| Objective: To observe the clinical evaluation of Yiqi Qingshi Huayu integrated program(internal medicine,Chinese medicine enema and moxibustion)the efficacy and safety of treatment of recurrent pelvic inflammatory disease,and immune regulation of TNF-alpha pathway from MyD88,IL-6 to explore the mechanism of its clinical application to provide a scientific basis.Methods: The recurrent pelvic inflammatory disease(Qi deficiency and blood stasis and dampness syndrome)50 cases of diagnostic criteria were selected as the experimental group,using traditional Chinese medicine Penyan Decoction oral rehabilitation + gynecological enema + moxibustion treatment for 12 weeks(Chinese medicine menstrual withdrawal;enema from the net after 14 consecutive days beginning 1 course of treatment,a total of 3 courses;moxibustion Shenque Guanyuan,Zusanli,Zhongwan,four points,3 times a week,menstrual disabled).Healthy control group of 25 cases,no intervention.The test group were randomly selected 15 cases of safety evaluation.Enzyme linked immunosorbent assay(ELISA)was used to detect MyD88,and chemiluminescence assay was used to detect the levels of TNF-alpha and IL-6.The clinical symptoms and signs,the security index and the two group of related index changes before and after exploratory experimental observation the treatment group.Results:1.clinical observation:(1)Individual symptoms,signs of efficacy: abdominal pain or pain or lumbosacral pain,menstrual or fatigue after the increase,leucorrhea,color is white or yellow,body tired fatigue,menstruation or menstruation,menstruation has a light or dark,greasy mouth,abdominal nausea,anorexia,uterine activity limitation the pressure and pain,left adnexal tenderness,right adnexal tenderness,left accessory thickening and mass,thickening of the right accessory bag piece,uterosacral ligament by more coarse and tenderness index before and after treatment,the differences were statistically significant(P<0.05).(2)Analgesic effect: after treatment,the test group was 24%,significant efficiency 36%,efficiency of 34%,the total efficiency of 94%,the experimental group before treatment of pelvic pain score was 4.80±1.40,1.68±1.10 after treatment than before treatment decreased 3.12±1.62,self control had a significant difference(P<0.05).(3)Signs of efficacy: after treatment,the test group was 2%,the effective rate was 56%,efficiency was 38%,the total efficiency of 96%,the experimental group before treatment effect of signs score was 9.02±1.99,3.60±1.83 after treatment than before treatment decreased 5.42±2.52,there was a self-control significant differences(P<0.05).(4)TCM syndrome curative effect: after treatment,the test group was 0%,the effective rate was 74%,efficiency was 22%,the total efficiency of 96%,the experimental group before the treatment of TCM syndrome curative effect score was 9.96±3.74,4.52±2.21 after treatment than before treatment decreased 5.44±1.53,self control was statistically significant compared the difference(P<0.05).(5)The recurrence rate: in 45 patients with recurrent pelvic inflammatory disease,30 cases of pelvic pain were cured and markedly effective in the treatment of patients after the withdrawal of the disease in the year of March,including the recurrence of the disease in 2 cases,no recurrence in 28 cases,the recurrence rate was 6.67%.(6)The safety evaluation of the experimental group: 3 adverse events occurred during the trial,including 2 cases mild adverse reactions in the study,no serious adverse events,and no abnormal laboratory examination.2.Exploratory outcome:(1)The expression levels of the two groups before treatment serum MyD88 were compared between the two groups,the experimental group was higher than the control group,the difference was not statistically significant(P>0.05);45 cases of recurrent pelvic inflammation in patients with peripheral serum MyD88 levels were compared before and after treatment,after treatment lower than that before treatment,the difference was statistically significant(P<0.05).(2)The expression levels of the two groups before treatment serum TNF-alpha,IL-6 were compared between the two groups,the expression level of IL-6 of the experimental group were higher than the control group,there was no significant difference between the former(P>0.05),the difference was statistically significant(P < 0.05);45 cases of recurrent pelvic inflammation in patients with peripheral serum TNF-alpha,before and after treatment were compared,TNF-alpha expression level of IL-6,the expression level of IL-6 after treatment was lower than that before treatment,the difference was statistically significant(P < 0.05).(3)The expression of MyD88 was positively correlated with TNF-alpha and IL-6,and there was no significant difference between the indexes(P>0.05).Conclusion:1.Recurrent Yiqi Qingshi Huayu comprehensive scheme for the treatment of pelvic inflammatory disease(Qi deficiency and blood stasis and dampness syndrome),can significantly improve the pelvic pain symptoms,signs and TCM syndromes.And the recurrence rate is low,no significant adverse reactions,is safe and effective in clinical use.2.The effect mechanism of recurrent Yiqi Qingshi Huayu combined therapy for pelvic inflammatory disease may be related to the down-regulation of peripheral serum MyD88 and TNF-alpha,MyD88 and TNF-alpha expression of IL-6 and IL-6 in patients with recurrent pelvic inflammatory disease in the peripheral blood expression was positively correlated,suggesting that it may be mainly by decreasing serum MyD88 and inhibit inflammation factor TNF-alpha the expression of IL-6,reduce inflammation,improve the immune function.3.IL-6 may be more suitable for the diagnosis and treatment of patients with recurrent pelvic inflammatory disease than TNF-alpha. |
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