目的 探讨宫颈高危型人乳头瘤病毒(HR-HPV)感染患者的中医证素分布特征,为其临床辨证论治提供客观依据.方法 采用流行病学研究方法,收集210例宫颈HR-HPV感染患者的四诊及相关信息,通过因子分析方法提取相关证候要素.结果 通过因子分析共提取14个公因子,累积方差贡献率为75.99％.结果 表明,宫颈HR-HPV感染者病位证素主要为胞宫、脾、肾、肝、心,病性证素主要为湿、热、阳虚、气虚、气滞、阴虚、血瘀.结论 本研究因子分析结果在一定程度上反映了宫颈HR-HPV感染的主要证素特点,对该病的证候研究有一定参考价值.

目的:探讨丹白颗粒对湿热瘀结型盆腔炎后遗症的疗效及安全性.方法:选取2020年12月至2021年12月北京中医药大学东直门医院、山东省中医院等妇科门诊收治的湿热瘀结型盆腔炎后遗症患者120例作为研究对象,采用随机数字表法将受试者按照1:1的比例分组,经病例脱落后,最终纳入观察组(n=58)和对照组(n=59),共计117例.对照组采用盐酸左氧氟沙星胶囊联合甲硝唑片口服治疗,观察组在对照组的基础上加用丹白颗粒口服,2组均治疗2周.比较2组的临床疗效、视觉模拟评分法(VAS)评分、健康调查量表36(SF-36)、C反应蛋白(CRP)、红细胞沉降率(ESR)、阴道分泌物清洁度、下腹痛消失时间、带下恢复正常时间及不良事件发生率.结果:观察组的总有效率93.10％(54/58)明显高于对照组的79.66％(37/59)(P<0.05).治疗后2组患者下腹疼痛VAS评分、下腹痛及白带增多的症状消失时间及CRP、ESR均明显降低,SF-36量表评分明显升高(P<0.05),阴道分泌物清洁度明显改善(P<0.05).观察组各项指标均优于对照组(均P<0.05).2组不良反应的发生率差异无统计学意义(P>0.05).结论:在西医常规治疗的基础上联合丹白颗粒可提高湿热瘀结证盆腔炎后遗症的疗效,进一步减轻患者的症状体征和疼痛程度,改善阴道分泌物清洁度,降低炎症指标水平,提高患者生命质量,值得临床借鉴应用.

宫颈癌(CC)是目前世界范围内威胁女性生命健康的第四大癌症相关性疾病[1].我国每年新发CC病例超过50万,占全球报告新发病例数的25％[2].ERK信号转导通路是一类介导细胞反应的重要信号通路,通过将细胞外的刺激信号传递至细胞内,进一步磷酸化下游底物,在细胞分化、增殖过程中发挥重要作用,从而参与多种肿瘤性疾病的发生发展.在CC的相关研究中发现,ERK信号通路上相关蛋白表达异常,现就ERK信号通路与CC相关研究进行综述.

目的:探讨清热除湿凝胶对HR-HPV16阳性宫颈癌细胞荷瘤小鼠模型肿瘤抑制作用及对Bcl-2、Bax蛋白的影响.方法:皮下种植法构建人宫颈癌SiHa细胞荷瘤小鼠模型,造模成功后,按肿瘤体积随机分为5组,即模型组、卡波姆940组(0.15 mL/50 mm3/d外用)、中药组(清热除湿凝胶0.3 mL/50 mm3/d外用)、顺铂组(0.2 mL/10 g/每3天腹腔注射)、联合用药组(清热除湿凝胶与顺铂联合应用),给药期间每周测量一次肿瘤大小及体质量,计算药物对肿瘤生长抑制情况.HE染色法观察肿瘤组织的形态学变化,免疫组化检测肿瘤组织中的Bcl-2及Bax蛋白表达情况.结果:用药干预后,顺铂组及联合用药组荷瘤小鼠体质量下降明显,与模型组、卡波姆940组、中药组比较,差异有统计学差异(P<0.05);中药组、顺铂组、联合用药组肿瘤生长情况与模型组、卡波姆940组比较,差异有统计学差异(P<0.05).HE染色显示中药组、顺铂组、联合用药组荷瘤小鼠肿瘤组织坏死现象较模型组、卡波姆940组明显,其中尤以联合用药组坏死最为突出.免疫组化发现中药组、顺铂组、联合用药组Bcl-2蛋白下调、Bax蛋白上调明显,与模型组、卡波姆940组比较,差异有统计学差异(P<0.05).结论:清热除湿凝胶对HR-HPV16阳性宫颈癌细胞肿瘤生长具有明显抑制作用,且未对其生活质量造成影响,其抑瘤机制可能是通过影响Bcl-2、Bax蛋白表达实现的.

