经阴道彩色多普勒超声评价中西医结合治疗多囊卵巢综合征的临床疗效
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摘要
目的:分析经阴道彩色多普勒超声评价中西医结合治疗多囊卵巢综合征的临床疗效。方法:86例多囊卵巢综合征患者,均给予中西医结合治疗,并采用阴道彩色多普勒超声对治疗前后患者子宫内膜厚度、卵巢体积、成熟卵泡数量、子宫相关动脉血流变化情况进行评价;观察患者治疗前后性激素水平、CRP、TNF-α、IGF-1水平。结果:治疗后患者子宫内膜厚度(7.04±0.66)mm、卵巢体积(10.49±2.67)cm~3、成熟卵泡数量(1.24±0.35)个与治疗前子宫内膜厚度(4.89±0.52)mm、卵巢体积(8.71±0.89)cm~3、成熟卵泡数量(0.13±0.08)个相比明显增加,差异具有统计学意义(P<0.05);治疗后间质动脉的血流搏动(0.60±0.09)及血流阻力指数(1.15±0.11)与治疗前的血流搏动(0.51±0.04)及血流阻力指数(0.89±0.10)相比明显增加,而螺旋动脉的血流搏动(0.54±0.04)与血流阻力指数(0.86±0.18)则低于治疗前的血流搏动(0.58±0.08)及血流阻力指数(1.18±0.38),差异具有统计学意义(P<0.05);治疗后患者促卵泡生成素(6.33±2.83)IU/L、睾酮(64.89±15.01)ng/dL、孕酮(14.49±2.57)ng/dL、黄体生成素(10.53±2.88)U/L、雌二醇(102.25±20.28)pmol/L及泌乳素水平(9.18±2.91)mIU/L与治疗前促卵泡生成素(5.27±1.54)IU/L、睾酮(92.51±30.52)ng/dL、孕酮(33.03±0.76)ng/dL、黄体生成素(21.34±3.75)U/L、雌二醇(22.65±3.69)pmol/L及泌乳素水平(15.04±5.79)mIU/L相比明显改善,差异具有统计学意义(P<0.05);治疗后患者CRP(2.03±0.49)mg/L、TNF-α(14.27±1.29)U/L、IGF-1水平(296.69±72.19)ng/mL与治疗前CRP(3.78±0.89)mg/L、TNF-α(28.91±2.82)U/L、IGF-1水平(457.87±136.76)ng/mL相比明显降低,差异具有统计学意义(P<0.05)。结论:中西医结合治疗多囊卵巢综合征的临床疗效显著,患者子宫内膜厚度、卵巢体积、成熟卵泡数量恢复良好,性激素分泌水平和子宫相关动脉血流指标改善明显。在实际检查过程中,经阴道彩色多普勒超声评价安全可靠,可对患者子宫、卵巢大小、厚度和形态以及卵泡情况、相关动脉血流速度做到全方位了解和掌握,为患者的进一步治疗和康复起到明显辅助作用。
Objective: To evaluate the clinical efficacy of transvaginal color Doppler ultrasound in the treatment of polycystic ovary syndrome(PCOS) with integrated traditional Chinese and Western medicine. Methods: Eighty-six cases of polycystic ovary syndrome(PCOS)were treated with traditional Chinese and Western medicine, and the endometrial thickness, ovarian volume, the number of mature follicles, and the blood flow of the uterus associated with the uterus were evaluated before and after treatment by color Doppler ultrasound. Sex hormone levels, CRP, TNF-α and IGF-1 levels before and after treatment were compared. Results: The thickness of endometrium(7.04±0.66) mm, ovarian volume(10.49±2.67) cm~3 and the number of mature follicles(1.24±0.35) after treatment were significantly higher than those of the endometrium thickness(4.89±0.52)mm, ovarian volume(8.71±0.89)cm3 and the number of mature follicles(0.13±0.08) before treatment. The difference was statistically significant(P<0.05). The blood flow pulsation(0.60±0.09) and blood flow resistance index(1.15±0.11) after treatment were significantly increased than the blood flow pulsation(0.51±0.04) and the index of blood flow resistance(0.89±0.10) before treatment, and the blood flow pulsation of the spiral artery(0.54±0.04) and the blood flow resistance index(0.86±0.18) was lower than blood flow pulsation of the spiral artery(0.58±0.08) and blood flow resistance index(1.18±0.38) before treatment(P<0.05). After treatment, the patients follicle stimulating hormone(6.33±2.83)IU/L, testosterone(64.89±15.01) ng/dL, progesterone(14.49±2.57)ng/dL, and luteinizing hormone(10.53±2.88)U/L, estradiol(102.25±20.28)pmol/L and prolactin level(9.18±2.91)mIU/L were compared with those before treatment [follicle stimulating hormone(5.27±1.54)IU/L, testosterone(92.51±30.52)ng/dL, progesterone(33.03±0.76)ng/dL, luteinizing hormone(21.34±3.75)U/L, estradiol(22.65±3.69)pmol/L and prolactin level(15.04±5.79)mIU/L], and the difference was statistically significant(P<0.05). After treatment, CRP(2.03±0.49)mg/L, TNF-α(14.27±1.29)U/L and IGF-1 level(296.69±72.19)ng/mL decreased significantly than those before treatment [CRP(3.78±0.89) mg/L, TNF-α(28.91±2.82) U/L, IGF-1 level(457.87±136.76)](P<0.05). Conclusion: The curative effect of combination of traditional Chinese and Western medicine in the treatment of polycystic ovary syndrome