OBJECTIVE To observe the clinical efficacy of Shuihuo Zhongyu Decoction combined with estrogen and progesterone sequential treatment for patients with intrauterine adhesion (IUA) of kidney deficiency and blood stasis syndrome, and to explore its possible mechanism of action by transcriptomics.

METHODS A total of 70 hospitalized patients with IUA of kidney deficiency and blood stasis syndrome who met the inclusion criteria were retrospectively selected, with 35 cases in the observation group and 35 cases in the control group. The control group underwent hysteroscopic transcervical resection of adhesion (TCRA) and then received estrogen and progesterone sequential treatment. The observation group was treated with Shuihuo Zhongyu Decoction on the basis of the treatment of the control group. The treatment course of both groups was 3 months. The TCM syndrome scores, therapeutic efficacy, AFS scores, endometrial thickness (ED), endometrial receptivity endometrial volume (EV), endometrial flow index (FI), vascularization index (VI), vascularization flow index (VFI), pregnancy outcomes and intrauterine re-adhesion were evaluated in the 2 groups before and after treatment. 10 cases of endometrial tissues in each group were selected for transcriptomic sequencing, and differentially expressed genes were verified by qPCR.

RESULTS After treatment, the TCM syndrome scores, AFS scores and CD138 positive rate in the 2 groups were significantly decreased (P < 0.05), and the observation group was better than the control group (P < 0.05); after treatment, ED, EV, FI, VI and VFI in the observation group were significantly increased (P < 0.01), which were better than those in the control group (P < 0.05, P < 0.01); the therapeutic efficacy, pregnancy rate and incidence of intrauterine re-adhesion in the observation group were better than those in the control group (P < 0.05, P < 0.01). Transcriptomics results showed that a total of 365 differentially expressed genes (DEGs) were found in the observation group compared with the control group, of which 132 were upregulated, including sulfotransferase family 2B member 1 (SULT2B1), apolipoprotein A1 (APOA1), etc.; 233 were downregulated, including lactoferrin (LTF), C-X-C chemokine ligand 1 (CXCL1), etc.; GO function and KEGG pathway enrichment analysis showed that SHT may interact with metal ions, glycosaminoglycans, protein serine/threonine kinases, endopeptidases, etc. in the membrane components, plasma membrane, extracellular part, extracellular matrix, etc., and play a role by regulating biological processes such as cell adhesion, extracellular tissue structure, and antigen receptor regulation. The signaling pathways involved include chemokine signaling pathway, chemokine and cytokine receptor interactions, IL-17 signaling pathway, nuclear factor-κ-light chain enhanced of activated B cells (NF-κB), etc.

CONCLUSION Shuihuo Zhongyu Decoction can effectively improve the clinical symptoms of IUA patients with kidney deficiency and blood stasis syndrome, reduce AFS scores, increase endometrial thickness, improve endometrial receptivity, improve pregnancy outcomes, and decrease the incidence of intrauterine re-adhesion. Its mechanism may be related to upregulating SULT2B1 and APOA1, downregulating the expression of genes such as LTF and CXCL1, and regulating signal pathways such as chemokines, IL-17, and NF-κB.