Effect Of The Compound Rhizoma Curcumae Powder On Expression Of VEGF And RANTES In Endometrium Of Patients With Endometriosis And Clinical Efficacy Observation

Compound Rhizoma curcumae powder is my mentor Professor Cao Baoli developed a effective traditional Chinese medicine granules in the treatment of endometriosis based on "blood stasis" mechanism and years of clinical experience. Early work on the preparation of pharmacodynamic test of rats with endometriosis have been done. We carried out this study on clinical efficacy comparison of compound Rhizoma curcumae powder and clinical experiment to investigate the mechanism of action.Objective1. To observe the therapeutic effects of compound Rhizoma curcumae powder or triptorelin used alone or in combination for consolidation medicine treatment after laparoscopic surgery in patients with moderate-severe endometriosis, the application value in clinic of compound Rhizoma curcumae powder were study.2. To study the expression of VEGF and RANTES in ectopic and eutopic endometrium in patients with endometriosis and significance of the expression.3. To study the effect of Compound Rhizoma curcumae powder on expression of VEGF and RANTES in ectopic and eutopic endometrium in patients with endometriosis, the mechanism of compound Rhizoma curcumae powder was explored and the theoretical basis for further applying in clinic was found.Methods1. The clinical data of 115 hospitalized patients with endometriosis having undertaken laparoscopic surgery in Department of Gynecology in Tianjin Nankai Hospital from June 2007 to June 2009 were retrospectively analyzed. According to the program of postoperative treatment,115 patients were divided into three groups: Rhizoma curcumae powder group(53 cases), triptorelin group(36 cases), and triptorelin combined with Rhizoma curcumae powder group(26 cases). Rhizoma curcumae powder group received compound Rhizoma curcumae powder since 1 week after surgery (drug composition:Rhizoma curcumae 15g, Rhizoma sparganii 15g, Herba epimedii 15g, Radix astragali 15g, Rhizoma corydalis 10g), twice daily for 3-6 months. Triptorelin group was given intramuscular injection of triptorelin 3.75mg since 7 days after surgery, once every 4 weeks for 3 consecutive times. Triptorelin combined with Rhizoma curcumae powder group accepted dosage regimen being the combination of the same program afforded alone in two groups. The therapeutic effects on clinical symptons (including remission,improvement,rate of recurrence),pain score,incidence of adverse reaction of patients in each group at the same points of3,6,12,and,18 months after surgery were observed.2. Using immunohistochemistry SP method, the expression level of VEGF and RANTES were detected in ectopic and eutopic endometrium in hospitalized patients with endometriosis having undertaken laparoscopic surgery in Department of Gynecology in Tianjin Nankai Hospital from July 2009 to January 2011 of 23 cases given compound Rhizoma curcumae powder for 3 months before surgery(treatment group)and 30 cases untreated(endometriosis group), compared with that in endometrium from hysteromyoma patients of 30 cases(control group).Results1. Clinical observation:The recurrence rate was 1.89% in Rhizoma curcumae powder group,2.78% in the triptorelin group, and none in triptorelin combined with Rhizoma curcumae powder group. There was no statistical significance (P>0.05) among the three treatment programs compared in clinical efficacy and pain score. The incidence of adverse reaction was significantly lower in the Rhizoma curcumae powder group(12.77%)than that in triptorelin group(86.11%) and in the triptorelin combined with Rhizoma curcumae powder group(88.46%) (P<0.01).2. Expression of VEGF and RANTES in ectopic and eutopic endometrium in patients with endometriosisExpression of VEGF and RANTES was significantly higher in eutopic endometrium of endometriosis group than that of control group(P<0.05). Expression of RANTES was higher in ectopic endometrium than that in eutopic endometrium(P<0.001). Expression of VEGF in ectopic endometrium was lower than that in eutopic endometrium and was higher than that of control group(P<0.05).There was no statistical significance between proliferative phase and secretory phase of ectopic, eutopic and control endometrium compared in expression of VEGF and RANTES(P>0.05). Expression of VEGF and RANTES in proliferative phase and secretory phase were both significantly higher in eutopic endometrium than that in same phase of control group(P<0.05).The expression of VEGF and RANTES were no statistical significance(P>0.05) among different clinic stage of endometriosis in ectopic and eutopic endometrium. The expression of RANTES in ectopic endometrium was obviously higher than that in eutopic endometrium of the same clinical stage in patients with moderate-severe endometriosis(P<0.05).3. Effect of Compound Rhizoma curcumae powder on expression of VEGF and RANTES in ectopic and eutopic endometrium in patients with endometriosisAfter three months treatment of Compound Rhizoma curcumae powder, the positive cells and brown-yellow in positive protein we observed were reduced when compared to that in endometriosis group. The expression of VEGF and RANTES in ectopic endometrium and eutopic endometrium in patients of treatment group were significantly lower than that in endometriosis group(P<0.05).Conclusion1. In the consolidation medicine treatment after laparoscopic surgery in patients with moderate-severe endometriosis, the Compound Rhizoma curcumae powder can play a role in better control of disease and reduce recurrence,and its incidence of adverse reaction is low, thus it is worthwhile in clinical application.2. Significantly increased expression of VEGF and RANTES in ectopic and eutopic endometrium in patients with endometriosis may be closely related to pathogenesis of endometriosis. The high expressions of VEGF and RANTES in eutopic endometrium is expected to become a new target of early diagnosis and therapy of endometriosis.3. Compound Rhizoma curcumae powder may reduce the expression of VEGF and RANTES in ectopic and eutopic endometrium in patients with endometriosis, thus it may intervene eutopic endometrium and play a therapeutic role in inhibiting angiogenesis in the endometrium and inflammatory immune responses.