Objective  To investigate the clinical effect of oral Huayuxiaozheng granules combined with retention-enema with Zhitongxiaozheng granules on the basis of gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of recurrent endometriosis (EMT).

Methods  168 patients with re-current EMT were randomly divided into four groups (group A, B, C and D) with 42 cases in each group. Group A was treated with leuprorelin acetate microspheres, group B was treated with oral Huayuxiaozheng granules on the basis of group A, group C was treated with retention-enema with Zhi-tongxiaozheng granules on the basis of group A, and group D was treated with oral Huayuxiaozheng granules combined with retention enema with Zhitongxiaozheng granules on the basis of group A. The changes of main clinical symptoms, quality of life, the serum levels of carbohydrate antigen-125 (CA125) and vascular endothelial growth factor (VEGF) before and after treatment in four groups were compared, and the clinical efficacy and adverse reactions of the four groups were observed.

Results  After treat-ment, the scores of clinical symptoms and quality of life as well as the levels of serum CA125 and VEGF in the four groups were lower than those before treatment (P<0.05), the above scores and levels of the group B, C and D were significantly lower than those of group A (P<0.05) and the above score and level of the group D were significantly lower than those of group B and C (P<0.05), but there was no signifi-cant difference in the above scores and levels between group B and C (P>0.05).  The total effective rate of group D was higher than that of group A (P<0.0083),  but it was not statistically different from the total effective rates of group B and group C (P>0.0083). There was no statistically significant difference in the incidence of adverse reactions among the four groups (P>0.05).

Conclusion  On the basis of treatment with GnRH-a leuprorelin acetate microsphere, the application of oral Huyuxiaozheng gran-ules combined with retention-enema with Zhitongxiaozheng granules in the treatment of recurrent EMT can alleviate the clinical symptoms, improve patients’ quality of life, reduce the levels of serum CA125 and VEGF, and has good effect.

1. Saunders P, Horne A. Endometriosis: Etiology, pathobiology, and therapeutic prospects[J]. Cell, 2021, 184(11): 2807-2824. DOI: 10.1016/j.cell.2021.04.041.

2. 孟侠, 王静依, 刘海凤, 等. 醋酸亮丙瑞林对子宫内膜异位症患者VEGF和CEA及CA125水平的影响[J]. 贵州医科大学学报, 2020, 45(1): 97-101. [Meng X, Wang JY, Liu HF, et al. Effect of lepirelin acetate on VEGF, CEA and CA125 levels in patients with endometriosis and safety analysis[J]. Journal of Guizhou Medical Univer-sity, 2020, 45(1): 97-101. [DOI: 10.19367/j.cnki.1000-2707.2020.01.019.

3. 郭亚楠, 单娇, 刘雁峰, 等. 琥珀散联合GnRHa抑制子宫内膜异位症术后复发[J]. 中医学报, 2020, 35(7): 1534-1537. [Guo YN, Shan J, Liu YF, et al. Hupo powder combined with GnRHa in inhibiting the recur-rence of endometriosis after operation[J]. Acta Chinese Medicine, 2020, 35(7): 1534-1537.] DOI: 10.16368/j.issn.1674-8999.2020.07.342.

4. Yang Y, Zhu W, Chen S, et al. Laparoscopic surgery combined with GnRH agonist in endometriosis[J]. J Coll Physicians Surg Pak, 2019, 29(4): 313-316. DOI: 10.29271/jcpsp.2019.04.313.

5. Wang X, Shi Y, Xu L, et al. Traditional Chinese medicine prescription Guizhi Fuling Pills in the treatment of endometriosis[J]. Int J Med Sci, 2021, 18(11): 2401-2408. DOI: 10.7150/ijms.55789.

6. 孙新慧, 张秀平, 郭亚楠, 等. 基于网络药理学研究琥珀散治疗子宫内膜异位症的作用机制[J]. 中国药师, 2020, 23(12): 2356-2365. [Sun XH, Zhang XP, Guo YN, et al. Study on the mechanism of amber powder in the treatment of endometriosis based on network pharmacology[J]. China Pharmacist, 2020, 23(12): 2356-2365.] DOI: 10.3969/j.issn.1008-049X.2020.12.011.

7. 周丽, 叶梅君. 中西医结合对子宫内膜异位症湿热瘀阻证及基质金属蛋白酶的影响[J]. 中华中医药学刊, 2018, 36(8): 2042-2045. [Zhou L, Ye MJ. Combination of traditional Chinese and western medicine with syndrome of heat-damp and blood stasis and effect on level of matrix metalloproteinase[J]. Chinese Archives of Traditional Chinese Medicine, 2018, 36(8): 2042-2045.] DOI: 10.13193/j.issn.1673-7717.2018.08.067.

8. 张晓甦. 消癥止痛方[J]. 江苏中医药, 2015, 47(12): 26. [Zhang XS. Xiaozheng Zhitong Fang prescription[J]. Jiangsu Journal of Traditional Chinese Medicine, 2015, 47(12): 26.] DOI: CNKI:SUN:JSZY.0.2015-12-014.

