| 张敏敏,刘淑华.补肾活血方调节TGF-β1/Smad信号通路治疗宫腔粘连机制研究[J].浙江中西医结合杂志,2024,34(3): |
| 补肾活血方调节TGF-β1/Smad信号通路治疗宫腔粘连机制研究 |
| Study on the mechanism of regulating TGF-β1/Smad signaling pathway in the treatment of intrauterine adhesions by tonifying kidney and activating blood formula |
| 投稿时间：2023-05-23 修订日期：2024-01-31 |
| DOI： |
| 中文关键词: 宫腔粘连，补肾活血方，肾虚血瘀，TGF-β1，Smad2/3，临床研究 |
| 英文关键词:Intrauterine adhesion, tonifying kidney and activating blood formula, Kidney deficiency and blood stasis, TGF-β1, Smad2/3, Clinical study |
| 基金项目:浙江省中国医药管理局：补肾活血方调节TGF-β1/Smad信号通路治疗宫腔粘连机制研究 |
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| 中文摘要: |
| 目的 探讨补肾活血方能否通过降低TGF-β1及Smad2/3蛋白表达从而减少肾虚血瘀型患者宫腔粘连的再发生,并改善相关症状,为宫腔粘连患者治疗提供方向。 方法 收集我院肾虚血瘀型宫腔粘连患者80例,随机分为对照组及观察组各40例。所有患者均行宫腔镜下粘连分解术并放置节育环,术后给予雌孕激素序贯治疗3个月。观察组在此基础上加用补肾活血方。3个月经周期后两组患者再次行宫腔镜探查术,观察用药前后两组患者的中医证候积分、宫腔粘连评分等。同时采用免疫组织化学法,计数两组患者治疗前后子宫内膜标本中TGF-β1、Smad2/3蛋白阳性表达,并参考免疫组织化学结果标准评分。最后综合进行临床疗效评定,并作统计学评价。结果 1.两组患者在年龄分布、治疗前中医证候积分、宫腔粘连评分、TGF-β1、Smad2/3蛋白表达评分方面无统计学差异(P＞0.05),具有可比性。2.两组患者治疗后中医证候积分、宫腔粘连评分均较治疗前降低,差异有统计学意义(P＜0.05)。治疗后观察组中医证候积分、宫腔粘连积分均低于对照组,差异有统计学意义(P＜0.05)。3.两组患者治疗后TGF-β1、Smad2/3蛋白表达水平评分较治疗前均降低,差异有统计学意义(P＜0.05)。治疗后观察组TGF-β1、Smad2/3蛋白表达水平评分低于对照组,差异有统计学意义(P＜0.05)。同时经kendall检验,子宫内膜TGF-β1与Smad2/3的关联性存在着统计学差异(P＜0.05)。结论 补肾活血方可降低肾虚血瘀型宫腔粘连患者术后再粘连程度,改善临床症状,其通过下调TGF-β1、Smad2/3表达,阻断TGF-β1/Smad信号通路来抑制纤维化形成,从而减少宫腔粘连再发生,且无明显副反应,安全可靠。 |
| 英文摘要: |
| Objective :
To investigate whether the tonifying kidney and activating blood formula can reduce the recurrence of intrauterine adhesions in patients with renal deficiency and blood stasis by reducing the expression of TGF-β1 and Smad2/3 proteins, and improve related symptoms, so as to provide direction for the treatment of patients with intrauterine adhesions.
Methods
A total of 80 patients with renal deficiency and blood stasis intrauterine adhesions were collected and randomly divided into control group and observation group, 40 cases were randomly divided. All patients underwent hysteroscopic adhesiolysis with birth control rings and sequential estrogen-progesterone therapy for 3 months. The observation group added kidney tonic and blood revitalization formula on this basis. After 3 menstrual cycles, the two groups underwent hysteroscopic exploration again, and the TCM syndrome score and uterine adhesion score of the two groups before and after the medication were observed. At the same time, immunohistochemistry was used to count the positive expressions of TGF-β1 and Smad2/3 proteins in endometrial samples before and after treatment of the two groups, and refer to the standard score of immunohistochemical results. Finally, the clinical efficacy was comprehensively evaluated and statistically evaluated.
Results
1. There were no significant differences in age distribution, TCM syndrome score before treatment, intrauterine adhesion score, TGF-β1 and Smad2/3 protein expression score (P>0.05), which were comparable.
2. The scores of TCM syndrome and intrauterine adhesions in the two groups were significantly lower than those before treatment (P<0.05). The scores of medical syndrome and intrauterine adhesions in the observation group after treatment were lower than those in the control group, and the differences were statistically significant (P<0.05).
3. The expression levels of TGF-β1 and Smad2/3 proteins in both groups were significantly lower than those before treatment (P<0.05). After treatment, the TGF-β1 and Smad2/3 protein expression levels in the observation group were lower than those in the control group, and the difference was statistically significant (P<0.05). At the same time, the association between endometrial TGF-β1 and Smad2/3 was statistically different by kendall test (P<0.05).
Conclusion
Tonifying kidney and activating blood formula can reduce the degree of postoperative readhesions and improve clinical symptoms in patients with renal deficiency and blood stasis type intrauterine adhesions, which inhibits fibrosis formation by downregulating TGF-β1 and Smad2/3 expression and blocking TGF-β1/SMAD signaling pathway, thereby reducing the recurrence of intrauterine adhesions without obvious side effect, safe and reliable. |
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