【摘要】 【目的】探讨补肾活血中药对无排卵功能失调性子宫出血(功血)子宫内膜Bcl-2、Bax蛋白表达的影响。【方法】将37例患者随机分为中药组(25例)和西药组(17例),中药组给予补肾活血中药宫血饮(主要由补骨脂、川续断、山茱萸、蒲黄、三七、党参、生龙骨、生牡蛎、白花蛇舌草等组成)治疗,西药组给予安宫黄体酮治疗。两组均以1个月经周期为1个疗程,连用3个疗程。采用免疫组化SP(Histostain-Plus)法检测治疗前后子宫内膜Bcl-2和Bax蛋白表达,并与10例正常对照组进行比较。【结果】无排卵功血患者无论其子宫内膜呈增生期或是增生性改变,其子宫内膜Bcl-2表达均高于正常对照组的分泌期(P<0.01),且从增生期到增殖症到复杂性增生的的子宫内膜Bcl-2表达逐渐降低,以增生期内膜的Bcl-2表达最强。而Bax的表达与Bcl-2恰好相反,与正常对照组的分泌期内膜比较,增生期或是增生性改变的子宫内膜Bax的表达均呈较低水平(P<0.01),且从增生期到增殖症到复杂性增生的子宫内膜Bax的表达逐渐增强,以复杂性增生内膜的Bax表达最强。经治疗后,两组患者的子宫内膜Bcl-2表达均降低,而Bax表达均增高(与治疗前比较,P<0.01),但两治疗组间比较差异无显著性意义(P>0.05)。【结论】合成孕激素和补肾活血中药均能降低子宫内膜Bcl-2的表达而增强Bax的表达,从而诱导无排卵功血患者子宫内膜细胞凋亡的发生,但二者作用途径可能不同。更多还原

【Abstract】 Objective To explore the therapeutic mechanism of kidney-tonifying and blood-activating herbal medicine for anovulatory dysfunctional uterine bleeding(ADUB).Methods Thirty-seven ADUB patients were randomized into two groups.Group A(N=25)was treated with Gongxue Yin(mainly composed of Fructus Psoraleae,Radix Dipsaci,Fructus Corni,Pollen Typhae,Radix Notoginseng,Radix Codonopsis,Os Draconis,Concha Ostreae,Herba Hedyotis Diffusae),and group B(N=17)received medroxyprogesterone.One menstrual cycle constituted one treatment course and the treatment lasted 3 continuous courses.Histostain-plus(HP)immunohistochemical assay was adopted to test the Bcl-2 and Bax protein expression in endometrium of the two groups.Ten healthy volunteers served as the control.Results Bcl-2 protein expression was higher in endometrium of ADUB patients at proliferative stage or with proliferative changes than that at secretory phase of the normal control group(P<0.01),and the Bcl-2 protein expression level in patients at proliferative stage,in patients with proliferative changes and in patients with complex proliferation was in a decreasing sequence.Bax protein expression was lower in endometrium of ADUB patients at proliferative stage or with proliferative changes than that at secretory phase of the normal control group(P<0.01),and the Bax protein expression level in patients at proliferative stage,in patients with proliferative changes and in patients with complex proliferation was in a increasing sequence,in particular in patients with complex proliferation.After treatment,Bcl-2 protein expression decreased and Bax protein expression increased(P<0.01 compared with those before treatment)in the two groups,the difference being insignificant between the two groups(P>0.05).Conclusion Both progesterone and kidney-tonifying and blood-activating herbal medicine decrease endometrial Bcl-2 protein expression and increase Bax expression,by which inducing the endometrial cell apoptosis in patients with anovulatory dysfunctional uterine bleeding.But their detailed mechanism may be different.更多还原