目的 讨论不同类型子宫内膜病变中医证候、证素的分布特点.方法 采用流行病学调查方法,收集子宫内膜病变患者中医四诊信息,根据症状出现的频率,对筛选出的31个主要症状进行判定与统计分析.结果 经因子分析共提取14个公因子,累计贡献率为72.6％.增生不伴非典型(endometrial hyperplasia without atypia,EHWA)病位证素以肝、脾为主,病性证素以湿、气滞、气虚为主,证候以肝郁气滞证为主,其次为脾虚痰湿证;增生伴非典型(atypical endometrial hyperplasia,AEH)病位证素以脾、肝为主,病性证素以湿、痰、热、气滞为主;子宫内膜癌(endometrial carcinoma,EC)病位证素以脾、肝为主,病性证素以湿、痰、热为主;AEH和EC以脾虚痰湿证和脾虚湿热证为主.结论 利用因子分析方法在一定程度上揭示了不同类型子宫内膜病变证候、证素的分布特点,其恶变的关键阶段为AEH,发挥中医药优势,延缓、阻断甚至逆转该演变过程是防治子宫内膜病变由良性向恶性转化的有效途径.

目的:探讨莪七煎膏对子宫肌瘤模型大鼠的治疗机制.方法:取同日龄雌性SD大鼠随机分为正常组和造模组,造模组采用雌激素、孕激素联合诱导法构建子宫肌瘤模型大鼠.将造模大鼠随机分为模型组、西药组(米非司酮组)、中药组(莪七煎膏组),连续给药4周,观察各组大鼠离体子宫肉眼形态及组织学形态,比较各组大鼠子宫组织平滑肌层增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)和凋亡抑制基因Bcl-2蛋白的表达.结果:与模型组比较,中药组大鼠子宫组织形态学明显改善、充血减轻,子宫平滑肌细胞PCNA及Bcl-2的表达量均显著低于模型组(P＜0.05).结论:莪七煎膏能改善雌激素、孕激素负荷子宫肌瘤大鼠子宫局部血液循环,降低子宫组织平滑肌层PCNA和Bcl-2蛋白的表达,具有祛瘀和抗子宫平滑肌瘤样增生的作用.

目的研究高、低浓度金雀异黄素对雌激素受体（ER）阳性人子宫内膜癌Ishikawa细胞增殖、集落形成及ERα/ERβ蛋白表达比值影响的差异。方法以ER阳性人子宫内膜癌Ishikawa细胞为研究对象,正式实验前用Opti-MEM无酚红减血清培养基培养24 h,然后分为金雀异黄素低浓度组、高浓度组及溶剂对照组,依次加入由2%DCS-FBS的Opti-MEM无酚红减血清培养基配置所需浓度的金雀异黄素药液及含0. 5‰DMSO的培养液。应用CCK-8法检测高浓度（10、25、50μmoL/L）和低浓度（0. 001、0. 01、0. 1、1μmoL/L）的金雀异黄素干预Ishikawa细胞24、48、72 h对增殖的影响。平板集落形成实验检测高浓度（25、50μmoL/L）和低浓度（0. 01、0. 1μmoL/L）金雀异黄素干预1周对集落形成的影响。用Western blot法检测高浓度（25、50μmoL/L）和低浓度（0. 01、0. 1μmoL/L）金雀异黄素干预48 h后对ERα/ERβ蛋白表达比值的影响。结果低浓度（0. 001、0. 01、0. 1μmoL/L）范围内金雀异黄素促进Ishikawa细胞增殖,在干预48 h后最明显,0. 1μmoL/L浓度促增殖作用达到最强（P ＜0. 01）;高浓度时（10、25、50μmoL/L）抑制细胞增殖（P ＜0. 05）,且呈时间和浓度的依赖性,50μmoL/L浓度下干预72 h后抑制作用达到最强（P ＜0. 01）。低浓度金雀异黄素的集落形成率分别为14. 60%和15. 13%,和溶剂对照组（12. 20%）相比有统计学差异（P＜0. 05）;高浓度集落形成率分别为6. 07%、4. 27%,显著低于溶剂对照组（P ＜0. 01）。高浓度和低浓度下ERα蛋白表达均上调,且在0. 1μmoL/L时达到最高; ERβ蛋白表达均下降,在25、50μmoL/L时达到最低; ERα/ERβ蛋白比值均明显上调,在0. 1μmoL/L时达到最高。结论低浓度金雀异黄素具有促ER阳性Ishikawa细胞生长的作用,可能通过上调ERα/ERβ蛋白表达比值实现;高浓度金雀异黄素虽然也可以上调ERα/ERβ蛋白表达比值,但可能存在其他非ER依赖机制主导发挥抑制Ishikawa细胞生长的作用。

