【摘要】 目的 探讨中药痛消饮治疗寒凝血瘀证原发性痛经的效果及对丝裂原活化蛋白激酶/细胞外调节蛋白激酶（mitogen activated protein kinase/extracellular regulated protein kinase, MAPK/ERK）信号通路的影响。方法 选取衡水市中医医院106例寒凝血瘀证原发性痛经患者，按照随机数字表法分为中药组和常规组，各53例。常规组给予布洛芬颗粒治疗，中药组给予中药痛消饮治疗，2组均于月经预来潮前7 d开始服药至月经来3 d后停服，共服用3个月经周期。比较2组疗效、治疗前后COX痛经症状量表（Cox dysmenorrhea symptom scale, CMSS）评分、疼痛视觉模拟评分（visual analog score, VAS）、血清疼痛介质[β-内啡肽（β-endorphins, β-EP）、前列腺素F2α（prostaglandin F2α,PGF2α）、前列腺素E₂（prostaglandin E₂,PGE₂）]水平、外周血单个核细胞MAPK/ERK信号通路相关因子[丝裂原活化细胞外调节激酶（mitogen activated extracellular regulated kinase, MEK）1、MEK2、ERK1、ERK2 mRNA]水平、子宫微循环状态[子宫动脉血流阻力指数（resistance index, RI）、搏动指数（pulsatility index, PI）、收缩期峰值/舒张期峰值（systolic peak/diastolic peak, S/D）]及不良反应发生率。结果 中药组总有效率高于常规组（P<0.05）。2组治疗后VAS评分、CMSS量表持续时间和严重程度评分低于治疗前，且中药组低于常规组（P<0.05）;2组治疗后血清β-EP、PGE₂水平高于治疗前，且中药组高于常规组（P<0.05）;2组治疗后PGF2α水平，外周血单个核细胞MEK1、MEK2、ERK1、ERK2 mRNA相对表达量，子宫动脉PI、RI、S/D低于治疗前，且中药组低于常规组（P<0.05）。2组不良反应发生率比较差异无统计学意义（P>0.05）。结论 中药痛消饮治疗寒凝血瘀证原发性痛经疗效显著，能通过抑制MAPK/ERK信号通路相关因子和疼痛介质表达显著减轻痛经症状，还可改善子宫微循环状态，且安全性良好。更多还原

【Abstract】 Objective To investigate the effect of traditional Chinese medicine Tongxiaoyin on primary dysmenorrhea with syndrome of congealing cold with blood stasis and its effect on mitogen-activated protein kinase/extracellular regulated protein kinase(MAPK/ERK) signaling pathway.Methods A total of 106 patients with primary dysmenorrhea due to cold coagulation and blood stasis syndrome were selected from Hengshui City Hospital of Traditional Chinese Medicine and divided into traditional Chinese medicine group and conventional group according to randomized numerical table method, each with 53 cases.The conventional group was treated with ibuprofen granules, while the traditional Chinese medicine group was treated with Tongxiaoyin.We compared the scores of Cox dysmenorrhea symptom scale(CMSS),pain visual analogue scales(VAS),serum pain mediator levels [β-Endorphin(β-EP),Prostaglandin F2α(PGF2α),Prostaglandin E2(PGE2)],peripheral blood mononuclear cell MAPK/ERK signaling pathway related factor levels [mitogen-activated extracellular signal-regulated kinase(MEK) 1,MEK2,ERK1,ERK2 mRNA],uterine microcirculation status [Uterine arterial blood flow pulsatility index(PI),resistance index(RI),systolic and diastolic blood flow velocity ratio(S/D)] before and after the treatment, and the incidence of adverse reactions between the two groups.Results The total effective rate of the traditional Chinese medicine group was higher than that of the conventional group(P<0.05).The post-treatment VAS score, CMSS duration and severity score of the 2 groups were lower than those before treatment, and they were lower in the traditional Chinese medicine group than in the conventional group(P<0.05); the post-treatment serum β-EP and PGE2 levels of the 2 groups were higher than those before treatment, and they were lower in the traditional Chinese medicine group than in the conventional group(P<0.05); the post-treatment PGF2α levels, the peripheral blood single nucleated cells MEK1,MEK2,ERK1,ERK2 mRNA relative expression, uterine artery PI,RI,S/D were lower than those before treatment, and they were lower in the traditional Chinese medicine group than in the conventional group(P<0.05).The difference in the incidence rate of adverse reactions between the 2 groups was not statistically significant(P>0.05).Conclusion Tongxiaoyin can have a significant therapeutic effect on primary dysmenorrhea due to syndrome of congealing cold with blood stasis.It can significantly alleviate dysmenorrhea symptoms by inhibiting the expression of factors related to the MAPK/ERK signaling pathway and pain mediators, and improving the uterine microcirculation status, with a good safety profile.更多还原