| Endometriosis(endometriosis,EMs)is a common and frequently occurring disease in gynecological clinical.the pain caused by endometriosis has been perplexing the physical and mental health of female patients for a long time and has a great negative impact on the quality of life.At present,the commonly used treatment methods include laparoscopic surgery,drug treatment and so on.However,these treatments have some side effects and limitations,and can not completely eliminate the recurrence of endometriosis.Because there is no method to cure endometriosis fully and completely,controlling the symptoms of endometriosis,improving the quality of life and preventing recurrence has become the research direction of the treatment of endometriosis.Traditional Chinese medicine in the treatment of endometriosis has many advantages,such as accurate curative effect,economy,small side effects and so on,and has unique advantages.The etiology of endometriosis is complex.since Sampson put forward the theory of "menstrual blood countercurrent",eutopic endometrium determinism,lumen metaplasia theory,vascular and lymphatic metastasis theory and stem cell theory have been put forward one after another.at the same time,Abnormal expression and regulation of related genes,immune inflammatory response and abnormal expression of sex hormone receptors have also been found to be closely related to the occurrence of endometriosis.The occurrence of complex pain symptoms of endometriosis is closely related to the location and type of lesions.The occurrence of pain is mainly related to estrogen sensitivity,neuroanatomical mechanism,pelvic inflammatory factors and other factors.At present,neuroanatomical mechanism is the most popular research field in the pathogenesis of endometriosis pain.Professor Xiao Chengxue believes that the pathogenesis of this disease is characterized by the simultaneous existence of yang qi weakness and blood stasis block,and has established a therapeutic rule of warming yang and dispersing cold,removing blood stasis and relieving pain,and the prescription is based on fenugreek pills for the treatment of endometriosis.Good curative effect has been obtained.This study was carried out from two aspects:(1)clinical study: clinical observation on the treatment of dysmenorrhea due to yang deficiency,cold,coagulation and blood stasis;(2)animal experiment: fenugreek pills on endometriosis.The effects of nerve growth factor(Nerve Growth Factor,NGF)and its receptor tyrosine kinase A(TrkA),neurotrophin receptorp75(p75)and mast cells in rats.And the effect on serum anti-endometrial antibody(EMAb)in endometriosis model rats.1.Clinical study:(1)objective: to observe the visual analog score(visual analogue scale,VAS),TCM dysmenorrhea score,TCM syndrome score and health investigation summary table(The MOS item short from health survey,SF-36).(2)method: A prospective randomized controlled trial was conducted in which 50 patients with dysmenorrhea of yang deficiency,cold coagulation and blood stasis type were randomly divided into two groups,with "Shaofu Zhuyu granule" as control drug.The experimental group: oral fenugreek pills(decoction,twice a day),the control group: Shaofu Zhuyu granules(Chong,1.6 g,3 times a day),4 weeks as a course of treatment,continuous treatment for 3 courses.During the menstruation stopped the drug and began to take medicine for 3 weeks on the 7th day.The main outcome measures were VAS score of dysmenorrhea patients during treatment(including self-comparison before and after treatment and comparison between groups).The secondary curative effect indexes included TCM dysmenorrhea score,TCM syndrome score,SF-36 scale score and serum CA125 level.During the treatment,adverse reactions,blood and urine routine,liver and kidney function and other safety indexes were recorded before and after treatment.(3)results: compared with those before treatment,the VAS scores of the patients in the experimental group and the control group were analyzed after 1 month,2months and 3 months of treatment,and the VAS scores of the patients were significantly lower than those before treatment.The VAS score of the treatment group was better than that of the control group(P < 0.01),and the difference was statistically significant(P < 0.01),and the score of the treatment group was better than that of the control group(P < 0.01).The results showed that both the experimental group and the control group could reduce the VAS score,and the therapeutic effect of fenugreek pills on endometriosis dysmenorrhea was better than that of the control group.Compared with those before treatment,the scores of dysmenorrhea in the experimental group and the control group after 1 month,2 months and 3months of treatment showed that the scores of dysmenorrhea in the two groups were significantly lower than those before treatment,and compared with those before treatment,the difference was statistically significant(P < 0.01).The treatment group in the completion of treatment of dysmenorrhea score of traditional Chinese medicine decreased better than the control group,and the difference was statistically significant.