【目的】 分析产后轻度子宫脱垂发生的危险因素及补中益气汤对血清转化生长因子 β1（TGF-β1）、基质金属蛋白酶 2（MMP-2）、微小 RNA-30d（miRNA-30d）的影响。【方法】 通过盲法、便利抽样、对照原则，回顾性收集唐山市妇幼保健 院 2020年1月至2022年1月接诊的80例产后轻度子宫脱垂患者，将其设为子宫脱垂组；另收集80例同期在唐山市妇幼保健 院就诊的产后无子宫脱垂患者，将其设为健康组。以问卷调查的方式收集2组患者的分娩方式、年龄、产次、孕周、新生儿 体质量和体质量指数（BMI）等基本信息，通过单因素分析、多因素 Logistic回归分析探讨产后子宫脱垂的危险因素。再根据 是否配合中药补中益气汤治疗将子宫脱垂组患者分为观察组和对照组，每组各40例。对照组采用电刺激生物反馈治疗，观 察组在对照组的基础上给予补中益气汤治疗，疗程为 1 个月。观察 2 组患者治疗前后盆底功能及血清 TGF-β1、MMP-2、 miRNA-30d水平的变化情况，并评价2组患者的临床疗效。【结果】（1）单因素分析结果显示，与健康组相比，子宫脱垂组患 者的年龄较大，产次多为2次及以上，分娩方式多为经阴道分娩，超重/肥胖（BMI≥24.0 kg/m2）及会阴撕裂情况占比较高，差 异均有统计学意义（P < 0.05 或 P < 0.01）。（2）多因素 Logistic 回归分析结果显示，年龄、分娩方式、产次、会阴撕裂情况、 BMI是导致产后子宫脱垂发生的危险因素（P < 0.01）。（3）补中益气汤对疗效的影响方面，治疗 1个月后，观察组的总有效率 为95.00%（38/40），对照组为77.50%（31/40）；组间比较（χ2检验），观察组的疗效明显优于对照组（P < 0.05）。（4）补中益气汤 对盆底功能的影响方面，治疗后，2组患者的宫颈口与处女膜缘距离、最大阴道内压、阴道肌电压、Ⅰ类及Ⅱ类肌纤维盆底 肌收缩时间均较治疗前明显改善（P < 0.05），且观察组的改善幅度均明显优于对照组（P < 0.01）。（5）补中益气汤对血清学指标 的影响方面，治疗后，2组患者的血清TGF-β1水平均较治疗前升高（P < 0.05），血清MMP-2、miRNA-30d水平均较治疗前 降低（P < 0.05），且观察组对血清TGF-β1水平的升高幅度及对血清MMP-2、miRNA-30d水平的降低幅度均明显优于对照组 （P < 0.01）。【结论】 产后子宫脱垂的发生与年龄、分娩方式、产次、会阴撕裂情况、BMI等有关；在电刺激生物反馈疗法的 基础上给予补中益气汤治疗，可有效改善患者盆底功能，调节血清TGF-β1、MMP-2、miRNA-30d表达，临床疗效显著。

Objective To analyze the risk factors of postpartum mild uterine prolapse and to investigate the effects of Buzhong Yiqi Decoction on serum transforming growth factor β1（TGF-β1），matrix metalloproteinase 2（MMP-2）， and microRNA-30d（miRNA-30d）. Methods By blinded and controlled methods and through convenience sampling， 80 postpartum patients with mild uterine prolapse were retrospectively collected from Tangshan Maternal and Children Health Hospital from January 2020 to January 2022 ， and they served as the uterine prolapse group. In addition ， 80 postpartum patients without uterine prolapse from the same department of the hospital in the same period served as the healthy group. Questionnaire investigation was performed for collecting the basic information such as delivery manner，age，parity，gestational weeks，neonatal weight and body mass index （BMI）. The risk factors of postpartum uterine prolapse were investigated by univariate analysis and multivariate logistic regression analysis. The patients in the uterine prolapse group were then divided into the observation group and the control group according to the medication of Buzhong Yiqi Decoction or not，with 40 cases in each group. The control group was treated with electromyographic biofeedback therapy（EBT），while the observation group was treated with Buzhong Yiqi Decoction combined with EBT，and the course of treatment for the two groups covered one month. The changes of pelvic floor function and levels of serum TGF - β1， MMP-2， miRNA-30d in the patients of the two groups were observed before and after treatment. After treatment，the clinical efficacy of patients in the two groups was evaluated. Results（1）The results of univariate analysis showed that compared with the healthy group，the patients in the uterine prolapse group were elder，usually had given two childbirths or more by vaginal delivery，and accounted for a high percentage of overweight / obesity（BMI ≥ 24.0 kg / m2）and perineal laceration， the difference being statistically significant（P < 0.05 or P < 0.01）.（2）The results of multivariate logistic regression analysis showed that age，delivery manner，parity，laceration of perineum，and BMI were risk factors for postpartum uterine prolapse（P < 0.01）.（3）After one month of treatment，the total effective rate of Buzhong Yiqi Decoction in the observation group was 95.00%（38 / 40）， while that in the control group was 77.50%（31 / 40）， and the intergroup comparison（tested by chi-square test）showed that the efficacy of the observation group was significantly superior to that of the control group（P < 0.05）.（4）The observation of effects of Buzhong Yiqi Decoction on pelvic floor function showed that after treatment，the distance between the cervix and the hymenal edge，the maximum intravaginal pressure，the voltage of vaginal muscles，the contraction time of pelvic floor muscles of type Ⅰ and Ⅱ muscle fibers in the two groups of patients were significantly improved compared with those before treatment（P < 0.05），and the improvement in the observation group was significantly superior to that in the control group（P < 0.01）.（5）The observation of effects of Buzhong Yiqi Decoction on serological indicators showed the post-treatment serum TGF-β1 levels in the two groups were increased compared with those before treatment（P < 0.05）， and the serum levels of MMP-2 and miRNA-30d were decreased compared with those before treatment（P < 0.05），and the increase of serum TGF- β1 level and the decrease of serum MMP-2 and miRNA-30d levels in the observation group were both significantly superior to those in the control group（P < 0.01）. Conclusion The incidence of postpartum uterine prolapse is related to age， delivery manner，parity，laceration of perineum，BMI，etc. The treatment of Buzhong Yiqi Decoction on the basis of EBT can improve the pelvic floor function of the patients and regulate the expression of serum TGF-β1，MMP-2，and miRNA-30d，and the clinical efficacy is remarkable.

R271.43

河北省中医药管理局中医药类科学研究计划项目（编号：2023207）