Effect on Treatment of Addition and Subtraction Therapy of Zhuyu Zhixuetang to Chronic Endometritis with Syndrome of Qi Deficiency and Blood Stasis / 中国实验方剂学杂志

Objective:To discuss clinical effect of Zhuyu Zhixuetang to chronic endometritis （CE） with syndrome of Qi deficiency and blood stasis and to study improvement effect to pregnancy outcome. Method:One hundred and forty-four patients were randomly divided into two groups， patients in control group were 72 cases and in observation group were 72 cases. In control group， 66 patients completed the therapy because of 4 falling off or missing visit and 2 eliminated， and in observation group， 65 patients completed the therapy because of 3 falling off or missing visit and 5 eliminated. In two groups. anti-infection treatment was gicen to patients. Patients in control group got Fuke Qianjin Pian， 6 tablets/time， 3 times/day. Patients in observation group got Zhuyu Zhixuetang， 1 dose/day. The treatment was continued for 3 months and the follow up was recorded for 6 months. Before and after treatment， changes of menstrual volume， period and cycle were recorded. And hysteroscopy and color Doppler ultrasound of vagina were made， and endometrial morphology and endometrial receptivity were evaluated ［endometrial thickness， resistance index （RI）， pulsation index （PI） and blood flow index （FI）］ were evaluated， and pathology of endometrial were tested. And scores of syndrome of Qi deficiency and blood stasis were graded， levels of interleukin-1 <italic>β</italic> （IL-1<italic> β</italic>）， IL-6 and tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） and T-lymphoid subsets （CD3⁺， CD4⁺， CD8⁺） in peripheral blood were measured. Pregnancy and miscarriage were recorded and the safety was evaluated. Result:After treatment， menstrual volume， menstrual period， cycle and complete normal rate of menstruation in observation group were all higher than those in control group （<italic>P</italic><0.05）. Endometrial thickness and FI were more than those in control group （<italic>P</italic><0.01）， RI and PI were lower than RI and PI in control group （<italic>P</italic><0.01）. And compared with control group， levels of IL-1<italic>β</italic>， IL-6， TNF-<italic>α</italic> and CD8⁺were less （<italic>P</italic><0.01）. And levels of CD3⁺， CD4⁺ and CD4⁺/ CD8⁺ were higher than the data in control group （<italic>P</italic><0.01）. During 6 months follow-up， pregnancy rate in observation group was 46.97% （31/66） was higher than 27.69% （18/65） in control group （<italic>χ</italic>²=5.197， <italic>P</italic><0.05）. Total effective rate of endometrial morphology was 96.97% （64/66） higher than 86.15% （56/65） in control group （<italic>χ</italic>²=4.981， <italic>P</italic><0.05）. Total effective rate endometrial pathology was 95.45% （63/66） higher than 84.62% （55/65） in control group （<italic>χ</italic>²=4.304， <italic>P</italic><0.05）. Total effective rate of comprehensive clinical effect was 93.94% （62/66） higher than 81.54% （55/65） in control group （<italic>χ</italic>²=4.696， <italic>P</italic><0.05）. There was no adverse reactions related to traditional Chinese medicine. Conclusion:Zhuyu Zhixuetang can regulate menstruation， relieve clinical symptoms， improve endometrial morphology under hysteroscopy， regulate systemic and local immune inflammatory response， improve CP， thus improve pregnancy outcome， with better comprehensive effect and safety.

Clinical Observation of Qingre Tiaoxue Decoction Combined with Wuwei Xiaodu Drink in Enema Treatment of Sequelae of Pelvic Inflammatory Disease / 中国实验方剂学杂志