目的 探究高危型人乳头瘤病毒(HR-H-PV)感染的宫颈病变患者中医体质分布特点,分析其临床特征与体质类型的关系,为中医药防治HR-HPV感染导致的宫颈病变提供依据.方法 采用流行病学研究方法,以问卷调查的方式收集135例HR-HPV感染的宫颈病变患者相关信息,进行体质判定,分析其体质分布特点及主要体质类型与宫颈病变程度、HR-HPV感染特点、年龄及p16抑癌蛋白表达强度的关系.结果 HR-HPV感染的宫颈病变患者体质类型所占比例由高到低依次为湿热质、阳虚质、平和质、气虚质、气郁质、阴虚质、痰湿质、血瘀质、特禀质,差异有统计学意义(P＜0.05).不同体质类型患者的宫颈病变程度、HR-HPV感染特点、年龄、p16抑癌蛋白表达强度比较,差异有统计学意义(P＜0.05).结论 HR-H-V感染的宫颈病变患者体质类型以湿热质、阳虚质为主,其体质类型与宫颈病变程度、HR-HPV感染特点、年龄、p16抑癌蛋白表达强度有关.

目的 研究外用中药清热除湿凝胶对人乳头瘤病毒(HPV)16阳性的宫颈癌荷瘤小鼠线粒体凋亡蛋白的影响.方法 培养HPV16阳性人宫颈癌SiHa细胞株,制成浓度为2×107/mL的细胞悬液.选取5周龄雌性裸小鼠,用1 mL注射器抽取充分混匀的细胞悬液,注入裸小鼠右前腿外上方皮下,造成HPV16阳性移植瘤模型.造模成功后采用随机数字表法将荷瘤小鼠分为5组,每组10只.即模型组、卡波姆940组、中药组、顺铂组及联合用药组.中药组于成瘤部位给予清热除湿凝胶外涂(每天每50 mm3瘤体体积外涂凝胶0.3 mL);顺铂组:将10 mg顺铂溶于66.7 mL生理盐水中制成顺铂注射液腹腔注射(每10 g体重注射0.2 mL,每3天注射1次);卡波姆940组(凝胶中辅料):卡波姆940外涂(每天每50 mm3体积外涂0.15 mL);联合用药组:同时给予中药外涂和顺铂腹腔注射,各组共给药28 d.而后麻醉剥取小鼠右前腿肿瘤组织,免疫荧光法进行检测细胞凋亡,同时Western blot法检测组织中凋亡相关蛋白Bax、Bcl-2、Caspase-9、Caspase-3.结果 与模型组、卡波姆940组比较,中药组、顺铂组、联合用药组细胞凋亡率均有升高,以联合用药凋亡率最高,差异有统计学意义(P<0.05);而卡波姆940组与模型组细胞凋亡率比较,差异无统计学意义(P>0.05).与模型组、卡波姆940组比较,中药组、顺铂组、联合用药组Bax、Caspase-3表达均上调,Bcl-2表达均下降,且联合用药组表达最明显,差异有统计学意义(P<0.05).与模型组、卡波姆940组比较,顺铂组、联合用药组Caspase-9表达上调,差异有统计学意义(P<0.05).结论 清热除湿凝胶能改变HPV16阳性的宫颈癌荷瘤小鼠的细胞凋亡,该外用药发挥抗毒抑瘤作用的机制可能与上调肿瘤组织线粒体凋亡相关蛋白Bax、Caspase-9、Caspase-3,下调Bcl-2有关.

