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目的:探讨化湿解毒汤对高级别CIN高危型HPV感染者LEEP术后湿热下注证患者的临床疗效,并从凋亡抑制基因即生存素(Survivin)和增殖细胞核抗原(Ki67)表达及HPV病毒载量等方面探讨了其对转归的影响。方法:将160例CIN高危型HPV感染者,采用SAS软件生成,随机按1∶1比例分为观察组和对照组。两组患者均给予LEEP术治疗。术后对照组给予重组人干扰素α-2 b凝胶宫颈外涂,连续10 d为1个疗程,共使用3个月经周期。观察组在对照组治疗的基础上加用化湿解毒汤内服,1剂/d。连续服用3个月经周期,再行3个月经周期随访。检测术前和术后6个月患者Survivin,Ki67水平阳性表达情况和人乳头瘤病毒(HPV)DNA基因(HPV-DNA)病毒载量;进行术前和术后3个月慢性宫颈炎和湿热下注证的评价;检测术前和术后3个月宫颈局部灌洗液γ-干扰素(IFN-γ),白细胞介素-10(IL-10),白细胞介素-12(IL-12),白细胞介素-2(IL-2)和白细胞介素-4(IL-4)水平。结果:观察组临床疗效总有效率为94.52%,对照组为81.69%,观察组高于对照组(χ~2=6.691,P<0.05);治疗后观察组中医证候疗效总有效率为95.89%,对照组为78.87%,观察组高于对照组(χ~2=9.529,P<0.01);术后6个月,观察组高危型人乳头瘤病毒(hr-HPV)阴转率为91.78%,对照组为77.46%,观察组高于对照组(χ~2=5.699,P<0.05);观察组患者在术后6个月hr-HPV病毒载量低于对照组(P<0.01);术后6个月,观察组Survivin和Ki67阳性表达情况弱于对照组(P<0.05),观察组Survivin阴转率为73.97%,高于对照组的56.34%(χ~2=4.938,P<0.05),观察组Ki67阴转率为80.82%,高于对照组的59.15%(χ~2=8.067,P<0.01);术后3个月观察组IFN-γ,IL-2和IL-12水平均高于对照组,IL-4和IL-10水平均低于对照组(P<0.01)。结论:采用化湿解毒汤干预CIN高危型HPV感染LEEP术后患者,能提高患者的临床治疗效果,能促使hr-HPV阴转,降低病毒载量,能降低Survivin和Ki67阳性表达,并调节Th1/Th2平衡,从而起到控制CIN向宫颈癌转变,改善其预后。
Objective: To investigate the clinical curative effect of Huashi Jiedu Decoction on patients with high-level CIN high-risk HPV infection after LEEP, and to detect the expression of survivin and proliferating cell nuclear antigen (Ki67) Viral load and other aspects of its impact on the outcome. Methods: 160 cases of CIN high risk HPV infection were generated by SAS software and randomly divided into observation group and control group according to the ratio of 1: 1. Two groups of patients were given LEEP surgery. Postoperative control group was given recombinant human interferon alpha-2 b gel cervical topical application, continuous 10 d for a course of treatment, a total of 3 menstrual cycle. Observation group in the control group based on the treatment plus Huashi Jiedu Tang oral, 1 / d. Take 3 menstrual cycles continuously and follow up 3 menstrual cycles. To detect the positive expression of Survivin and Ki67 and the HPV-DNA viral load in preoperative and postoperative 6 months, and chronic cervicitis and damp-heat 3 months before and 3 months after operation The evaluation of betting card was performed. The levels of IFN-γ, IL-10 and IL-12 in cervical local lavage fluid before and 3 months after operation were measured. ), Interleukin-2 (IL-2) and interleukin-4 (IL-4) levels. Results: The total effective rate was 94.52% in the observation group and 81.69% in the control group, and the observation group was higher than the control group (χ ~ 2 = 6.691, P <0.05). The total effective rate of the TCM syndromes in the observation group after treatment was 95.89 %, The control group was 78.87%, the observation group was higher than the control group (χ ~ 2 = 9.529, P <0.01); 6 months after operation, the negative conversion rate of the high-risk human papillomavirus (hr- %, The control group was 77.46%, the observation group was higher than the control group (χ ~ 2 = 5.699, P <0.05); the hr-HPV viral load of the observation group was lower than that of the control group ; The expression of Survivin and Ki67 in observation group was weaker than that in control group at 6 months after operation (P <0.05). Survivin conversion rate was 73.97% in observation group, which was higher than 56.34% in control group (χ ~ 2 = 4.938, P <0.05). The negative conversion rate of Ki67 in the observation group was 80.82%, which was higher than 59.15% (χ ~ 2 = 8.067, P <0.01) in the control group. The levels of IFN-γ, IL- 12 levels were higher than the control group, IL-4 and IL-10 levels were lower than the control group (P <0.01). Conclusion: The intervention of Huashi Jiedu Decoction in patients with LEEP after CIN high-risk HPV infection can improve the clinical curative effect, promote the negative conversion of hr-HPV, decrease the viral load, decrease the expression of Survivin and Ki67, and regulate Th1 / Th2 balance, which play a role in controlling the CIN cervical cancer change, improve its prognosis.