中华中医药学刊

目的 观察补肾活血方联合灌肠治疗对慢性子宫内膜炎合并不孕症患者激素、炎症水平以及妊娠结局的影响。方法 前瞻性选取2022年7月—2024年3月在衡水市人民医院接受治疗的慢性子宫内膜炎(chronic endometritis, CE)患者102例作为研究对象，按照随机数字表法把患者分为对照组和观察组，各51例。对照组采用西医抗感染治疗，观察组同时联合补肾活血方口服及中药灌肠，连续治疗3个月经周期。比较两组的中医证候积分、临床疗效、血清性激素和炎症水平患者妊娠结局以及不良反应等。结果 观察组的总有效率(96.08%,49/51)显著优于对照组(84.31%,43/51),差异具有统计学意义(P<0.05)。干预前，两组患者的主症和次症中医证候积分无明显差异(P>0.05)。干预后，与对照组比较，观察组患者的主症和次症中医证候积分均显著下调(P<0.01)。干预前两组患者的孕酮(progesterone, P)、雌二醇(estradiol 2,E2)和卵泡刺激素(follicle stimulating hormone, FSH)水平无明显差异(P>0.05)。干预后，两组P和FSH均下降，E2均升高，且观察组改善更显著(P<0.01)。干预后，观察组患者的白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-6(interleukin-6,IL-6)和肿瘤坏死因子-α(tumor necrosis factor, TNF-α)水平均显著下调(P<0.01)。观察组患者不良反应发生率(15.68%,8/51)相较于对照组(9.80%,5/51)无明显差异(P>0.05)。与对照组比较，观察组患者的临床妊娠率和胚胎着床率明显上调(P<0.05),而两组异位妊娠率、流产率以及早产率无明显差异(P>0.05)。结论 补肾活血方联合灌肠治疗CE合并不孕症患者能够显著增强疗效，减轻腹痛、月经不调等临床症状，调节激素水平，抑制炎症反应，并改善不孕症患者的妊娠结局。

Objective To observe the effects of Bushen Huoxue Formula(补肾活血方) combined with enema treatment on hormone, inflammation levels and pregnancy outcomes in patients with chronic endometritis complicated with infertility. Method A prospective study was conducted on 102 patients with chronic endometritis who received treatment at Hengshui People's Hospital from July 2022 to March 2024.. The patients were divided into a control group and an observation group according to the random number table method, with 51 patients in each group. The control group received Western medicine anti infection treatment, while the observation group was treated with a combination of Bushen Huoxue Formula orally and traditional Chinese medicine enema for three consecutive menstrual cycles. The traditional Chinese medicine syndrome scores, traditional Chinese medicine syndrome efficacy, serum sex hormone and inflammation levels, pregnancy outcomes and adverse reactions were compared between two groups. Results The total effective rate of the observation group(96.08%,49/51) was significantly better than that of the control group(84.31%,43/51),and the difference was statistically significant(P<0.05). Before intervention, there was no significant difference in the TCM syndrome scores of the main or secondary symptoms between the two groups(P>0.05). After intervention, compared with those of the control group, the TCM syndrome scores of the main and secondary symptoms in the observation group were significantly down-regulated(P<0.01). There was no significant difference in the levels of progesterone(P),estradiol 2(E2) or follicle stimulating hormone(FSH) between the two groups before intervention(P>0.05). After intervention, the levels of P and FSH were down-regulated and the E2 levels up-regulated in the two groups and the changes of the observation group was more obvious(P<0.01). After intervention, the levels of interleukin-1β(IL-1β),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in the observation group were significantly down-regulated(P<0.01). The incidence of adverse reactions in the observation group(15.68%,8/51) showed no significant difference compared to that in the control group(9.80%,5/51)(P>0.05). Compared with those of the control group, the clinical pregnancy rate and embryo implantation rate of the observation group were significantly up-regulated(P<0.05),while there was no significant difference in ectopic pregnancy rate, miscarriage rate or preterm birth rate between the two groups(P>0.05).Conclusion The combination of Bushen Huoxue Formula and enema can significantly enhance the therapeutic effect, alleviate the clinical symptoms such as abdominal pain and menstrual disorders, regulate the hormone levels, inhibit the inflammatory reactions and improve the pregnancy outcomes of infertile patients with chronic endometritis.