| Objective This research observed the availability and security of the yiqiqingshihuayu method(oral traditional Chinese medicine,Chinese medicine enema and moxibustion)through clinic trial,explored the pharmacodynamic action and mechanism of recurrent PID from the TLRs/My D88 immune pathways regulating su PAR,hs-CRP,at the same time,looked for the targets and special diagnostic indexes in the prevention and treatment of recurrent PID.Methods Patients with recurrent PID were collected in the gynaecological clinic of the chengdu university of traditional chinese medicine between February 2016 and December 2016.50 patients were included in test group according to the inclusion criteria,as well,25 healthy people were included in control group.Patients in test group were treated for 3 months with the comprehensive method-yiqi qingshi huayu method(oral penyankangfu decoction,traditional chinese medicine enema,moxibustion(Zhongwan/Shenque/Guanyuan/Zusanli).Healthy people in control group were without any treatment.Recording the syndrome score of test group every two weeks and signs score every 4 weeks.The blood of test group were collected separately before and after the treatment,while the healthy group before the study.Making tests just as follows: Testing the rate of TLR2 and TLR4 expression in peripheral blood leukocytes by flow cytometry detection,detecting the expression level of TLR2 and TLR4 m RNA in peripheral blood mononuclear cells by real-time PCR,detecting the expression level of My D88 and su PAR by ELISA method and detecting the expression levels of hs-CRP by immunoturbidimetry.There had 15 cases of test group were picked up randomly for safety evaluation.Results 1.Clinical observation results: 1.1 General situation of the patients: most patients are between 29 to 39 years old(40.00%);The courses of majority patients are during four with five years(56.00%).1.2 Single symptom and sign efficacy: the lower abdomen pain or bearing-down pain,lumbosacral pain,which could be worse during menstruation or being tired,much Leucorrhea,of which color could be white or yellow,getting tired easily,menostaxis or menorrhagia,dark menstrual blood or menstruation mixed with blood clot,chest stufly,anorexia,sticky and greasy in mouth,uterine is restricted to move and tenderness,left and right adnexa tenderness,left and right adnexa are thickening and enclosed mass,uterosacral ligament is thickening and tenderness,all of which were comparised as observing indexes before and after treatment,the difference had statistical significance(P<0.05).1.3 Analgesic effect: After the treatment,the cure rate,the remarkable effect rate and effect rate were 24.00%,36.00%,34.00%,total effective rate were 94.00%.Pelvic pain score of the test group was 4.80±1.40 before the treatment,and after that was 2.00 ± 0.90,falling 3.12±1.62 than before,the difference had statistical significance(P<0.05).1.4 Syndromes curative effect: After the treatment,the cure rate,the remarkable effect rate and effect rate were 0.00%,74.00%,22.00%,total effective rate were 96.00%.The TCM syndrome score of the test group was 9.96±3.74 before the treatment,and after that was 4.52±2.21,falling 5.44±1.53 than before,the difference had statistical significance(P<0.05).1.5 Signs effect: After the treatment,the cure rate,the remarkable effect rate and effect rate were 2.00%,56.00%,38.00%,total effective rate were 96.00%.The signs score of the test group were 9.02±1.99 before the treatment,and after that were 3.60±1.83,falling 5.42±2.52 than before,the difference had statistical significance(P<0.05).1.6 Recurrence rate: Evaluating the 30 patient's condition with PID recurrent after stoping the treatment for three months,2 cases were recurrent,28 cases weren't recurrent,the recurrence rate was 6.67%.1.7 Safety evaluation: There was no serious adverse events and three adverse events during the process of tests,of which 2 cases happened mild adverse reaction and there was no obvious abnormal for laboratory examination.2.Exploratory results: 2.1 Gene expression index: The comparison between two groups before observing showed that TLR2?TLR4 m RNA expression level of test group was higher than that of the control group,the difference between two groups had statistical significance(P<0.05).Comparing the expression of TLR2?TLR4 m RNA before the treatment with after the treatment showed that the expression of the former was lower than that of the latter,the difference had statistical significance(P<0.05).2.2 Protein expression index: The rate expression of TLR2,TLR4 of two groups in monocyte were 59.80±21.39,32.17±21.16(test group)and 45.99±18.91 ?23.70±16.76(control group),which were significantly higher than which in lymphocyte and granulocyte.And the level of test group were higher than that of control group,the difference of TLR2 had statistical significance(P<0.05),while TLR4 had no statisticant significance(P>0.05).Comparing the rate of TLR2?TLR4 expression before the test with after the test showed that the latter former was higher than the latter,the difference of TLR2 's expression in lymphocyte,monocyte and granulocyte had statistical significance(P<0.05),the difference of TLR4 's expression in monocyte had statistical significance(P<0.05),the difference of which in lymphocyte and granulocyte had no statistical significance(P>0.05).2.3 Cytokines indicators: Comparing the two groups before observing discovered that,the expression level of peripheral blood My D88,su PAR and hs-CRP in test group were higher than which in control group,the difference of both three had no statistical significance(P>0.05).Comparing the expression of them before the treatment with after the treatment showed that the expression of the former was higher than that of the latter,the difference of My D88 and su PAR had statistical significance(P<0.05),while the difference of hs-CRP had no statistical significance(P>0.05).2.4 correlation analysis: The expression of My D88 and su PAR were positively correlated,correlation coefficient is 0.841,the pertinence had statistical significance(P<0.05),the pertinence of the rest indicators had no statistical significance(P>0.05).Conclusions 1.With no obvious adverse reactions and low recurrence rate after therapy discontinued for 3 months,Using yiqiqingshihuayu comprehensive method to treat recurrent PID has exact curative effect in relieving pelvic pain,TCM syndrome and signs.2.TLR2?TLR4?My D88?su PAR may participate in the process of recurr ent PID.3.The therapeutic mechanism of yiqiqingshihuayu comprehensive method tr eat recurrent PID may be related to reduce the expression of TLR2,TLR4 in lymphocyte,and My D88 in peripheral blood.The expression of My D88 and su PAR were positively correlated,which hinted that the methods may mainly red uce My D88 to restrain the expression of inflammatory markers su PAR,thus rel ieved inflammation and improved the immune function of the body.4.Preliminary thinking that su PAR is more suitable as one of the therapeutic effect evaluation index for recurrent PID than hs-CRP. |
PDF Full Text Request