9. 康瑾婕, 陈清心, 陈兵. 桂枝茯苓胶囊联合中药保留灌肠治疗子宫内膜异位症的临床效果分析[J]. 中国妇幼保健, 2021, 36(16): 3688-3690. [Kang JJ, Chen QX, Chen B. Clinical effect analysis of Guizhi Fuling capsule combined with traditional Chinese medicine retention enema in the treatment of endometriosis[J]. Maternal and Child Health Care of China, 2021, 36(16): 3688-3690.]DOI: 10.19829/j.zgfybj.issn.1001-4411.2021.16.010.

10.谢幸, 苟文丽. 妇产科学(第8版)[M]. 北京: 人民卫生出版社, 2013: 345.

11.张玉珍. 中医妇科学[M]. 北京: 中国中医药岀版社, 2007: 124 -136, 308 -313.

12.李祥云. 实用妇科中西医诊断治疗学[M]. 北京: 中国中医药出版社, 2005: 100.

13.王曼, 俞瑾, 钱祖淇. 子宫内膜异位症、妊娠高血压综合征及女性不孕症的中西医结合诊疗标准[J]. 中国中西医结合杂志, 1991, 11(6): 376-379. [Wang M, Yu J, Qian ZQ. Diagnosis and treatment standards of endometri-osis, pregnancy induced hypertension syndrome and female infertility with integrated traditional Chi-nese and western medicine[J]. Chinese Journal of Integrated Traditional and Western Medicine, 1991, 11(6): 376-379.]DOI: 10.7661/CJIM.1991.6.376.

14.Jones G, Jenkinson C, Kennedy S, et al. Development of the short form endometriosis health profile questionnaire: the EHP-5[J]. Qual life Res, 2004, 13(3): 695-704. DOI: 10.1023/B:QURE.0000021321.48041.0e.

15.Zakhari A, Delpero E, McKeown S, et al. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis[J]. Hum Reprod Update, 2021, 27(1): 96-107. DOI: 10.1093/humupd/dmaa033.

16.陈静娴, 林海鹏, 梁雪芳, 等. 益肾逐瘀汤联合醋酸亮丙瑞林微球治疗肾虚痰瘀型子宫内膜异位症的效果[J]. 中国医药导报, 2021, 18(35): 93-96, 109. [Chen JX, Lin HP, Liang XF, et al. Effect of Yishen Zhuyu decoction combined with leuprolide acetate microspheres in the treatment of endometriosis with kidney defi-ciency and phlegm stasis[J]. China Medical Herald, 2021, 18(35): 93-96, 109.] DOI: 1673-7210(2021)12(b)-0093-05.

17.Zhao R, Sun W, Liu Y, et al. Chinese medicine in management of chronic disease endometriosis[J]. Chin J Integr Med, 2020, 26(2): 88-91. DOI: 10.1007/s11655-018-2937-3.

18.倪喆鑫, 程雯, 孙帅, 等. 中药作为子宫内膜异位症保守治疗的一线方案可行性分析[J]. 中国妇幼保健, 2020, 35(1): 178-181. [Ni ZX, Cheng W, Sun S, et al. Feasibility analysis of traditional Chinese medicine as a first-line conservative treatment for endometriosis[J]. Maternal and Child Health Care of China, 2020, 35(1): 178-181.] DOI: 10.19829/j.zgfybj.issn.1001-4411.2020.01.059.

19.Fang Y, Wu LC, Ma K, et al. Paeoniflorin alleviates lipopolysaccharide-induced disseminated intravas-cular coagulation by inhibiting inflammation and coagulation activation[J]. Drug Dev Res, 2020, 81(4): 517-525. DOI: 10.1002/ddr.21647.

20.姜美华, 陈利锋, 韩志武, 等. 复方芪芎方联合甲氨蝶呤治疗肝肾阴虚型类风湿性关节炎疗效的回顾性观察[J]. 药物流行病学杂志, 2022, 31(1): 34-38. [Jiang MH, Chen LF, Han ZW, et al. Retrospective observation on the curative effect of compound Qixiong prescription combined with methotrexate in the treatment of rheumatoid arthritis with liver-kidney Yin deficiency[J]. Chinese Journal of Pharmacoepidemiology, 2022, 31(1): 34-38. ]DOI: 10.19960/j.cnki.issn1005-0698.2022.01.005.

21.Zhang L, Lv, Liu J. Phthalide derivatives with anticoagulation activities from angelica sinensis[J]. J Nat Prod, 2016, 79(7): 1857-1861. DOI: 10.1021/acs.jnatprod.6b00080.

