發(fā)布時間：2018-03-14 15:04

  本文選題：宮頸上皮內(nèi)瘤變　切入點(diǎn)：人類乳頭狀瘤病毒　出處：《中國實驗方劑學(xué)雜志》2017年16期 　論文類型：期刊論文

【摘要】：目的:探討化濕解毒湯對高級別CIN高危型HPV感染者LEEP術(shù)后濕熱下注證患者的臨床療效,并從凋亡抑制基因即生存素(Survivin)和增殖細(xì)胞核抗原(Ki67)表達(dá)及HPV病毒載量等方面探討了其對轉(zhuǎn)歸的影響。方法:將160例CIN高危型HPV感染者,采用SAS軟件生成,隨機(jī)按1∶1比例分為觀察組和對照組。兩組患者均給予LEEP術(shù)治療。術(shù)后對照組給予重組人干擾素α-2 b凝膠宮頸外涂,連續(xù)10 d為1個療程,共使用3個月經(jīng)周期。觀察組在對照組治療的基礎(chǔ)上加用化濕解毒湯內(nèi)服,1劑/d。連續(xù)服用3個月經(jīng)周期,再行3個月經(jīng)周期隨訪。檢測術(shù)前和術(shù)后6個月患者Survivin,Ki67水平陽性表達(dá)情況和人乳頭瘤病毒(HPV)DNA基因(HPV-DNA)病毒載量;進(jìn)行術(shù)前和術(shù)后3個月慢性宮頸炎和濕熱下注證的評價;檢測術(shù)前和術(shù)后3個月宮頸局部灌洗液γ-干擾素(IFN-γ),白細(xì)胞介素-10(IL-10),白細(xì)胞介素-12(IL-12),白細(xì)胞介素-2(IL-2)和白細(xì)胞介素-4(IL-4)水平。結(jié)果:觀察組臨床療效總有效率為94.52%,對照組為81.69%,觀察組高于對照組(χ~2=6.691,P0.05);治療后觀察組中醫(yī)證候療效總有效率為95.89%,對照組為78.87%,觀察組高于對照組(χ~2=9.529,P0.01);術(shù)后6個月,觀察組高危型人乳頭瘤病毒(hr-HPV)陰轉(zhuǎn)率為91.78%,對照組為77.46%,觀察組高于對照組(χ~2=5.699,P0.05);觀察組患者在術(shù)后6個月hr-HPV病毒載量低于對照組(P0.01);術(shù)后6個月,觀察組Survivin和Ki67陽性表達(dá)情況弱于對照組(P0.05),觀察組Survivin陰轉(zhuǎn)率為73.97%,高于對照組的56.34%(χ~2=4.938,P0.05),觀察組Ki67陰轉(zhuǎn)率為80.82%,高于對照組的59.15%(χ~2=8.067,P0.01);術(shù)后3個月觀察組IFN-γ,IL-2和IL-12水平均高于對照組,IL-4和IL-10水平均低于對照組(P0.01)。結(jié)論:采用化濕解毒湯干預(yù)CIN高危型HPV感染LEEP術(shù)后患者,能提高患者的臨床治療效果,能促使hr-HPV陰轉(zhuǎn),降低病毒載量,能降低Survivin和Ki67陽性表達(dá),并調(diào)節(jié)Th1/Th2平衡,從而起到控制CIN向?qū)m頸癌轉(zhuǎn)變,改善其預(yù)后。
[Abstract]:Objective: to investigate the clinical effect of Huashi jiedu decoction (Huishjiedu decoction) on the patients with damp and heat betting syndrome after LEEP operation in high grade CIN patients with high risk of HPV infection. The effects of apoptosis suppressor gene (survivin), proliferating cell nuclear antigen (PCNA) Ki67) and HPV viral load on prognosis were discussed. Methods: 160 cases of high risk HPV infected with CIN were generated by SAS software. The patients in the two groups were divided into observation group and control group randomly according to the ratio of 1: 1. The patients in both groups were treated with LEEP. The control group was treated with recombinant human interferon 偽 -2 b gel for 10 days as a course of treatment. Three menstrual cycles were used altogether. The observation group was treated with Huashi jiedu decoction on the basis of the treatment in the control group. The positive expression of survivin Ki67 and the HPV-DNAvirus load of human papillomavirus (HPV-HPV-DNA) gene were detected before and 6 months after the operation, and the evaluation of chronic cervicitis and damp-heat betting syndrome were performed before and 3 months after the operation. The levels of IFN- 緯, IL-10, IL-12, IL-2) and IL-4IL-4 were measured before and 3 months after operation. Results: the total effective rate was 94.52 in the observation group and 94.52 in the control group. 81.69, which was higher in the observation group than in the control group (蠂 ~ (2) 2) 6.691n (P0.05), the total effective rate of TCM syndrome in the observation group was 95.89 and 78.87 in the control group, which was higher than that in the control group (蠂 ~ (2) 2) 9.529 (P0.01); 6 months after operation, the total effective rate of TCM syndromes in the observation group was 95.89 and 78.87, respectively. The negative conversion rate of high-risk human papillomavirus (HPV) was 91.78 in the observation group and 77.46 in the control group, which was higher in the observation group than in the control group (蠂 ~ (2 +) 5.699) P0.05.The hr-HPV viral load in the observation group was lower than that in the control group at 6 months after operation (P 0.01), and at 6 months after operation, the viral load of hr-HPV in the observation group was lower than that in the control group. The positive expression of Survivin and Ki67 in the observation group was weaker than that in the control group (P 0.05). The negative conversion rate of Survivin in the observation group was 73.97, which was higher than that in the control group (56.34%) (蠂 ~ 2 = 4.938, P 0.05), and the negative conversion rate of Ki67 in the observation group was 80.82%, which was higher than that in the control group (59.15%) (蠂 ~ (28.067) P 0.01). The levels of IL-2 and IL-12 in the observation group were higher than those in the control group 3 months after operation. Conclusion: Huashi jiedu decoction is used to treat the patients with CIN high risk HPV infection after LEEP operation, and the level of IL-10 is lower than that of the control group (P 0.01). It can improve the clinical therapeutic effect of patients, promote the negative conversion of hr-HPV, reduce the viral load, decrease the positive expression of Survivin and Ki67, and regulate the balance of Th1/Th2, so as to control the transition of CIN to cervical cancer and improve its prognosis.
【作者單位】： 河南大學(xué)淮河醫(yī)院;
【基金】：河南省高等學(xué)校重點(diǎn)科研計劃項目(17A320023)
【分類號】：R737.33

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本文編號：1611728