| Objective:This study observed the therapy efficacy and safety of ectopic pregnancy(EP)patients with Chinese medicine which called Modified Ectopic ? Party(the following referred to as Party) and methotrexate(MTX). Observed the influence of trophoblast, liver tissue pathology change and apoptosis factors Bcl-2/Bax with different doses Party. To providing animals experiments and clinical basis for conservative treatment EP.Methods:Clinical research:The 60 cases of EP patients who be included in the conservative treatment standard were randomly divided into the western medicine group (treat by methotrexate) and the combination of Chinese and western medicine group (treat by methotrexate and Party), every group were 30 cases. Detection ?-HCG after dosing, until the ?-HCG value fell to the normal range. Observe its cure days, the improvement of the clinical curative effect and adverse drug reactions, calculate the cure rate. Experimental research:The building successful pregnancy rats were randomly divided into 6 groups:the western medicine group (treat by methotrexate), the combination of Chinese and western medicine group (treat by methotrexate and Party), and low, medium, high dose group (Party low, medium, high dose group), blank group (saline). Shall give appropriate drugs. During the period of drug delivery record ing the pregnant rats weight daily. The eighth day of drug delivery kill the rats. Take the femoral arterial blood, liver and gravid uterus, using ELISA measuring the ?-HCG value. Using the measuring of HE staining slice to observe the pathology change of trophoblast and liver tissue. Transmission Electron Microscopy(TEM) to observe the ultrastructural changes of trophoblast. Immunohistochemical method detection the apoptosis factors Bcl-2/Bax of trophoblast.Results:1. Clinical research results:The western medicine group cure rate was 76.7%, the time drop to normal range of the mean of ?-HCG was 18.05±7.39 days. The combination of Chinese and western medicine group cure rate was 93.3%, the time drop to normal range of the mean of ?-HCG was 10.80±2.65 days. The needing time of clinical symptoms recovered to the combination of Chinese and western medicine group was shorter than the western medicine group after treatment. And the drug side effect was lower than western medicine group.2. Experimental research results:2.1 Influence on pregnant rat body weight:Some pregnant rat weight were down after the medication. The most obvious was the western medicine group, next was the combination of Chinese and western medicine group, traditional Chinese medicine (TCM)high dose group, there were differences between the blank group(P<0.05). But there were no differences between the TCM medium dose group and low dose group (P> 0.05).2.2 Influence on pregnant rat liver:Influence on pregnant rat liver tissue pathology:The most obvious was the western medicine group,next was the combination of Chinese and western medicine group, TCM high dose group, there were differences between the blank group(P<0.05). But there were no differences between the TCM medium dose group low dose group and the blank group (P>0.05). The western medicine group:Mild edema of liver cells, a small amount of fat vacuoles, Interstitial infiltrates with inflammatory cells,small amount of fibrous connective tissue hyperplasia. The combination of Chinese and western medicine group:abnormal structure of liver tissue, liver physiology arrangement structure disorder, marked edema of liver cells, a lot of fat degeneration, intlammatory cells be found in portal area, lobular central vein and infiltration, fibrous connective tissue hyperplasia significantly. The TCM medium group:normal hepatic lobular structure, liver cell radiated distribution but mild swelling, a small amount of fibrous tissue hyperplasia and inflammatory cell infiltration. The TCM high dose group:liver cell swelling obviously, a lot of fat degeneration, a lot of inflammatory cells infiltration, fibrous connective tissue hyperplasia significantly. The TCM low dose group:normal liver tissue structure, radiate out in hepatic cord centered around the central vein, liver cell edema not seen, a small amount of inflammatory cells in the stroma, around the central vein mild fibrosis.2.3 Influence on ?-HCG value of pregnant rats:Western medicine and traditional Chinese medicine can reduced ?-HCG value to varying degrees. The minimum value of ?