22.周正, 方芳, 王鹏, 等. 益气化瘀平肝滋肾方联合西医治疗高血压视网膜病变临床观察[J]. 药物流行病学杂志, 2021, 30(2): 90-94. [Zhou Z, Fang F, Wang P, et al. Clinical observation on treatment of hypertensive reti-nopathy with Yiqi Huayu Pinggan Zishen recipe combined with western medicine[J]. Chinese Journal of Pharmacoepidemiology, 2021, 30(2): 90-94.] DOI: 10.19960/j.cnki.issn1005-0698.2021.02.003.

23.刘军标, 熊英, 杨堃, 等. 三棱活性成分研究概况及质量标志物的预测分析[J]. 中国药房, 2021, 32(6): 763-768. [Liu JB, Xiong Y, Yang K, et al. Research overview of active ingredients of rhizoma sparganii and prediction analysis of quality indicators[J]. China Pharmacy, 2021, 32(6): 763-768.] DOI: 10.6039/j.issn.1001-0408.2021.06.20.

24.吴丽, 王丽丽, 费文婷, 等. 芍药苷和芍药内酯苷对小鼠疼痛模型的镇痛作用及对β - EP、PGE2的影响[J]. 中华中医药杂志, 2018, 33(3): 915 - 918. [Wu L, Wang LL, Fei WT, et al. Analgesic effect of paeoniflorin and albiflorin on acetic acid induced writhing mice and the expression of β-EP and PGE2[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2018, 33(3): 915-918.] DOI: CNKI:SUN:BXYY.0.2018-03-027.

25.尚坤, 李敬文, 常美月, 等. 延胡索药理作用研究[J]. 吉林中医药, 2019, 39(1): 108-110. [Shang K, Li JW, Chang MY, et al. Research of corydalis yanhusuo pharmacological effects[J]. Jilin Journal of Chinese Medicine, 2019, 39(1): 108-110.] DOI: 10.13463/j.cnki.jlzyy.2019.01.030.

26.刘如秀, 刘宇, 汪艳丽, 等. 当归的药理作用[J]. 西部中医药, 2014, 27(11): 153-156. [Liu RX, Liu Y, Wang YL, et al. Pharmacological actions of Dang Gui[J]. Western Journal of Traditional Chinese Medicine, 2014, 27(11): 153-156.] DOI: 10.3969/j.issn.1004- 6852.2014.11.054.

27.常春艳, 陈晓辉, 赵艳, 等. 化瘀消癥汤保留灌肠治疗子宫内膜异位症的效果及对复发率的影响[J]. 中国医药导报, 2022, 19(17): 100-103 . [Chang CY, Chen XH, Zhao Y, et al. Effect of Huayu Xiaozheng decoction reten-tion enema on endometriosis and its effect on recurrence rate[J]. China Medical Herald, 2022, 19(17): 100-103.] DOI: 1673-7210(2022)06(b)-0100-04.

28.杨新春, 鲍美如, 时光, 等. 少腹逐瘀汤加减联合西医疗法治疗子宫内膜异位症的Meta分析[J]. 世界中医药, 2021, 16(23): 3516-3522. [Yang XC, Bao MR, Shi G, et al. Meta-analysis of modified Shaofu Zhuyu decoction combined with western medicine in the treatment of endometriosis[J]. World Chinese Medicine, 2021, 16(23): 3516-3522.] DOI: 10.3969/j.issn.1673-7202.2021.23.019.

29.刘佳, 曾俊萍, 林蓉蓉, 等. 凝血与炎症因子联合血清CA125在子宫内膜异位症诊断中的价值[J]. 检验医学与临床, 2021, 18(16): 2353-2357. [Liu J, Zeng JP, Lin RR, et al. The value of coagulation and inflammatory fac-tors combined with serum CA125 in the diagnosis of endometriosis[J]. Laboratory Medicine and Clinic, 2021, 18(16): 2353-2357.] DOI: 10.3969/j.issn.1672-9455.2021.16.014.

30.王君, 李霞, 原迪, 等. GnRH-a对子宫内膜异位症患者血清CA125、EMAB及RANTES的影响[J]. 现代生物医学进展, 2015, 15(34): 6686-6688, 6745. [Wang J, Li X, Yuan D, et al. Effect of GnRH-a on the CA125, EMAB and RANTES in patients with endometriosis[J]. Progress in Modern Biomedicine, 2015, 15(34): 6686-6688, 6745.]DOI: 10.13241/j.cnki.pmb.2015.34.021.

31.郁平, 姬小凡, 王敏, 等. 腹腔镜手术联合亮丙瑞林、戊酸雌二醇治疗子宫内膜异位症效果及对腹腔液血管内皮生长因子、糖类抗原125水平影响[J]. 临床误诊误治, 2020, 33(2): 46-51. [Yu P, Ji XF, Wang M, et al. Effects of laparoscopic surgery combined with leuprolide and estradiol valerate on endometriosis and its influ-ence on vascular endothelial rrowth factor and carbohydrate antigen 125 in peritoneal fluid[J]. Clinical Misdiagnosis & Mistherapy, 2020, 33(2): 46-51.] DOI: 10.3969/j.issn.1002-3429.2020.02.011.