is remarkable. The thickness of endometrium, the volume of the ovary, the number of mature follicles in the patients recover well, the level of sex hormone secretion and the index of the blood flow of the uterine artery are improved obviously. In the actual examination process, the transvaginal color Doppler ultrasound is safe and reliable. It can understand and master the size, thickness and shape of the uterus and the ovary, the follicular situation and the blood flow velocity of the related arteries. It can play an important role in the further treatment and rehabilitation of the patients.
Objective: To evaluate the clinical efficacy of transvaginal color Doppler ultrasound in the treatment of polycystic ovary syndrome(PCOS) with integrated traditional Chinese and Western medicine. Methods: Eighty-six cases of polycystic ovary syndrome(PCOS)were treated with traditional Chinese and Western medicine, and the endometrial thickness, ovarian volume, the number of mature follicles, and the blood flow of the uterus associated with the uterus were evaluated before and after treatment by color Doppler ultrasound. Sex hormone levels, CRP, TNF-α and IGF-1 levels before and after treatment were compared. Results: The thickness of endometrium(7.04±0.66) mm, ovarian volume(10.49±2.67) cm~3 and the number of mature follicles(1.24±0.35) after treatment were significantly higher than those of the endometrium thickness(4.89±0.52)mm, ovarian volume(8.71±0.89)cm3 and the number of mature follicles(0.13±0.08) before treatment. The difference was statistically significant(P<0.05). The blood flow pulsation(0.60±0.09) and blood flow resistance index(1.15±0.11) after treatment were significantly increased than the blood flow pulsation(0.51±0.04) and the index of blood flow resistance(0.89±0.10) before treatment, and the blood flow pulsation of the spiral artery(0.54±0.04) and the blood flow resistance index(0.86±0.18) was lower than blood flow pulsation of the spiral artery(0.58±0.08) and blood flow resistance index(1.18±0.38) before treatment(P<0.05). After treatment, the patients follicle stimulating hormone(6.33±2.83)IU/L, testosterone(64.89±15.01) ng/dL, progesterone(14.49±2.57)ng/dL, and luteinizing hormone(10.53±2.88)U/L, estradiol(102.25±20.28)pmol/L and prolactin level(9.18±2.91)mIU/L were compared with those before treatment [follicle stimulating hormone(5.27±1.54)IU/L, testosterone(92.51±30.52)ng/dL, progesterone(33.03±0.76)ng/dL, luteinizing hormone(21.34±3.75)U/L, estradiol(22.65±3.69)pmol/L and prolactin level(15.04±5.79)mIU/L], and the difference was statistically significant(P<0.05). After treatment, CRP(2.03±0.49)mg/L, TNF-α(14.27±1.29)U/L and IGF-1 level(296.69±72.19)ng/mL decreased significantly than those before treatment [CRP(3.78±0.89) mg/L, TNF-α(28.91±2.82) U/L, IGF-1 level(457.87±136.76)](P<0.05). Conclusion: The curative effect of combination of traditional Chinese and Western medicine in the treatment of polycystic ovary syndrome is remarkable. The thickness of endometrium, the volume of the ovary, the number of mature follicles in the patients recover well, the level of sex hormone secretion and the index of the blood flow of the uterine artery are improved obviously. In the actual examination process, the transvaginal color Doppler ultrasound is safe and reliable. It can understand and master the size, thickness and shape of the uterus and the ovary, the follicular situation and the blood flow velocity of the related arteries. It can play an important role in the further treatment and rehabilitation of the patients.
