was lower than the control group. PGE2 was significantly increased than that before treatment,and the observation group was higher than the control group( P < 0. 05). 5) There was no significant difference in the adverse drug reactions between the 2 groups( P > 0. 05). Conclusion: Wenjing Decoction can effectively improve the degree of pain in patients with primary dysmenorrhea of cold coagulation and stasis syndrome,reduce inflammation,promote endocrine balance,promote uterine artery hemodynamics,and achieve the clinical effect of relieving pain. It has high safety and high clinical value.
引文
[1]万安霞,明琳琳.加味温经汤治疗寒凝血瘀型原发性痛经临床观察[J].湖南中医药大学学报,2018,38(7):798-800.
[2]刘瑜,高修安,卿璐芝.中药内外合治原发性痛经寒凝血瘀型临床观察[J].实用中医药杂志,2018,34(6):657-658.
[3]叶璐,都乐亦,吴昆仑.温通散神阙穴敷贴治疗寒凝血瘀型原发性痛经的疗效及作用机制研究[J].上海中医药杂志,2018,52(5):51-54.
[4]王蔚文.临床疾病诊断与疗效判定标准[S].北京:科学文献技术出版社,2010.
[5]中国中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994.
[6]张惠.中医药治疗寒凝血瘀型原发性痛经45例[J].中国民族民间医药,2017,26(22):112-113.
[7]张彦,袁海光.温经化瘀止痛方联合艾灸治疗原发性痛经疗效观察[J].四川中医,2017,35(11):165-167.
[8]马青.温经化瘀止痛法调控T细胞亚群分化治疗原发性痛经的机制以及原发性痛经现代文献用药规律的研究[D].济南:山东中医药大学,2017.
[9]仰漾,葛华,许小凤.少腹逐瘀汤合四逆汤治疗寒凝血瘀型痛经43例临床观察[J].江苏中医药,2014,46(9):39-40.
[10]苏芳静.温经汤加减联合艾灸治疗寒凝血瘀型原发性痛经的临床疗效观察[J].中国实用医药,2017,12(11):149-150.
[11]杨石慧.自拟温经活血饮联合艾灸治疗寒凝血瘀型原发性痛经效果观察[J].中国乡村医药,2016,23(24):45-46.
[12]刘亚琴.温经活血方口服加外敷治疗寒凝血瘀型原发性痛经临床疗效观察[J].内蒙古中医药,2016,35(16):44-45.
[13]徐冬艳.痛经贴治疗寒凝血瘀型原发性痛经疗效观察[J].山西中医,2016,32(11):44-45.
[14]主苏云,李信春,马金琼.温宫活血汤治疗寒凝血瘀型原发性痛经的临床观察[J].湖北中医药大学学报,2016,18(4):21-24.
[15]黄竞萱.口服中药、穴位贴敷治疗原发性痛经的研究进展[J].中国社区医师,2016,32(14):9,11.
[16]蒋雪霞,陈红,邓选碧,等.痛经方结合砭石疗法治疗寒凝血瘀型原发性痛经的临床研究[J].中医临床研究,2016,8(14):63-65.
[17]渠艳芳,王金平,张晋峰.原发性痛经的中医药研究进展[J].光明中医,2016,31(2):299-301.
[18]郤书颖.中医综合治疗寒凝血瘀型原发性痛经40例[J].河南中医,2016,36(1):138-139.
[19]贺冰.温经汤联合消炎贴穴位贴敷治疗寒凝血瘀型原发性痛经50例临床观察[J].湖南中医杂志,2018,34(3):70-72.
[20]甘华婵,林锦璇,曹立幸.温经汤治疗寒凝血瘀型原发性痛经Meta分析[J].辽宁中医药大学学报,2018,20(3):65-68.
[2]刘瑜,高修安,卿璐芝.中药内外合治原发性痛经寒凝血瘀型临床观察[J].实用中医药杂志,2018,34(6):657-658.
[3]叶璐,都乐亦,吴昆仑.温通散神阙穴敷贴治疗寒凝血瘀型原发性痛经的疗效及作用机制研究[J].上海中医药杂志,2018,52(5):51-54.
[4]王蔚文.临床疾病诊断与疗效判定标准[S].北京:科学文献技术出版社,2010.
[5]中国中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994.
[6]张惠.中医药治疗寒凝血瘀型原发性痛经45例[J].中国民族民间医药,2017,26(22):112-113.
[7]张彦,袁海光.温经化瘀止痛方联合艾灸治疗原发性痛经疗效观察[J].四川中医,2017,35(11):165-167.
[8]马青.温经化瘀止痛法调控T细胞亚群分化治疗原发性痛经的机制以及原发性痛经现代文献用药规律的研究[D].济南:山东中医药大学,2017.
[9]仰漾,葛华,许小凤.少腹逐瘀汤合四逆汤治疗寒凝血瘀型痛经43例临床观察[J].江苏中医药,2014,46(9):39-40.
[10]苏芳静.温经汤加减联合艾灸治疗寒凝血瘀型原发性痛经的临床疗效观察[J].中国实用医药,2017,12(11):149-150.
[11]杨石慧.自拟温经活血饮联合艾灸治疗寒凝血瘀型原发性痛经效果观察[J].中国乡村医药,2016,23(24):45-46.
[12]刘亚琴.温经活血方口服加外敷治疗寒凝血瘀型原发性痛经临床疗效观察[J].内蒙古中医药,2016,35(16):44-45.
[13]徐冬艳.痛经贴治疗寒凝血瘀型原发性痛经疗效观察[J].山西中医,2016,32(11):44-45.
[14]主苏云,李信春,马金琼.温宫活血汤治疗寒凝血瘀型原发性痛经的临床观察[J].湖北中医药大学学报,2016,18(4):21-24.
[15]黄竞萱.口服中药、穴位贴敷治疗原发性痛经的研究进展[J].中国社区医师,2016,32(14):9,11.
[16]蒋雪霞,陈红,邓选碧,等.痛经方结合砭石疗法治疗寒凝血瘀型原发性痛经的临床研究[J].中医临床研究,2016,8(14):63-65.
[17]渠艳芳,王金平,张晋峰.原发性痛经的中医药研究进展[J].光明中医,2016,31(2):299-301.
[18]郤书颖.中医综合治疗寒凝血瘀型原发性痛经40例[J].河南中医,2016,36(1):138-139.
[19]贺冰.温经汤联合消炎贴穴位贴敷治疗寒凝血瘀型原发性痛经50例临床观察[J].湖南中医杂志,2018,34(3):70-72.
[20]甘华婵,林锦璇,曹立幸.温经汤治疗寒凝血瘀型原发性痛经Meta分析[J].辽宁中医药大学学报,2018,20(3):65-68.