Objective:To discuss clinical effect of comprehensive Qingre Tiaoxue decoction combined with Wuwei Xiaodu drink and enema to sequelae of pelvic inflammatory disease (syndrome of dampness heat stasis) and to study the moderating effect to immune inflammatory factor. Method:One hundred and sixty patients were randomly divided into control group (80 cases) and observation group (80 cases) by random number table. The 73 patients in control group completed the therapy (4 patients were exfoliated or lost to follow-up, 3 patients were eliminate), 74 patients in observation group completed the therapy (4 patients were exfoliated or lost to follow-up, 2 patients were eliminate). Patients in control group got Fuke Qianjin capsules,2 grains/time, 3 times/day, and at the third day after menstruation, addition and subtraction therapy of Wuwei Xiaodu drink with enema for 14 days at every night, 1 dose/day, and enema continued for 2-4 h/day. Based on the treatment of enema in control group, patients in observation group added Qingre Tiaoxue decoction for 3 menstrual cycles, 1 dose/day, and stopping during menstrual cycle. Degree of pelvic pain, dysmenorrhea and the degree of pain in the lower abdomen and lumbosacral in the non menstrual period were evaluated by pain visual simulation score (VAS). Before and after treatment, scores of syndrome of dampness heat stasis, Mc Cormack scale, and Summary of the World Health Organization Quality of Life Measurement Scale (WHOQOL-BREF) scale were graded, and vaginal ultrasonography, culture of cervical secretion and routine examination of leucorrhea were detected. And levels of CD4+, CD8+, CD4+/CD8+, T lymphocyte subsets, tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2) and IL-6 were detected and safety was evaluated. Result:By ANOVA of repeated measurement, after treatment, scores of VAS during dysmenorrheal and VAS during non menstrual period in two groups decreased (P<0.05), and during 3 menstrual cycles, scores of VAS during dysmenorrheal and VAS during non menstrual period in observation group were lower than those in control group (P<0.01). Scores of physical sign and syndrome of damp heat and stasis were lower than those in control group (P<0.01), score of WHOQOL-BREF was higher than that in control group (P<0.01). The depth of pelvic effusion and the volume of pelvic inflammatory mass in observation group were less than those in control group (P<0.01). Levels of CD4+, CD4+/CD8+ and IL-2 were higher than those in control group (P<0.01), and levels of CD8+, TNF-α and IL-6 were lower than those in control group (P<0.01). Comprehensive curative effect in observation group was better than that in control group (Z=2.028, P<0.05). And curative effect of traditional Chinese medicine（TCM） Syndrome in observation group was better than that in in control group (Z=2.064, P<0.05). And there were no serious adverse events and adverse reaction caused by Chinese medicine. Conclusion:Comprehensive therapy of Chinese medicine and enema to sequelae of pelvic inflammatory disease can improve the clinical symptoms and signs, improve the quality of life of patients, and regulate the cellular immune function and inflammatory factors. It has better comprehensive curative effect and TCM syndrome curative effect, and is safe for clinical use.

Effects of estrogen on CD4(+) CD25(+) regulatory T cell in peripheral blood during pregnancy

OBJECTIVE@#To investigate the effects of estrogen (E2) level on regulatory T cells (Treg) in peripheral blood during pregnancy.@*METHODS@#A total of 30 healthy non-pregnant women were selected as control group, 90 pregnant women of early, middle and late pregnancy and 30 postpartum women at 1 month after parturition were selected as experimental groups including early pregnancy group, middle pregnancy group and late pregnancy group; the proportions of CD4(+)CD25(+) Treg and CD4(+)CD25(+)CD127(-) Treg among CD4(+)T cells were detected by flow cytometry; the serum estrogen content in peripheral blood was detected by electrochemical immune luminescence method.@*RESULTS@#E2 level was coincident with the change of Tregs number during pregnancy. The estrogen content in peripheral blood increased gradually from early pregnancy to late pregnancy, then decreased significantly after parturition, and the level at 1 month after parturition down to the level in non- pregnancy group (P>0.05); the level of E2 in pregnancy groups were significantly higher than those in non- pregnancy group (P0.05); the proportions in middle and late pregnancy groups were significantly higher than those in early pregnancy group (P0.05). There was correlation between Tregs number with estrogen level during pregnancy. The proportion of CD4(+) CD25(+) Treg and CD4(+) CD25(+) CD127(-) Treg were positively correlated with estrogen level.@*CONCLUSIONS@#High proportion of CD4(+) CD25(+) Treg and CD4(+)CD25(+)CD127(-) Treg is closely related to the high level of E2 during pregnancy. It suggested that high level of estrogen may induce an increase of CD4(+) CD25(+) Treg in peripheral blood, and then influence the immune function of pregnant women. The results of this experiment might play an important role of estrogen in immune-modulation during pregnancy.