张福云　王文华　陈琳

[摘要] 目的 探讨暖宫七味散治疗原发性痛经寒凝血滞证的作用机制。 方法 选择2014年4月～2016年4月间我院确诊的原发性痛经寒凝血滞证患者122例作为研究对象，随机分为两组。治疗组口服暖宫七味散3 g/次，2次/d；对照组口服芬必得300 mg/次，2次/d。治疗3个月经周期后对比治疗前后两组血清PGF2α、PGE2、PGF2α/PGE2水平及子宫微循环指标和VAS评分。 结果 治疗后，治疗组的血清PGE2水平高于对照组，而PGF2α水平、PGF2α/PGE2则低于对照组，差异有统计学意义（P<0.05）。治疗后，治疗组PI、RI、A/B值均低于对照组，差异有统计学意义（P<0.05）。治疗前后VAS评分在治疗组的差值为（5.15±0.35）分、对照组为（3.93±1.07）分，两组比较差异有统计学意义（P<0.05）。 结论 暖宫七位散能够提高原发性痛经患者血清PGE2水平，降低PGF2α水平、PGF2α/PGE2，改善子宫微循环，提高临床疗效。

[关键词] 暖宫七味散；痛经；寒凝血滞证；PGF2α/PGE2；微循环

[中图分类号] R289.5；R271.11 [文献标识码] A [文章编号] 1673-9701（2017）23-0010-03

[Abstract] Objective To analyze the action mechanism of Nuangong Qiwei powder in Hanning Xuezhi patients with dysmenorrhea. Methods 122 patients who were diagnosed with Hanning Xuezhi of primary dysmenorrhea were collected from April 2014 to April 2016. All patients were randomly divided into two groups. The treatment group was given Nuangong Qiwei powder 3 g orally， twice a day. The control group was given Fenbid 300 mg orally， twice a day. The serum PGF2α， PGE2， PGF2α/PGE2 levels， related indice of uterine mierocireulation and VAS score were detected and compared before and after 3 menstrual periods between two groups. Results After treatment， the serum PGE2 level in the treatment group was higher than that in the control group， and level of serum PGF2α， PGF2α/PGE2 in the treatment group were lower than those in the control group， the differeces were statistically significant（P<0.05）. The PI value， RI value and A/B value of uterine artery in treatment group were lower than those in the control group， the differeces were statistically significant（P<0.05）. The diffence of VAS score before and after treatment in the treatment group was（5.15±0.35） score and the control group was（3.93±1.07） score， the difference was statistically significant between the two groups（P<0.05）. Conclusion Nuangong Qiwei powder can increase the semrum PGE2 level， reduce the serum PGF2α， PGF2α/PGE2 levels in patients with dysmenorrhea， improve the uterine microcirculation and the clinical efficacy.

[Key words] Nuangong Qiwei powder； Dysmenorrhea； Hanning Xuezhi； Prostaglandins F2α/prostaglandin E2； Microcirculation

原發性痛经属中医“痛经”、“经行腹痛”范畴，与冲任二脉、肝脾肾及胞宫关系密切。流行病学表明，原发性痛经的发病率为38.7%～51.2%[1]，我国流行病学显示64.4%的患者因痛经影响日常工作、学习，且痛经发病及影响有明显上升趋势[2]。现代医学认为，子宫肌肉收缩活动增强，子宫张力增加，过度挛缩是原发性痛经发生的主要机制，子宫合成、释放的前列腺素增加是原发性痛经发生的重要原因，其中前列腺素F2α（prostaglandins F2α，PGF2α）过度生成、释放是关键因素[3]。而前列腺素E2（prostaglandin E2，PGE2）则会抑制子宫平滑肌的自发活动，它与PGF2α共同调节着子宫舒缩状态[4]。同时，微循环是细胞、组织、器官信息传递的重要场所，痛经的发生与微循环障碍关系亦紧密[5]。暖宫七味散收载于《卫生部药品标准·蒙药分册》中，用于治疗心、肾“赫依”病所致的小腹冷痛、月经不调、腰痛、白带等，具有调理气血、温经止痛的作用[6]。本次以前瞻性的研究方法，着重观察患者应用暖宫七味散后血中PGF2α、PGE2的水平变化及对子宫微循环的影响，探讨本药的作用机制，从而为临床治疗本病提供更多的参考，现报道如下。……