(P < 0.05).The results showedthat both groups could reduce the score of dysmenorrhea in traditional Chinese medicine,and the experimental group was better than the control group.The scores of TCM syndromes before and after treatment in the two groups were significantly different from those before treatment(P < 0.01),suggesting that the syndromes of dysmenorrhea patients with endometriosis after treatment in the two groups were significantly improved compared with those before treatment.There was significant difference between the experimental group and the control group after treatment and before and after treatment(P < 0.05),which proved that the effect of improving TCM syndrome score in the experimental group was better than that in the control group.Compared with before and after treatment,the syndrome scores of lower abdominal pain,pain duration,less menstrual volume,menstrual color,limb cold,fear of cold,cold sweat and anal distension in the experimental group were significantly lower than those before treatment.The difference was statistically significant(P < 0.01),which indicated that fenugreek pills could effectively reduce the scores of TCM syndromes for dysmenorrhea relief of endometriosis.The scores of menstrual abdominal pain,pain duration,menstrual volume,menstrual color,limb cold and chills in the control group were significantly lower than those before treatment(P < 0.01).The symptoms of cold sweating and anal distension were not significantly alleviated(P > 0.05).Comparison of the difference of TCM syndromes between the two groups before and after treatment,There was no significant difference in menstrual abdominal pain,pain duration,menstrual volume,menstrual color,limb cold,chills and other symptoms between the two groups(P > 0.05).After treatment,the decrease trend of cold sweating and anal distension in the treatment group was more obvious than that in the control group.The difference was statistically significant(P < 0.05).It can be considered that the two groups can effectively reduce menstrual abdominal pain,pain duration,menstrual volume,menstrual color,limb cold,cold fear and other six symptoms,there is no significant difference between the two groups,but in the treatment of cold sweating,anal distension two syndromes,Fenugreek pills have a good effect,but the control group is ineffective.After treatment,the five dimensions in physical functioning(PF),role limitations due to physical health(RP),bodily pain(BP),general health perceptions(GH)and social function(SF)of experimental group patients were significantly improved compared with those before treatment(P < 0.01).The four dimensions of BP,GH,SF and the total physical healthevaluation(PCS)were significantly improved compared with those before treatment(P <0.01).After treatment,the role limitations due to emotional problems(RE)and the mental component summary(MCS)of the experimental group were improved compared with those before treatment(P < 0.05),while the PF and MCS of the control group were improved compared with those before treatment(P < 0.05).There was no significant improvement in vitality(VT)and mental health(MH)between the two groups,and there was no significant difference between the two groups before and after treatment(P > 0.05).There was no significant difference in RE and MCS between before and after treatment in the control group(P > 0.05).Through comparing and analysing,the two groups of drugs can alleviate the patients`,so they can bring about the improvement of the quality of life.In particular,general health perception(GH),physiological function(PF),role limitations due to physical health(RP),social function(SF)and bodily pain(BP)were the most obvious.In the dimension of the role limitations due to emotional problems(RE),the performance of the experimental group was improved(P < 0.05),but there was no significant change in the control group(P >0.05).There was no significant change in vitality(VT)and mental health(MH)between the two groups before and after treatment,(P > 0.05),the statistically significant is meaningless.The serum CA125 level of the patients in the experimental group and the control group decreased to a certain extent in before and after treatment,but the difference doesn`t have statistically significant(P > 0.05).The results showed that fenugreek pills had no obvious effect on reducing serum CA125 level.2.Animal experiments:(1)objective: to observe the expression of NGF and its receptors TrkA and p75 in fenugreek pills on endometriosis model rats,effects of mast cell(MC)and serum EMAb(2)methods: According to the random table method,select 36 healthy female SD rats of clean grade,7 ≤ 8 weeks old.And divided into 6 groups: sham operation group,blank model group,western medicine group(gestrinone group),low dose group of TCM,middle dose group and high dose group of traditional Chinese medicine.Each group has 6rats.The rat model of endometriosis was established by endometrial autotransplantation.After the auto-transplantation model was established,the rats rested for 4 weeks to recover their physical strength,and then began to give gavage.Rats in sham operation group and blank model group were given normal saline every day;rats in low and high dose groups were given fenugreek pills every day;western medicine group was given gestrinone suspensionand the rest time was given the same amount of normal saline for 4 weeks.The expression of NGF,TrkA and p75 was detected by immunohistochemistry,the level of serum EMAb was detected by Elisa method,and the number of mast cells was detected by toluidine blue staining.(3)results: fenugreek pills could effectively decrease the expression of NGF and its receptors TrkA and p75 in endometriosis model rats,and according to the level of NGF,both the middle dose group was more obvious and the high dose group can lower the level,the high dose group was more obviously.However,there was no significant difference in the effect of dose on its receptors TrkA and p75.Due to the EMAb level study,it was found that the serum EMAb level of endometriosis model rats was higher than that of sham operation group,but after treatment,the EMAb levels of low,middle and high dose groups and western medicine group were lower than those of blank model group.And the traditional Chinese medicine group is better than the western medicine group,which indicated that the treatment of traditional Chinese medicine is much more effective for the reduction of serum EMAb in rats with endometriosis.It is proved that fenugreek pills are effective in the treatment of endometriosis.In this study,it was found that there was no significant difference in the number of mast cells in each group. |
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