| Objective To investigate the cytokine interleukin -6 (IL-6), tumor necrosis factor (TNF-α) in patients with chronic pelvic inflammatory disease leading to infertility in the pathogenesis; observe the effect of combined cycle therapy with laparoscopic/and hysterscopic surgery on different degree of inflammatory adhesion infertility serum,peritoneal fluid inflammatory cytokines IL-6,TNF-αand clinical curative effect; to study the mechanism of Chinese cycle therapy working on inflammatory infertility, and to guide the clinical application.Methods Collection for"pelvic inflammatory disease infertility"in Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, two gynecological laparoscopic surgery (or hysteroscopy) in the treatment of 85 cases and for"ovarian cyst"laparoscopic surgery 20 patients as non-inflammatory control group.42 cases of mild pelvic adhesions,43 cases of moderate pelvic adhesions meeting the income standard set were divided into four groups:①operation group (mild):20 cases, after laparoscopic (or and hysterscopic)surgery to monitor follicular to guide the sexing time;②surgery plus Chinese medicine group (mild):22 cases, periodically use penyankang mixture (before ovulation), zhuyun 3 pill (after ovulation) orally, while monitoring the follicle, guiding the sexing time;③operation group (moderate):21 cases,3-7 days after the first menstrual period a clean water line tubal surgery will be given, and monitoring follicular;④surgery plus medicine group (moderate):22 cases, periodically use penyankang mixture (before ovulation), zhuyun 3 pill (after ovulation) orally, while monitoring the follicle, guiding the sexing time; four groups were treated or monitored for 3 months.Measured by enzyme-linked immunosorbent assay, the IL-6, TNF-αlevels of local peritoneal fluid and serum in patients before and after treatment were observed and symptoms and signs before and after treatment were compared, and follow up until'9 months after surgery, compare the pregnancy rate and its ectopic pregnancy rates after 3,9 months.Result1 Symptoms:After treatment, expect mild adhesions wich surgery alone group, the other three groups symptom score after treatment decreased than before treatment. For moderate adhesions, symptom score after treatment of surgery plus medicine group was lower than surgery alone (P＜0.05), whether mild or moderate adhesions, the improvement of the abdominal pain, lumbar soreness and other symptoms of surgery+Chinese group compared with surgery alone group was significantly (P＜0.05)2 Signs:After treatment, patients with signs score in each group decreased, in which moderate adhesions with surgery+cycle therapy decreased the most significantly (P＜0.01); for moderate adhesions, signs score of surgery plus medicine group is lower than the surgery alone group (P＜0.05).3 IL-6, TNF-αlevels:①Before treatment,43 cases of moderate pelvic adhesions in patients with serum, local peritoneal fluid IL-6, TNF-αlevels compared with 42 cases of mild pelvic adhesions,20 cases of normal control group increased in patients with mild pelvic adhesions, partial peritoneal fluid IL-6, TNF-αlevels higher than the normal control group also (P＜0.05).②pelvic infertility TNF-αin patients with localized peritoneal fluid levels of TNF-αwas positively correlated with correlation coefficient R= 0.994 (P＜0.01); local peritoneal fluid TNF-αlevels and pelvic adhesion score was significantly correlated (P＜0.01):TNF-αlevel is higher, the higher rate of pelvic adhesions.③After treatment, surgery plus medicine group (mild) serum TNF-αin patients with near normal (P＞0.05), the other three groups of serum TNF-αwas still higher than the normal control group (P＜0.05). After treatment, regardless of mild or moderate adhesions, surgery plus medicine group serum IL-6, TNF-αlevels than before treatment decreased (P＜0.01 or P＜0.05), while the surgical group, mild adhesion group Serum IL-6 levels, moderate adhesions compared serum concentrations of TNF-αtreatment had no significant change (P＞0.05). After treatment, surgery plus medicine group (mild) than the operation group (mild) low levels of serum IL-6, the difference was highly significant (P＜0.01), surgery plus medicine group (moderate) than the operation group (moderate) serum IL-6, TNF-αlevels decreased, the difference was significant (P＜0.05).4 Pregnancy conditions:after 3 months, all groups were no significant differences in pregnancy (P＞0.05); after 6 months, mild adhesion of the operation+Medicines pregnancy rate 59.1%(13/22) pregnancy rate than the surgical group 45%(9/20) high, the difference was not significant (P＞0.05); moderate adhesion surgery+Medicines pregnancy rate 54.5%(12/22) pregnancy rate than the surgery group 23.5%(5/21) increased, significant difference (P＜0.05).Conclusion1 Damp heat and evil as the standard, Deficiency of kidney as the center is the key to pelvic inflammatory disease in patients with infertility machine.2 Infertility in patients with chronic pelvic inflammatory disease and local pelvic fluid IL-6, TNF-αconcentrations were significantly elevated compared with non-inflammatory, and with TNF-αconcentration, the more severe pelvic adhesions more obvious. Serum TNF-αconcentration and local peritoneal fluid TNF-αconcentration was significantly positively related to serum levels of TNF-αlevel to a certain extent representative of the local concentration of TNF-αin peritoneal fluid and the degree of pelvic adhesions.3 Laparoscopic surgery is the effective treatment of infertility patients with chronic pelvic inflammatory disease, as soon as possible to restore fertility in patients; after suigery combining traditional Chinese medicine can improve clinical symptoms and signs of improvement, and increase the pregnancy rate.4 The initial cycle of treatment that medicine has a role in modulation of immune function, either directly or indirectly, enhance the body's anti-inflammatory capacity; Also can reduce the serum IL-6, TNF-αconcentrations, inhibit over increasing of the inflammatory cytokines in patients with chronic pelvic inflammatory disease and excessive immune response, to restore tubal function, correct pelvic pathological condition, to obtain a better clinical efficacy. |
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