【目的】 探讨温肾消癥汤联合地诺孕素对子宫内膜异位症（EMT）的治疗效果及其对子宫超声指标和血清晚期蛋白氧化 产物（AOPP）水平的影响。【方法】 采用倾向性得分匹配及前瞻性研究的方法，收集2020年3月至2023年3月在西安市高陵区 中医医院妇科接受治疗的 525 例肾虚血瘀型 EMT 患者，包括采用地诺孕素治疗者 321 例，加用温肾消癥汤者 204 例，按照 1∶1最邻近匹配法进行匹配，结果成功匹配 304例，分成西药组和中西组各 152例。西药组给予常规西药（地诺孕素）治疗， 中西组在西药组的基础上联合温肾消癥汤治疗，2组均连续治疗6个月。观察2组患者治疗前后子宫超声指标、中医证候积 分、痛经情况、性激素指标及氧化应激指标的变化情况，并评价 2组患者的临床疗效和用药安全性。【结果】（1）疗效方面， 治疗6个月后，中西组的总有效率为93.42%（142/152），西药组为78.29%（119/152），组间比较（χ2 检验），中西组的疗效明显 优于西药组（P＜0.01）。（2）结局指标方面，治疗后，2组患者的囊肿直径均较治疗前缩小（P＜0.05），痛经持续时间均较治疗 前缩短（P＜0.05），中医证候积分和痛经程度视觉模拟量表（VAS）评分均较治疗前降低（P＜0.05），且中西组对上述指标的改 善作用均明显优于西药组（P＜0.01）。（3）性激素指标方面，治疗后，2组患者的血清卵泡刺激素（FSH）、雌二醇（E2）、促黄体 生成素（LH）水平均较治疗前降低（P＜0.05），且中西组对血清 FSH、E2、LH 水平的降低作用均明显优于西药组（P＜0.01）。 （4）氧化应激指标方面，治疗后，2组患者的血清 AOPP水平均较治疗前降低（P＜0.05），血清超氧化物歧化酶（SOD）水平均 较治疗前升高（P＜0.05），且中西组对血清 AOPP 水平的降低作用及对血清 SOD 水平的升高作用均明显优于西药组（P＜0.01）。（5）安全性方面，中西组的不良反应总发生率为13.16%（20/152），西药组为9.87%（15/152），组间比较，差异无统计学 意义（P＞0.05）。【结论】 针对肾虚血瘀型EMT患者，采用温肾消癥汤联合地诺孕素治疗，临床疗效确切，可有效改善卵巢功 能，降低氧化损伤，缓解痛经情况，调节性激素水平，缩小囊肿体积，其疗效优于单纯西药治疗，且使用较为安全。

Objective To investigate the therapeutic effect of Wenshen Xiaozheng Decoction combined with dienogest on endometriosis （EMT） and to observe its impact on uterine ultrasound parameters and serum advanced oxidation protein products （AOPP） levels. Methods Using propensity score matching and a prospective design， 525 EMT patients with kidney deficiency and blood stasis syndrome treated in the Gynecology Department of Gaoling District Traditional Chinese Medicine Hospital from March 2020 to March 2023 were enrolled，including 321 receiving dienogest and 204 receiving additional Wenshen Xiaozheng Decoction. After 1∶1 nearest neighbor matching，304 patients were successfully matched and then were divided into a western medicine group （n=152） and an integrated Chinese-western medicine group （n=152）. The western medicine group received conventional dienogest，while the integrated group received additional Wenshen Xiaozheng Decoction. Both groups were treated for 6 months. Changes in uterine ultrasound parameters，traditional Chinese medicine （TCM） syndrome scores， dysmenorrhea conditions， sex hormone levels， and oxidative stress markers were observed before and after treatment. Clinical efficacy and safety were evaluated. Results （1） Regarding efficacy，after 6 months，the total effective rate was 93.42% （142/152） in the integrated group versus 78.29% （119/152） in the western medicine group. The intergroup comparison （by chi-square test） showed that the integrated group showed significantly superior efficacy （P＜0.01）.（2） Regarding outcome indicators，after treatment，cyst diameter decreased （P＜ 0.05） and dysmenorrhea duration shortened （P＜0.05） in both groups versus before treatment；TCM syndrome scores and dysmenorrhea VAS scores decreased （P＜0.05） in both groups，with significantly greater improvements in the integrated group （P＜0.01）.（3） Regarding sex hormones，serum FSH，E2，and LH levels decreased in both groups after treatment （P＜0.05），with significantly greater reductions in the integrated group （P＜0.01）. （4） Regarding oxidative stress， serum AOPP levels decreased （P＜0.05） and superoxide dismuntase （SOD） levels increased （P＜0.05） in both groups after treatment， with significantly greater changes in the integrated group （P＜0.01）. （5） Regarding safety， the total adverse reaction incidence was 13.16% （20/152） in the integrated group and 9.87% （15/152） in the western medicine group，with no statistically significant difference （P＞0.05）. Conclusion For EMT patients with kidney deficiency and blood stasis syndrome，Wenshen Xiaozheng Decoction combined with dienogest demonstrates definite clinical efficacy，effectively improving ovarian function， reducing oxidative damage， alleviating dysmenorrhea， regulating sex hormone levels， and reducing cyst size， with superior outcomes to dienogest alone and a comparable safety profile.

R271.9

陕西省重点研发计划项目（编号：2022-YBSF-137）