丹归祛瘀丸联合针刺治疗子宫腺肌病的疗效观察

doi:10.11958/20250601

摘要/Abstract

摘要：

目的探究丹归祛瘀丸联合针刺治疗子宫腺肌病（ADS）的疗效及对血清血管内皮生长因子（VEGF）,糖类抗原（CA）199、CA125水平的影响。方法选取120例ADS患者，随机均分为对照组（针刺治疗）和治疗组（丹归祛瘀丸联合针刺治疗）各60例。采用疼痛视觉模拟量表（VAS）评估患者治疗前及治疗6个月的痛经程度；评估中医症候积分；入组当日、治疗6个月（避免经期）彩超检测子宫体积；酶联免疫吸附试验（ELISA）检测VEGF、CA199、CA125水平；观察并记录患者的不良反应和复发情况。结果治疗组总有效率高于对照组（P<0.05）；治疗后2组的VAS评分、中医症候积分、月经量、子宫体积，血清VEGF、CA199、CA125水平均较治疗前降低，且治疗组较对照组更低（P<0.05）。2组间总不良反应发生率的差异无统计学意义；治疗组复发率低于对照组（P<0.05）。结论丹归祛瘀丸联合针刺对治疗ADS效果显著，安全性高。

关键词: 子宫腺肌病, 针刺疗法, CA-125抗原, 丹归祛瘀丸, CA199抗原, 血管内皮生长因子类

Abstract:

Objective To explore the therapeutic effect of Dangui Quyu Pill combined with acupuncture on adenomyosis (ADS) and its influences on serum levels of vascular endothelial growth factor (VEGF) and carbohydrate antigen 199 and 125 (CA199, CA125). Methods A total of 120 ADS patients were randomly divided into the control group (treated with acupuncture) and the treatment group (treated with Dangui Quyu Pills combined with acupuncture), with 60 cases in each group. The degree of dysmenorrhea before treatment and 6 months after treatment was evaluated by Visual Analogue Scale (VAS). Traditional Chinese Medicine (TCM) syndrome score was conducted. Uterine volume was detected by color Doppler ultrasound on the day of enrollment and 6 months after treatment (avoiding the menstrual period). Levels of VEGF, CA199 and CA125 were detected by ELISA before treatment and 6 months after treatment. The adverse reactions and recurrence of patients were observed and recorded. Results The total effective rate was higher in the treatment group than that of the control group (P<0.05). After treatment, the VAS score, TCM syndrome score, menstrual volume, uterine volume, serum levels of VEGF, CA199 and CA125 were lower in both groups than those before treatment, and the treatment group was even lower than those of the control group (P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups, and the recurrence rate of the treatment group was lower than that of the control group (P<0.05). Conclusion The combination of Dangui Quyu pill and acupuncture has obvious effect and high safety in the treatment of ADS.

Key words: adenomyosis, zhen ci liao fa, CA-125 antigen, Dangui Quyu pill, CA199 antigen, vascular endothelial growth factors

中图分类号:

