张鸢　蒋惠瑜

摘要 目的：使用加味桂枝茯苓湯治疗子宫内膜异位症不孕的患者，观察临床疗效及妊娠结局，同时试对其相关治疗机制进行探讨分析。方法：选取2016年1月至2017年1月海南医学院附属第二医院收治的子宫内膜异位症不孕的患者98例，按照随机数字表法随机分为观察组和对照组，每组49例。对照组使用孕三烯酮口服治疗，观察组在此基础之上加以加味桂枝茯苓汤口服治疗，2组疗程3个月。在治疗结束后观察2组患者的临床疗效，同时对2组患者血管内皮生长因子（VEGF）、卵泡刺激素（FSH）、黄体生成素（LH）、血清雌二醇（E2）、孕酮（P）、肿瘤坏死因子-α（TNF-α）和糖类抗原125（CA125）的含量进行分析，同时对2组患者进行为期12个月的电话随访，比较各组患者的妊娠结局。结果：1）治疗后对照组的总有效率为71.43%，观察组的总有效率为91.84%，观察组明显优于对照组（P<0.05）；2）2组患者治疗后FSH、LH、E2、P水平均较治疗前明显下降（P>0.05）；与对照组比较，治疗后2组FSH、LH水平差异无统计学意义（P>0.05），而观察组E2、P下降程度优于对照组（P<0.05）；3）2组患者血清内VEGF、CA125、TNF-α水平均明显降低（P<0.05），且观察组优于对照组（P<0.05）；4）在对2组患者的随访显示，在1年内，对照组中有23例成功妊娠（妊娠率46.94%），观察组中38例成功妊娠（妊娠率77.55%），观察组明显优于对照组（P<0.05）。结论：加味桂枝茯苓汤可以有效改善子宫内膜异位症不孕患者的临床症状，提高其妊娠率，这可能与其可调节患者体内激素及细胞因子水平有关。

关键词 加味桂枝茯苓汤；子宫内膜异位症；不孕；VEGF；CA125、TNF-α；性激素；机制

Abstract Objective：To observe the clinical efficacy and pregnancy outcomes and to try to explore and analyze the related mechanism of treatment by treating endometriosis infertility patients with modified Guizhi Fuling Decoction.Methods：A total of 98 patients with endometriosis infertility treated in the Second Affiliated Hospital of Hainan Medical University from January 2016 to January 2017 were selected and randomly divided into the observation group and the control group，with 49 cases in each group.The control group was treated with gestrinone orally while the observation group was given Guizhi Fuling Decoction on the basis of the same treatment.The treatment course of both groups was 3 months.The clinical efficacy of 2 groups of patients was observed after the treatment，and the contents of vascular endothelial growth factor （VEGF），follicle stimulating hormone （FSH），luteinizing hormone （LH），serum estradiol （E2），progesterone （P），tumor necrosis factor-alpha （TNF-a） and carbohydrate antigen 125 （CA125） in both groups were analyzed.A 12-month telephone follow-up was performed on both groups to compare the pregnancy outcomes of each group.Results：The total effective rate of the control group was 71.43%，and the total effective rate of the observation group was 91.84%.The rate of observation group was obviously superior to the control group （P<0.05），and the levels of FSH，LH，E2 and P in both groups were significantly decreased after the treatment （P>0.05）.Compared with the control group，there was no significant difference in the levels of FSH and LH between the 2 groups after treatment （P>0.05），and the E2 and P in the observation group decreased more than that of the control group （P<0.05）.The levels of VEGF，CA125 and TNF-α in the serum of both groups significantly decreased （P<0.05），and the observation group decreased more than the control group （P<0.05）.In both groups of patients，23 patients in the control group had a successful pregnancy in 1 year （pregnancy rate 46.94%），and 38 patients in the observation group had a successful pregnancy （pregnancy rate 77.55%）.The pregnancy rate of observation group was better than the control group （P<0.05）.Conclusion：Jiawei Guizhi Fuling Decoction can effectively improve the clinical symptoms of infertile patients with endometriosis and improve their pregnancy rate，which may be related to the regulation of hormone and cytokine levels in the patients.

Key Words Modified Guizhi Fuling Decoction； Endometriosis； Infertility； VEGF； CA125，TNF-α； Sex hormone； Mechanism

中图分类号：R271.14文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.09.029

子宫内膜异位症（Endometriosis，EMS）是育龄期妇女多发病，正常生理状态下有生长能力的子宫内膜组织是在子宫腔被覆黏膜的部位生长的，当这一有生长能力的子宫内膜组织在子宫腔被覆黏膜以外的部位生长，则称之为子宫内膜异位。EMS的主要临床表现为痛经、不孕等。目前研究显示EMS在育龄女性的发病率中约为7%～50%[1]，而这部分患有EMS的女性中不孕的发生率是未患有EMS女性的20倍[2]，而其中36%～87%的内膜异位于卵巢[3]。在E……