目的:观察ERK及P38/MAPK信号通路在紫柏凝胶影响宫颈癌裸鼠移植瘤致癌蛋白E6、E7表达中的作用.方法:体外培养Siha细胞,成功建立人宫颈癌荷瘤裸鼠模型,随机分为模型组,顺铂组(腹腔内注射0.5 ml顺铂,4 d1次),紫柏凝胶高、中、低剂量组(外用紫柏凝胶0.9428、0.4714、0.2357 g/kg,1 d1次),试验期28 d.称取瘤重并测量瘤体积,HE染色观察移植瘤组织病理学变化,免疫组化SP法检测瘤体中的p-p38、p-ERK、E6及E7蛋白表达水平.结果:紫柏凝胶各组的裸鼠肿瘤体积均明显小于模型组(P＜0.05),高、中、低剂量组抑瘤率分别为36.23％、31.24％和14.94％.HE染色紫柏凝胶各剂量组移植瘤组织出现明显坏死样改变.与模型组比较,高、中剂量紫柏凝胶组瘤组织的E6、E7蛋白表达水平降低(P＜0.05),同时p-ERK及p-p38蛋白水平明显下降(P＜0.05).结论:紫柏凝胶对HPV(+)宫颈癌Siha细胞裸鼠移植瘤的生长具有明显抑制作用,可下调致癌蛋白E6和E7的表达,其机制可能与抑制ERK及P38/MAPK信号通路有关.

目的 探讨超声弹性成像参数变化对早期预测宫颈癌同步放化疗(CCRT)疗效的临床价值.方法 选择2016年2月-2018年10月在我院经病理确诊的宫颈癌(均为鳞状癌细胞)患者66例,通过超声弹性成像技术评估CCRT后完全缓解组与部分缓解组患者的疗效.结果 CCRT治疗结束后,47例(71.21％)患者病灶完全消失,为完全缓解组;19例(28.89％)部分缓解,为部分缓解组;无进展与稳定患者.治疗1周后与治疗结束时,两组的应变比值均明显降低(P<0.05),且完全缓解组的应变比值明显低于部分缓解组(P<0.05).治疗前,两组的弹性评分、病灶剪切波速度(SWV)比较无统计学差异(P>0.05);治疗1周后与治疗结束时,两组的弹性评分、SWV均明显降低(P<0.05),且完全缓解组的弹性评分明显低于部分缓解组(P<0.05).结论 经超声弹性成像的应变比值、弹性图像评分及SWV可以早期预测宫颈癌CCRT疗效,具有较高的诊断与鉴别价值.

目的 分析宫颈高危型人乳头瘤病毒(High-risk human papillomavirus,HR-HPV)感染者中医体质分布特点,及其与年龄、感染类型的相关性,为中医药治疗宫颈HR-HPV感染提供理论依据.方法 对210例宫颈HR-HPV感染者进行问卷调查,获取相关信息,进行体质判定,采用卡方检验及相关性分析等方法,分析HR-HPV感染者中医体质分布规律及其与相关指标的关系.结果 宫颈HR-HPV感染者以湿热质、阳虚质多见,其次依次为气郁质、平和质、气虚质、血瘀质、痰湿质、阴虚质、特禀质;湿热质、阳虚质与其他体质比较,差异有统计学意义(P<0.01);湿热质、阳虚质者分别多见于20～39岁、40～49岁,组间比较差异有统计学意义(P<0.01);宫颈HR-HPV感染者中湿热质较其他体质双重、三重及以上感染更多见,组间比较差异有统计学意义(P<0.01);宫颈HR-HPV感染者体质与其年龄、感染类型具有相关性(P<0.01).结论 宫颈HR-HPV感染者主要为湿热质和阳虚质,其体质与年龄及感染类型具有相关性,临床治疗应综合考虑感染者的体质、年龄及感染类型.