R711.74

图/表 4

参考文献 23

[1]	陈紫均, 沈宇杰, 廖文静, 等. 子宫腺肌病引发不孕的发病机制及治疗进展[J]. 医学综述, 2024, 30(1):87-92.
	CHEN Z J, SHEN Y J, LIAO W J, et al. Pathogenesis and treatment progress of infertility caused by adenomyosis[J]. Medical Recapitulate, 2024, 30(1):87-92. doi:10.3969/j.issn.1006-2084.2024.01.015.
[2]	DONNEZ J, STRATOPOULOU C A, DOLMANS M M. Uterine adenomyosis:From disease pathogenesis to a new medical approach using GnRH antagonists[J]. Int J Environ Res Public Health, 2021, 18(19):9941. doi:10.3390/ijerph18199941.
[3]	ANTERO M F, AYHAN A, SEGARS J, et al. Pathology and pathogenesis of adenomyosis[J]. Semin Reprod Med, 2020, 38(2):108-118. doi:10.1055/s-0040-1718922.
[4]	何浏铭, 黄剑, 黄菲. 地诺孕素在子宫腺肌病患者高强度超声聚焦治疗后的应用效果及安全性[J]. 临床和实验医学杂志, 2024, 23(24):2636-2640.
	HE L M, HUANG J, HUANG F. Comparison of the effects and safety of dienogest after high-intensity focused ultrasound therapy in patients with uterine adenomyosis[J]. Journal of Clinical and Experimental Medicine, 2024, 23(24):2636-2640. doi:10.3969/j.issn.1671-4695.2024.24.016.
[5]	杨帅, 刘婷. 子宫切除术中采用复合麻醉对患者围术期镇痛及卵巢功能的影响[J]. 陕西医学杂志, 2022, 51(7):803-806.
	YANG S, LIU T. Effect of compound anesthesia in hysterectomy on perioperative analgesia and ovarian function[J]. Shaanxi Medical Journal, 2022, 51(7):803-806. doi:10.3969/j.issn.1000-7377.2022.07.008.
[6]	潘丹, 郎伯旭, 林巧. 针刺联合隔药饼灸周期调治肾虚血瘀型子宫腺肌症疗效观察[J]. 上海针灸杂志, 2020, 39(1):42-46.
	PAN D, LANG B X, LIN Q. Observations on the efficacy of periodic treatment with acupuncture plus herbal cake moxibustion for adenomyosis of kidney deficiency and blood stasis type[J]. Shanghai J Acu-mox, 2020, 39(1):42-46. doi:10.13460/j.issn.1005-0957.2020.01.0042.
[7]	李世大, 陈秀英, 张士表. 针刺联合丹归祛瘀丸治疗子宫腺肌症临床研究[J]. 光明中医, 2023, 38(20):3899-3903.
	LI S D, CHEN X Y, ZHANG S B. Clinical study of acupuncture combined with Danguiquyu pill in the treatment of adenomyosis[J]. Guangming Traditional Chinese Medicine, 2023, 38(20):3899-3903. doi:10.3969/j.issn.1003-8914.2023.20.003.
[8]	温馨, 萨日娜, 宋建东. CA125、MDM2、VEGF、FAK在子宫腺肌症中的表达水平及其意义[J]. 中国医学创新, 2022, 19(24):41-45.
	WEN X, SA R N, SONG J D. Expression and significance of CA125,MDM2,VEGF and FAK in adenomyosis[J]. Medical Innovation of China, 2022, 19(24):41-45. doi:10.3969/j.issn.1674-4985.2022.24.010.
[9]	SHUANG T, WANG Y, ZHAO L, et al. Extremely high serum CA19-9 level along with elevated D-dimer in assisting detection of ruptured ovarian endometriosis[J]. Ann Med, 2022, 54(1):1444-1451. doi:10.1080/07853890.2022.2074534.
[10]	谈勇. 中医妇产科学[M]. 4版. 北京: 中国中医出版社,2016:324-350.
	TAN Y. Obstetrics and Gynecology[M]. 4th ed. Beijing: China Traditional Chinese Medicine Press,2016:324-350.
[11]	国家中医药管理局. 中医病证诊断疗效标准[M]. 南京大学出版社,1994:244-245.
	National Administration of Traditional Chinese Medicine(NATCM). Diagnostic efficacy criteria of TCM syndrome[M]. Nanjing University Press,1994:244-245.
[12]	SUNG Y T, WU J S. The visual analogue scale for rating,ranking and paired-comparison(VAS-RRP):A new technique for psychological measurement[J]. Behav Res Methods, 2018, 50(4):1694-1715. doi:10.3758/s13428-018-1041-8
[13]	郑筱萸. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社,2002:68-69.
	ZHENG X Y. Guiding principles of clinical research of new traditional Chinese medicine(trial implementation)[M]. Beijing: China Medical Science and Technology Press,2002:68-69.
[14]	夏心瑀, 梁艳, 曹世杰, 等. 基于“病因、病位、病性、病势”浅析子宫腺肌症的针灸治疗思路[J]. 中国针灸, 2024, 44(4):455-459.
	XIA X Y, LIANG Y, CAO S J, et al. Treatment ideas of acupuncture and moxibustion for adenomyosis based on "etiology,location natureand development of disease"[J]. Chinese Acupuncture & Moxibustion, 2024, 44(4):455-459. doi:10.13703/j.0255-2930.20230726-k0001.
[15]	ZHAI J, VANNUCCINI S, PETRAGLIA F, et al. Adenomyosis:mechanisms and pathogenesis[J]. Semin Reprod Med, 2020, 38(2/3):129-143. doi:10.1055/s-0040-1716687.
[16]	KHO K A, CHEN J S, HALVORSON L M. Diagnosis,evaluation,and treatment of adenomyosis[J]. JAMA, 2021, 326(2):177-178. doi:10.1001/jama.2020.26436.
[17]	李世大, 陈秀英, 张士表. 丹归祛瘀丸联合醋酸亮丙瑞林治疗子宫腺肌病的临床观察[J]. 中国民间疗法, 2024, 32(1):80-82.
	LI S D, CHEN X Y, ZHANG S B. Clinical observation of Danguiquyu pill combined with leuprolide acetate in the treatment of adenomyosis[J]. China's Naturopathy, 2024, 32(1):80-82. doi:10.19621/j.cnki.11-3555/r.2024.0125.
[18]	侯学思, 赵吉平, 王宁, 等. 针刺治疗子宫腺肌病继发性痛经:前瞻性病例系列研究[J]. 中国针灸, 2020, 40(8):834-838.
	HOU X S, ZHAO J P, WANG N, et al. Acupuncture for secondary dysmenorrhea of adenomyosis: a prospective case-series study[J]. Chinese Acupuncture & Moxibustion, 2020, 40(8):834-838. doi:10.13703/j.0255-2930.20190630-0002.
[19]	王应梅. 针刺法治疗子宫腺肌病的效果观察[J]. 当代医药论丛, 2018, 16(21):188-189.
	WANG Y M. Effect of acupuncture therapy on adenomyosis[J]. Contemporary Medicine Forum, 2018, 16(21):188-189. doi:CNKI:SUN:QYWA.0.2018-21-137.
[20]	田丽颖, 成自霞, 程晓嫚, 等. 针刺治疗子宫腺肌病痛经——随机临床试验(英文)[J]. 世界针灸杂志(英文版), 2022, 32(3):199-203.
	TIAN L Y, CHENG Z X, CHENG X M, et al. Acupuncture for dysmenorrhea of adenomyosis:A randomized clinical trial[J]. World Journal of Acupuncture and Moxibustion, 2022, 32(3):199-203. doi:10.1016/j.wjam.2021.11.004.
[21]	张玉, 王凯平. 当归多糖的研究进展[J]. 中国药学杂志, 2023, 58(12):1065-1073.
	ZHANG Y, WANG K P. Research progress of Angelica sinensis Polysaccharide[J]. Chin Pharm J, 2023, 58(12):1065-1073. doi:10.11669/cpj.2023.12.002.
[22]	杨卜瑞, 贺小芳, 师晶晶, 等. 基于网络药理学分析山慈菇-浙贝母药对治疗乳腺癌的作用机制[J]. 世界中医药, 2021, 16(21):3143-3147.
	YANG B R, HE X F, SHI J J, et al. Study on mechanisms of drug pair of Edible Tulip-Bulbus Fritillariae Thunbergii on the treatment of breast cancer based on network pharmacology[J]. World Chinese Medicine, 2021, 16(21):3143-3147. doi:10.3969/j.issn.1673-7202.2021.21.007.
[23]	黄艺婷, 苏丹, 鲍毅, 等. 青皮的炮制历史沿革,效应物质及古今临方配伍研究进展[J]. 中南药学, 2024, 22(1):186-193.
	HUANG Y T, SU D, BAO Y, et al. Research progress in process evolution,effector substances,and compatibility of Citri reticulatae pericarpium viride[J]. Central South Pharmacy, 2024, 22(1):186-193. doi:10.7539/j.issn.1672-2981.2024.01.029.