Objective To observe the curative effect of Modified Zhibai Dihuang Decoction (MZBDHD) to treat polycystic ovary syndrome (PCOS) hyperandrogenism (HT) patients with yin deficiency induced fire hyperactivity syndrome (YDIFHS).Methods Totally 45 PCOS HT patients with YDIFHS were randomly assigned to the MZBDHD group (30 cases) and the Diane-35 group (DG,15 cases).Patients in the MZBDHD group took MZBDHD from the 5th day of menstrual cycle for 28 successive days,while those in the DG group took Diane-35 according to routine methods (starting from the 5th day of menstrual cycle at 2 mg per day for 21 successive days,and then with an interval of 7 days).Levels of serum testosterone (T),luteinizing hormone (LH),follicle stimulating hormone (FSH),prolactin (PRL),estrogen (E2),liver functions (ALT and AST),and acne score (Rosenfield score),menstrual cycle score,menstrual flow score,basal body temperature (BBT) were observed before and after treatment.Biphasic rate of BBT was calculated.Results (1) Compared with before treatment,serum T level significantly decreased in the two groups (P ＜0.01),but with no statistical difference between the two groups (P ＞0.05).Compared with before treatment,serum LH level decreased significantly in the DG group after treatment (P ＜0.01).There was no statistical difference in levels of serum E2,FSH,or PRL between the two groups (P ＞0.05).(2) Compared with before treatment,acne score and menstrual cycle score were significantly lower in the two groups (P ＜0.05).There was no statistical difference in acne score between the two groups after treatment (P ＞0.05).The menstrual cycle score was obviously lower in the DG group than in the MZBDHD group (P ＜0.01).There was no statistical difference in menstrual flow score between the two groups after and before treatment (P ＞0.05).(3) Biphasic BBToccurred in 7 cases of the MZBDHD group,with the biphasic rate of BBT being 23.3％.No biphasic BBT occurred in the DG group.(4) There was no statistical difference in levels of ALT and AST of the two groups between after treatment and before treatment(P ＞0.05).Conclusions MZBDHD could improve biochemical indices of PCOS HT patients with YDIFHS.It played certain roles in promoting spontaneous ovulation.No adverse effects on liver function was observed.

目的:观察清胃健脾法治疗超重胰岛素抵抗(Insulin Resistance,IR)型多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)的疗效.方法:选取52例BMI＞ 23、证属胃热脾虚合并IR的PCOS患者作为研究对象,予半夏泻心汤加减治疗12周.分别统计治疗前及治疗后空腹和餐后1h、2h的血糖、胰岛素(INS)及雌二醇(E2)、促卵泡素(FSH)、黄体生成素(LH)、睾酮(T)、总胆固醇(CHO)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),计算胰岛素和血糖曲线下面积;治疗4周、8周、12周的妊娠率、基础体温双相率.治疗前、治疗4周、8周、12周月经周期评分、身高、体重、腰围、臀围,计算体重指数(Body Mass Index,BMI)和腰臀比(WHR).结果:1)治疗后胰岛素曲线下面积、餐后2 h INS和TG较治疗前明显降低(P＜0.05);2)治疗前后E2 、FSH、LH、LH/FSH、T无明显统计学意义;3)治疗后累计妊娠率18.2％,基础体温周期双相率53.1％;4)治疗4周、8周、12周后月经周期评分较治疗前均降低(P＜0.05;P＜0.01);5)治疗后4周、8周、12周后腰围较治疗前明显缩小(P＜0.01),BMI及WHR无明显变化.结论:清胃健脾法可提高超重胰岛素抵抗型PCOS患者胰岛素敏感性,降低三酰甘油,促进自发排卵和自主月经的恢复.

升阳散火汤是金元四大家之补土派代表人物李杲的代表方之一，载于《内外伤辨惑论》，由升麻、葛根、独活、羌活、柴胡、防风、人参、白芍、甘草等药物组成，能“发散郁火”，治疗“血虚”或“胃虚火郁”症见“男子妇人四肢发困热，肌热，筋骨间热，表热如火燎于肌肤，扪之烙手。”[1]现代文献报道，该方可用于治疗由于脾胃气虚或湿气下流[2]，导致郁而生热引起的白细胞减少、慢性咽炎、顽固性口腔溃疡、小儿过敏性紫癜性肾炎、糖尿病周围神经病变等疾病[3-7]。笔者在临床实践中发现，部分月经失调、排卵功能障碍患者存在“郁热”的状况，临证合用升阳散火汤能起到事半功倍、立竿见影的效果，现举验案3则以飨同道。