目的 确定妇科痛经分散片的处方和制备工艺,并建立其质量标准.方法 经过系列单因素筛选,初步确定填充剂、崩解剂等辅料的种类和用量范围,在此基础上通过D-最优混料设计筛选确定,进一步再通过单因素筛选确定助流剂、矫味剂用量,确定妇科痛经分散片处方,并检测其崩解时限、硬度、脆碎度、片重差异、毒性成分3种双酯型乌头生物碱的含量及指标性成分6-姜辣素的含量.结果 妇科痛经分散片的最佳处方为药粉35.00％,微晶纤维素(MCC) 17.90％,山梨醇6.75％,交联聚维酮(PVPP) 19.70％,低取代羟丙基纤维(L-HPC) 17.40％,阿斯巴甜0.75％、柠檬酸1.00％,微粉硅胶1.00％,硬脂酸镁0.50％;平均崩解时限(50.83±1.47)s,平均硬度(6.44±0.27) kg/cm2,平均脆碎度1.95％,片重差异1.09％,未检测到新乌头碱、乌头碱和次乌头碱3种剧毒双酯型生物碱,6-姜辣素质量分数(0.617 0±0.007 9) mg/g.结论 制备的妇科痛经分散片剂外观光洁,崩解时限、硬度、脆碎度、片重差异以及3种双酯型乌头生物碱的含量均符合2015年版《中国药典》要求,指标性成分6-姜辣素含量均匀.

目的 通过挖掘分析王子瑜教授的子宫内膜异位症(EMT)医案信息,探讨王老治疗该病的辨证规律,评价贝叶斯网络在传承老专家经验方面的应用价值.方法 回顾整理王老治疗EMT的门诊医案150例.在王老本人及其学术传承人对症状信息进行辨证的基础上,运用贝叶斯网络方法对症状-证素信息做分类识别,结合王老学术思想分析数据挖掘结果.结果 150例医案的常见证素为血瘀、肾虚、气滞、肝郁、寒凝、湿热.证候要素单纯出现者仅为血瘀证,占12％;证素组合更为常见,占78％;组合者前两位分别为肾虚血瘀证、气滞血瘀证.贝叶斯网络算法对寒凝证、湿热证、气滞证、肝郁证、肾虚证的识别率分别为94.67％、90.67％、86％、82.67％、77.33％.结论 150例医案均存在血瘀证,其中肾虚血瘀、气滞血瘀为最常见证素组合.与王老的“EMT根本上是血瘀证,肝肾功能失调,气血运行逆乱是病机基础”的学术思想完全符合.贝叶斯网络算法在传承老专家学术经验方面具有较好的应用前景,值得进一步推广.

Objective Infrared thermal imaging technology was used to analyze the infrared thermal image of coagulated cold and non-coagulated cold induced dysmenorrhea, and the difference with healthy people. Methods 60 patients with primary dysmenorrhea were involved in this study, including coagulated cold group ( n=30 ) and non-coagulated group ( n=30 ) . 30 healthy cases in the same age were chosen as control group. Infrared thermal imaging were conducted on all cases. The calorific value was detected on 6 zones:upper limb, lower limbs, pelvic cavity, Shenque, Du meridian and Ren merid-ian. SPSS 17. 0 was used to analyze the data. Results ①Compared to control group, the calorific val-ue of pelvic cavity, Shenque, Ren meridian, upper limbs and lower limbs of dysmenorrhea group was sig-nificantly lower, the difference was significant. ② In dysmenorrhea group, significant difference only showed in upper limbs, the calorific value of coagulated cold group was lower than non-coagulated cold group. ③ In coagulated group, the patients with longer dysmenorrhea history, the calorific value was lower. Conclusion The calorific value of upper limbs, lower limbs pelvic cavity, Shenque and Ren me-ridian of primary dysmenorrhea group was significantly lower than healthy group, and the difference was significant in extremities. In dysmenorrhea group, there is no significant difference between coagulated cold group and non-coagulated group.

