红藤合剂灌肠联合输卵管通液术治疗输卵管阻塞性不孕的临床疗效及对盆腔局部微环境的影响

Influence of Hongteng mixture combined with tubal ablation on local microenvironment of pelvic cavity with tubal obstructive infertility

摘要:

目的 评价红藤合剂灌肠联合输卵管通液术治疗对输卵管阻塞性不孕的临床疗效及对盆腔局部微环境的影响。方法 选取2019年5月—2020年9月海南省中医院140例输卵管阻塞性不孕患者作为研究对象，按照随机数字表法分为对照组和观察组，每组70例。对照组采用输卵管通液术治疗；观察组在对照组治疗的基础上给予红藤合剂灌肠。3个月后行子宫输卵管造影检查，比较两组输卵管再通情况；随访12个月，比较两组妊娠情况和复发情况；对所有患者进行治疗前后中医症候和局部体征评分；比较两组子宫内膜厚度和子宫内膜类型、子宫内膜动脉阻力指数（RI）、搏动指数（PI）及血管化血流指数（VFI）；检测治疗前后宫腔液白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、转化生长因子-β₁（TGF-β₁）及结缔组织生长因子（CTGF）水平；检测治疗前后月经血趋化因子1（CXCL1）、趋化因子13（CXCL13）、IL-6及TNF-α水平；对所有患者行安全性评价。结果 治疗后，观察组输卵管再通率为76.19%（48/63），高于对照组的58.06%（36/62）（P <0.05）。12个月随访期间，观察组妊娠率为70.83%（34/48），高于对照组的44.44%（16/36）（P <0.05）；观察组复发率为12.50%（6/48），低于对照组的30.56%（11/36）（P <0.05）。治疗后两组患者中医症候和局部体征评分较治疗前均降低（P <0.05），且观察组评分低于对照组（P <0.05）。治疗后两组患者子宫内膜厚度、A型子宫内膜类型比例及VFI增加（P <0.05），RI和PI较治疗前降低（P <0.05），且观察组VFI高于对照组，RI和PI低于对照组（P <0.05）。治疗后两组患者宫腔液IL-6、TNF-α、TGF-β₁及CTGF水平较治疗前降低（P <0.05），且观察组低于对照组（P <0.05）。治疗后两组患者月经血CXCL1、CXCL13、IL-6及TNF-α水平较治疗前降低（P <0.05），且观察组低于对照组（P <0.05）。研究期间未发现与使用红藤合剂灌肠相关的不良反应。结论 红藤合剂灌肠联合输卵管通液术治疗输卵管阻塞性不孕可减轻临床症状，改善局部微循环和局部微环境，提高输卵管再通率和临床妊娠率，并降低复发率，临床使用安全。

关键词:输卵管阻塞;不孕;红藤合剂;局部微环境;子宫内膜容受性;趋化因子;转化生长因子-β₁;结缔组织生长因子;炎症因子

Abstract:

Objective To evaluate the clinical efficacy of Hongteng mixture enema combined with tubal fluidization in the treatment of tubal obstructive infertility and its impact on the local microenvironment of the pelvis.Method The 140 patients were randomly divided into observation group and control group, 70 cases in each group. The control group was treated with salpingectomy. The observation group was given Hongteng mixture enema on the basis of the treatment of the control group. All patients had been observed for 3 months and performed a hysterosalpingogram. Tubal recanalization after treatment was compared between two groups. Patients with recanalization were followed up for 12 months to compare pregnancy and recurrence. Comparisons of TCM symptoms, local signs before and after treatment, endometrial thickness, endometrial type, endometrial arterial resistance index (RI), pulsatility index (PI), and vascularized flow index (VFI) were performed. The levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), transforming growth factor-β₁ (TGF-β₁), and connective tissue growth factor (CTGF) in uterine fluid before and after treatment were detected. Menstrual blood chemokine 1 (CXCL1), CXCL13, IL-6, and TNF-α levels before and after treatment were detected. Safety evaluation was conducted.Result After treatment, the recanalization rate of fallopian tubes in the observation group was 76.19% (48/63), which was higher than 58.06% (36/62) in the control group (P < 0.05). During the one-year follow-up period, the pregnancy rate in the observation group was 70.83% (34/48), which was higher than that in the control group, which was 44.44% (16/36) (P < 0.05). The recurrence rate in the observation group was 12.50% (6/48), which was lower than 30.56% (11/36) in the control group (P < 0.05). After treatment, the scores of TCM symptoms and local signs in the two groups were significantly decreased (P < 0.05), and the data in observation group was lower than that in control group (P < 0.05). After treatment, the endometrial thickness, the proportion of type A endometrial and VFI in the two groups increased (P < 0.05), while the RI and PI decreased (P < 0.05). The VFI in the observation group was higher than that in the control group, while the RI and PI were lower than those in the control group (P < 0.05). After treatment, the levels of IL-6, TNF-α, TGF-β₁ and CTGF in the uterine fluid of the two groups of patients were decreased (P < 0.05), and the levels were lower than those in the control group (P < 0.05). After treatment, the menstrual blood levels of CXCL1, CXCL13, IL-6 and TNF-α in the two groups were significantly decreased (P < 0.05), and the observation group was lower than the control group (P < 0.05). No adverse reactions related to the use of Hongteng mixture enema were found during this study.Conclusion Hongteng mixture enema combined with tubal cannulation in the treatment of TOI can relieve clinical symptoms, improve local microcirculation and local microenvironment, increase tubal recanalization rate and clinical pregnancy rate, and reduce recurrence rate. It was safe for clinical use.

Key words:fallopian tube obstruction;infertility;Hongteng mixture;local microenvironment;endometrial receptivity;chemokines;transforming growth factor beta 1;connective tissue growth factor;inflammatory factors