目的 探讨桂枝茯苓丸联合地诺孕素片治疗子宫内膜异位症的临床疗效。方法 选取2020年2月—2022年2月在周口市中医院就诊的90例子宫内膜异位症患者，按照随机数字表法将90例患者分为对照组和治疗组，每组各45例。对照组口服地诺孕素片，1片/次，1次/d。治疗组在对照组基础上口服桂枝茯苓丸，9粒/次，2次/d。两组患者连续治疗3个月。观察两组的临床疗效，比较两组的病灶最长直径、疼痛程度以及血清中雌二醇、促黄体生成素、血管细胞黏附因子-1（VCAM-1）、血管内皮生长因子（VEGF）、血清糖类抗原125（CA125）水平。结果 治疗后，治疗组的总有效率88.89%高于对照组的总有效率66.67%，差异有统计学意义（P<0.05）。治疗后，两组病灶最长直径、数字疼痛强度量表（NRS）评分均明显减小（P<0.05），治疗组的病灶最长直径、NRS评分小于对照组（P<0.05）。治疗后，两组雌二醇、促黄体生成素水平较治疗前降低（P<0.05），治疗组的雌二醇、促黄体生成素低于对照组（P<0.05）。治疗后，两组的血清VCAM-1、VEGF、CA125水平均显著降低（P<0.05）；且治疗组的血清VCAM-1、VEGF、CA125水平均显著低于对照组（P<0.05）。结论 桂枝茯苓丸联合地诺孕素片可提高子宫内膜异位症的疗效，有助于减轻疼痛程度，缩小病灶大小，降低激素水平，调节血清VCAM-1、VEGF、CA125水平。

Objective To investigate the clinical effect of Guizhi Fuling Pills combined with Dienogest Tablets in treatment of endometriosis. Methods Patients (90 cases) with endometriosis in Zhoukou Hospital of TCM from February 2020 to February 2022 were divided into control and treatment groups according to random number table method, and each group had 45 cases. Patients in the control group were po administered with Dienogest Tablets, 1 tablet/time, once daily. Patients in the treatment group were po administered with Guizhi Fuling Pills on the basis of the control group, 9 pills/time, twice daily. Patients in two groups were treated for 3 months. After treatment, the clinical efficacies were evaluated, and the longest diameter of the lesion, the degree of pain, and the serum levels of estradiol, luteinizing hormone, VCAM-1, VEGF, and CA125 in two groups were compared. Results After treatment, the total effective rate of the treatment group was 88.89%, which was higher than that of the control group (66.67%), and the difference was statistically significant (P < 0.05). After treatment, the longest diameter of the lesions and the NRS score in two groups were significantly decreased (P < 0.05), and the longest diameter of the lesions and the NRS score in the treatment group were lower than those in the control group (P < 0.05). After treatment, the levels of estradiol and luteinizing hormone in two groups were decreased compared with those before treatment (P < 0.05), and the levels of estradiol and luteinizing hormone in the treatment group were lower than those in the control group (P < 0.05). After treatment, the serum levels of VCAM-1, VEGF, and CA125 in both groups were significantly decreased (P < 0.05). The serum levels of VCAM-1, VEGF, and CA125 in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Guizhi Fuling Pills combined with Dienogest Tablets has clinical curative effect in treatment of endometriosis, can helps to reduce the degree of pain, reduce the size of lesions, reduce hormone levels, and regulate the serum levels of VCAM-1, VEGF, and CA125.

R984

河南省医学教育研究项目（Wjjx2020115）