目的：研究苦参碱对宫颈癌SiHa细胞增殖及其凋亡相关蛋白表达的影响，并探讨其作用机制。方法：苦参碱作用于SiHa细胞，倒置显微镜下观察其形态变化；MTT法检测苦参碱对SiHa细胞增殖的影响，并筛选苦参碱作用的适当浓度及时间。 Western blot法检测所筛选各浓度苦参碱对SiHa细胞凋亡相关蛋白bcl－2与bax表达的影响。结果：同空白对照组相比，苦参碱作用后倒置显微镜下见SiHa细胞出现皱缩、变圆，细胞质浓缩、水泡化等凋亡形态学改变。苦参碱能够抑制SiHa细胞的增殖，且在一定时间、剂量范围内，呈时间－剂量依赖性。苦参碱能降低 bcl－2蛋白表达量，增加bax蛋白表达量，差异具有显著统计学意义（ P＜0．05）。结论：苦参碱对宫颈癌SiHa细胞增殖具有抑制作用，可诱导其细胞凋亡，抑制Bcl －2蛋白表达、促进Bax蛋白表达从而降低Bcl－2／Bax比率可能是其机制之一。

Objective To observe the effects of external use of Zibai gel on cervical high-risk human papilloma virus (HR-HPV) infection.Methods 85 cases with cervical HR-HPV infection were recruited and then divided into two groups quasi-randomly.57 cases in the treatment group were applied with Zibai gel,while 28 cases in control group did not use any medication.The outcome was measured and observed.Results In the treatment group,the load of HR-HPV was reduced in 56 cases (98.24%)compared with only 9 cases (32.14%)in the control group.There was a significant difference between the two groups (Z = -5.770,P <0.05 ).In the treatment group,clinical symptoms were relieved in 56 cases (98.24%),compared with only 3 cases(10.71 %)in the control group.There was a significant difference between the two groups (Z =-7.485,P <0.05 ).Cases of 12 patients from the treatment group were followed up after six months,and the load of HR-HPV showed no significant difference compared with those at the time right after the treatment (Z =-0.405,P >0.05).Conclusion The external use of Zibai gel could reduce the load of HR-HPV, and convert some of high-risk HPV infection negative.According to the results in the six-month follow-up observation,the clinical effect was affirmative.

Objective To investigate the immunological reaction mechanism of medicated serum in Zibai Gelatin for SiHa cells of the cervical cancer infected by high risk human papilloma virus (HPV). Methods Through immunohistochemical comparison and the cell culture, and after medicated serum was administrated to SiHa cells of cervical cancer for 24 h, 48 h, and 72 h, optical densities of IL-6, IL-10, CD83 and TNF-αin the same time but different concentrations and different times but the same concentration were observed. Relationships of dose-effect and time-effect between expressions of IL-6, IL-10, CD83 and TNF-α and medicine action were analyzed by calculating average optical density. Results With the increase of medicine concentration and administration time of Zibai Gelatin, the expressions of IL-6 and TNF-αgradually decreased, while the expressions of CD83 and IL-10 gradually increased (P<0.05). Conclusion Zibai Gelatin with medicated serum can inhibit local inflammatory reaction by improving local immunologic function of cervix, which is beneficial to reduce cervix high-risk HPV.

Objective To observe the effect of Chinese formulation Zibai Gel on cervical high-risk human papillomavirus(HR-HPV) infection and provide the clinical evidence for Chinese medicine treatment.Methods Sixty-two cases of cervical HR-HPV infection patients(damp-heat downward syndrome) were divided into two groups.The treatment group(32 cases) was treated with Zibai Gel and control group(30 cases) was followed-up without treatment.The effects of the two groups was compared after two courses.Results The cure rate of symptom and sign score of treatment group and control group was 28.12%(9/32) and 3.33%(1/30) respectively,and the effective rate was 90.63%(29/32) and 30.00%(9/30),which of the treatment group was superior to the control group(P0.01).The cure rate of virus load of treatment group and control group was 37.5%(12/32) and 10.00%(3/30) respectively,and the effective rate was 81.25%(28/32) and 53.33%(16/30) respectively.The treatment group was better than the control group(P0.05).The Reid score of vaginoscope of treatment group decreased obviously than control group(P0.01).Liquid-based cervical cytology test and pathologic indexes of treatment group were better than control group.Conclusion Zibai Gel can effectively improve the clinical symptom and sign,reduce the virus load,improve the cytologic and pathologic characteristics of cervical HR-HPV infection patients.It is an effective drug in treating cervical HR-HPV infection.