组别	n	显效	有效	无效	总有效
对照组	60	15（25.00）	28（46.67）	17（28.33）	43（71.67）
治疗组	60	22（36.67）	32（53.33）	6（10.00）	54（90.00）
χ²					6.508^＊

组别	n	显效	有效	无效	总有效
对照组	60	15（25.00）	28（46.67）	17（28.33）	43（71.67）
治疗组	60	22（36.67）	32（53.33）	6（10.00）	54（90.00）
χ²					6.508^＊

组别	疼痛VAS评分			中医症候积分
组别	治疗前	治疗后	Z	治疗前	治疗后	Z
对照组	7（6，8）	5（4，6）	9.335^＊＊	14（13，16）	6（5，8）	9.566^＊＊
治疗组	7.（6，8）	4（3，5）	9.601^＊＊	14（13，15）	5（4，6）	9.623^＊＊
Z	0.836	6.721^＊＊		0.153	6.651^＊＊

组别	疼痛VAS评分			中医症候积分
组别	治疗前	治疗后	Z	治疗前	治疗后	Z
对照组	7（6，8）	5（4，6）	9.335^＊＊	14（13，16）	6（5，8）	9.566^＊＊
治疗组	7.（6，8）	4（3，5）	9.601^＊＊	14（13，15）	5（4，6）	9.623^＊＊
Z	0.836	6.721^＊＊		0.153	6.651^＊＊

组别	月经量/mL
组别	治疗前			治疗后		t
对照组	95.47±10.23			74.52±8.14		11.648^＊＊
治疗组	97.88±10.17			65.30±7.11		19.368^＊＊
t	1.297			6.607^＊＊
组别		月经周期/d
组别		治疗前			治疗后		t
对照组		28.20±4.47			27.65±3.32		0.725
治疗组		29.25±4.54			28.15±4.01		1.467
t		1.277			0.743
组别			子宫体积/cm³
组别			治疗前		治疗后		t
对照组			155.58±18.36		123.65±13.47		9.926^＊＊
治疗组			157.22±17.89		110.22±12.02		18.046^＊＊
t			0.496		5.762^＊＊