林　晶　赵珊琼

宁波市中医院妇科，浙江宁波315010

滋肾凉血调周法对子宫内膜异位症合并不孕患者血清及内膜VEGF表达的影响

林晶赵珊琼▲

宁波市中医院妇科，浙江宁波315010

目的通过观察中药滋肾凉血调周法对子宫内膜异位症合并不孕患者的血清及在位内膜VEGF水平的影响，探讨中药滋肾凉血调周法提高子宫内膜容受性的作用机制。方法选取120例内异症合并不孕患者，随机单盲分为中药组60例和西药组60例。中药组：轻度患者术后第一次月经来潮开始中药口服；中重度患者术后月经第一天皮下注射GnRH-a，隔28 d一次，共三针，第三针后30 d开始服用中药。西药组：轻度患者术后观察6个月经周期；中重度患者术后月经第一天皮下注射GnRH-a，隔28 d一次，共三针。采用ELISA方法检测中药滋肾凉血调周法治疗60例内异症合并不孕患者的前后血清VEGF水平及在位内膜VEGF阳性表达。结果治疗后中药组的血清VEGF水平及在位内膜VEGF阳性表达低于西药组，差异有统计学意义（P＜0.05）。结论中药滋肾凉血调周法可以明显降低EMT患者的血清VEGF水平及在位内膜VEGF阳性表达，提高子宫内膜容受性。

滋肾凉血；子宫内膜异位症；不孕；VEGF

［Abstract］Objective To discuss the mechanism of TCM nourishing kidney cooling blood and regulating menstrual cycle method in improvement of endometrial receptivity by observing the influence of nourishing kidney cooling blood and regulating menstrual cycle method on serum and endometrial VEGF expression in patients with endometriosis combined with infertility.Methods 120 patients with endometriosis combined with infertility were selected and randomly and single-blindly divided into the TCM group and the western medicine group，each with 60 cases.Patients with mild symptoms in the TCM group were orally given TCM since first menstruation after operation，and those with middle to severe symptoms were subcutaneously injected with GnRH-a at the first day of menstruation，once for 28 days，three times in total，and were orally given TMC at 30 days after the third injection.Patients with mild symptoms in the western medicine group were observed for 6 cycles of menstruation，and those with middle to severe symptoms were subcutaneously injected with GnRH-a at the first day of menstruation，once for 28 days，three times in total.The serum VEGF level and positive expression of VEGF in ednometrium before and after treatment were detected by EISIA.Results The serum VEGF level and positive expression of VEGF in ednometrium after treatment were significantly lower in the TCM group than that in the western medicine group（P＜0.05）.Conclusion The TCM nourishing kidney cooling blood and regulating menstrual cycle method can significantly lower the serum VEGF level and positive expression of VEGF in ednometrium in EMT patients and improve the endometrial receptivity.

［Key words］Nourishing kidney and cooling blood；Endometriosis；Infertility；VEGF子宫内膜异位症（endometriosis，EMS）是一种与不孕密切相关的妇科疑难病。发病率在一般人群中约为1%～10%，在不孕妇女中高达30%～40%，而子宫内膜异位症患者中不孕的发病率为30%～50%［1］。生育期EMS虽为良性病变，但与恶性疾病有相似的特征，其最明显的特征是具有组织侵袭和血管生成能力［2］，引起体内免疫机制的改变，从而改变子宫内膜环境，不利于妊娠［3］。……