-HCG was the combination of Chinese and western medicine group, next was TCM high dose group, TCM medium dose group, western medicine group, TCM low dose group, there were differences between the five group and the blank group (P<0.05).2.4 Influence on pregnant rat uterus and trophoblast:Influence on pregnant rat pregnancy uterine weight:Compared with the blank group, the rest rats of the five groups pregnancy uterine weight were decreased (P<0.05). From low to high alignment by weight was:the combination of Chinese and western medicine group, TCM high dose group, TCM medium dose group, western medicine group, TCM low dose group. Influence on the tissue pathology of trophoblast on rats:The trophoblast clearance of the western medicine group was not clear, disordered arrangement, small volume, a large number of inflammatory cells infiltration, normal embryo sac form destruction moderately. The trophoblast and normal morphology embryo sac of the combination of Chinese and western medicine group disappeared entirely, or a small amount of necrotic tissue residue, even without a residue. The trophoblast clearance of the TCM medium dose group was increased, disordered arrangement, big volume, inflammatory cells infiltration, normal embryo sac form destruction moderately. The trophoblast clearance of the TCM low dose group was not clear, disordered arrangement, a samll number of inflammatory cells infiltration. The trophoblast of the TCM high dose group was imcomplete, normal morphology embryo sac organization structure was severely damaged, or a small amount of necrotic tissue residue. Influence on trophoblast ultrastructure of pregnant rat.:The western medicine group:The nucleus had no obvious abnormalities, heterochromatin edge set,there is part of the cavitation of mitochondria in the cell cytoplasm. The combination of Chinese and western medicine group:Cell gap widened significantly, the nucleus shape is irregular, the nucleus heterochromatin increased and edge set, organelles decreased, mitochondria in vacuoles. The TCM medium dose group:The nucleus shape is irregular, heterochromatin increased, mitochondria swelling. The TCM low dose group:The nuclei are normal, mitochondria swelling.The TCM high dose group:The entire cell swelling, cytoplasm sparse, mitochondria swelling,spinal fracture or disappeared.2.5 Influence on Bcl-2/Bax of trophoblast:Influence on Bcl-2 score of trophoblast:Western medicine and traditional Chinese medicine could reduced the Bcl-2 score in different degrees.the most obvious was the combination of Chinese and western medicine group, next was the TCM high dose group, the TCM medium dose group,the western medicine group, the TCM low dose group, there were statistical significance between the five group and the blank group (P<0.05). the TCM low dose group, There were statistical significance between the western medicine group and the combination of Chinese and western medicine group(P<0.05). There were statistical significance between the western medicine group and the combination of Chinese and western medicine group, TCM medium dose group, TCM low dose group(P<0.05). There were statistical significance between TCM medium dose group and the combination of Chinese and western medicine group, TCM low dose group(P<0.05). There were statistical significance between TCM high dose group and the TCM low dose group(P <0.05). Influence on Bax score of trophoblast:Western medicine and traditional Chinese medicine could recreased the Bax score in different degrees. the most obvious was that the combination of Chinese and western medicine group,next was the TCM high dose group, the western medicine group, the TCM medium dose group,the TCM low dose group,there were statistical significance between the five group and the blank group(P <0.05). There were statistical significance between the western medicine group and the combination of Chinese and western medicine group, TCM low dose group(P<0.05). There were statistical significance between the combination of Chinese and western medicine group and the western medicine group, TCM medium dose group, TCM low dose group(P<0.05). There were statistical significance between TCM medium dose group and the combination of Chinese and western medicine group(P<0.05). There were statistical significance between TCM high dose group and the TCM low dose group(P<0.05). The influence of ratio of the Bcl-2/Bax:Compared with the blank group, the rest of the five groups are reduced the Bcl-2/Bax ratio. According to the ratio of ordered from low to high:the combination of Chinese and western medicine group,the TCM high dose group,the TCM medium dose group, western medicine group,the TCM low dose group,blank group.Conclusion:1.Combine traditional Chinese and western medicine treatment could improved the cure rate, shortened the treatment time, improved the clinical symptoms, reduced the drug side effects. 2. The mechanism of action of Party may be by destructing trophoblast morphological structure, reducing the amount of sertoli cell, damaging the normal physiological function, reducing the synthesis and secretion of ?-HCG. Reducing the Bel-2/Bax ratio to promoting cell apoptosis, killing the embryos ultimately. There was concentration-response relationship,dose, the higher the better, killing the embryos stronger.3. MTX could caused liver damage, high dose Party also could caused liver damage. Combined the Party and MTX, embryo and trophoblast damage were more obvious than Party or MTX alone. The liver damage was much less than western medicine group. |
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