目的:探讨宫颈高危型HPV感染的症状体征特点和中医证型规律,为中医药防治提供依据。方法:回顾整理122例病例并总结上述规律。结果:主要临床症状为白带异常(57.38%)、性交出血(21.32%)、异常流血及腰痛(各19.67%)等,无症状者占18.85%。主要异常体征为柱状上皮异位。中医证候以脾系证候为主,证型以湿热下注为最多(占40.40%)。结论:宫颈高危型HPV感染早期多数无症状和异常体征,病情进展主要出现白带异常、性交出血、阴道异常流血、柱状上皮异位等,中医证型以湿热下注为主。

目的:探讨子宫内膜病变患者中医证候特点及规律。方法:回顾性分析113例子宫内膜病变患者的中医证型和合并疾病,并比较不同程度的子宫内膜病变患者中医证型的变化。结果:随着子宫内膜病变的进展及恶变,中医证型中肝郁化火、湿热蕴结、阴虚火旺等具有火热之邪的证型逐渐增多。结论:火热之邪是促进子宫内膜恶变的病因之一。

Objective To explore the law of Chinese medicine syndrome differentiation of female endometrial lesion so as to provide the evidence for the treatment with Chinese medicine.Methods By retrospective collection of 113 inpatients of endometrial lesion in gynecological department of Dongzhimen Hospital from January 2005 to January 2010,it was found that of the cases,50 cases(A group)were simple hyperplasia,15 cases were complex hyperplasia and 9 cases were atypical hyperplasia(both were in B group),and 39 cases(C group)were endometrial carcinoma.Macroscopically,based on syndrome differentiation of eight principles,four types of syndromes were analyzed.The cases with cold,heat,deficiency or excess syndrome in each group were recorded,and the constructional proportion of syndromes was analyzed statistically.Results In A group,there were 16 cases(32.00%)of heat syndrome and 34 cases(68.00%)of cold syndrome.In B group,there were 14 cases(58.33%)of heat syndrome and 10 cases(41.67%)of cold syndrome.In C group,there were 32 cases(82.05%)of heat syndrome and 7 cases(17.95%)of cold syndrome.In comparison of the data among three groups,the difference was significant statistically(P0.01).Concerning to heat syndromes among groups,there were 11 cases(68.75%)of excess heat syndrome and 5 cases(31.25%)of deficiency heat syndrome in A group;there were 6 cases(42.86%)of excess heat syndrome and 8 cases(57.14%)of deficiency heat syndrome in B group and there were 10 cases(31.25%)of excess heat syndrome and 22 cases(68.75%)of deficiency heat syndrome in C group.In comparison of the data between A group and C group,the difference was significant statistically(P0.05).Conclusion With the lesion development,the cases of cold syndrome of endometrial lesion decrease and those of heat syndrome increase gradually.Deficiency cold syndrome is predominated in benign lesion and deficiency heat syndrome presents mainly in malignant lesion.

目的:观察少腹逐瘀汤加减治疗原发性痛经的临床疗效。方法:选取在门诊就诊的88例符合寒凝血瘀型原发性痛经的患者,给予少腹逐瘀汤加减,根据症状评分进行治疗前后的自身对照,观察方药的疗效。结果:88例患者,痊愈15例(17.05%),显效34例(38.64%),有效18例(20.45%),无效21例(23.86%),总有效率为76.14%。结论:少腹逐瘀汤加减治疗寒凝血瘀型原发性痛经疗效肯定,总体有效率为76.14%,尤其对于轻中度痛经疗效尤佳。