引文
[1] 卢如玲,古子娟,袁烁.补肾中药联合达英-35治疗多囊卵巢综合征疗效的Meta分析[J].西部中医药,2018,31(1):64-70.
[2] 余洁,周兴伟,张坤,等.子宫内膜厚度及卵巢血液改变的超声诊断在多囊卵巢综合征中的应用价值[J].实用临床医药杂志,2016,20(13):77-79.
[3] Francesca,Teede. Mental health and physical activity in women with polycystic ovary syndrome:A brief review[J]. Sports Med,2015,45(4):497-504.
[4] 杨丹红,赵美,谈佳红.针刺调周法治疗多囊卵巢综合征的临床疗效分析[J].中国针灸,2017,37(8):825-829.
[5] 寇丽辉,侯丽辉,王颖.非药物治疗多囊卵巢综合征的研究进展[J].现代中西医结合杂志,2018,27(2):226-228.
[6] Niraj K,Sirisha.Outcome of ovarian drilling in women with polycystic ovary syndrome[J].Journal of clinical and diagnostic research,2015,9(2):QC01-QC03.
[7] 虞莉青,曹莲瑛,谢菁,等.电针联合克罗米芬干预多囊卵巢综合征促排卵助孕的疗效研究[J].中国针灸,2018,38(3):263-268.
[8] 薛晓蕊,范春艳.多囊卵巢综合征的超声检查研究进展[J].医学综述,2016,22(19):3863-3867.
[9] Subarna,Prasanta,Sarita. Laparoscopic ovarian drilling:An alternative but not the ultimate in the management of polycystic ovary syndrome[J].Journal of Natural Science Biology and Medicine,2015,6(1):40-48.
[10] Rajan RK,M SS,Balaji B. Soy isoflavones exert beneficial effects onletrozole-induced rat polycystic ovary syndrome(PCOS)model through anti-androgenic mechanism[J].Pharm Biol,2017,55(1):242-251.
[11] 秦张艳,俞而慨.针灸结合补肾方对多囊卵巢综合征患者促排卵作用和性激素水平的影响[J].中国妇幼保健 ,2018,33(5):1162-1164.
[12] 吴朝霞,吴才标,周运专,等.多普勒超声在多囊卵巢综合征中的影像学特征及诊断价值[J].中国性科学,2017,26(2):25-27.
[13] Mahalingaiah S,Diamanti-Kandarakis E. Targets to treat metabolic syndrome in polycystic ovary syndrome[J].Expert Opin Ther Targets,2015,19(11):1561-1574.
[14] 寇丽辉,王颖,孙淼,等.中药复方治疗脾虚痰湿型多囊卵巢综合征疗效观察[J].世界中西医结合杂志,2018,13(1):8-11.
[15] 薛春芬,陈莲萍.多囊卵巢综合征的药物治疗进展[J].医学综述,2018,24(1):144-149.
[16] Jensterle M,Goricar K,Janez A. Metformin as an initial adjunct to low-dose liraglutide enhances the weight-decreasing potential of liraglutide in obese polycystic ovary syndrome:Randomized control study[J].Exp Ther Med,2016,11(4):1194-1200.
[17] 吕云,刘素琴,古咏梅.阴道超声检查多囊卵巢综合征所致不孕症的诊断价值分析[J].山西医药杂志,2018,47(1):37-38.
[18] 王金玲.多囊卵巢综合征患者彩色多普勒超声血流变化及其与内分泌参数的相关性[J].实用临床医药杂志,2016,20(17):81-84.
[19] 黄泽健,阚娜.多囊卵巢综合征患者经阴道彩色超声检查研究[J].中国全科医学,2016,19(12):401.
[20] 张美微,侯丽辉,刘颖华.中医药治疗痰湿型多囊卵巢综合征的研究进展[J].世界中西医结合杂志,2017,12(2):287-289.
[21] 滕杨,陈丽羽,侯丽辉.中医药治疗多囊卵巢综合征研究进展[J].辽宁中医药大学学报,2018,20(4):127-129.
[22] 姚凌,金修才,王萃,等.彩色多普勒超声在多囊卵巢综合征患者中医证候分型中的应用价值[J].中医药导报,2016,22(23):107-110.
[2] 余洁,周兴伟,张坤,等.子宫内膜厚度及卵巢血液改变的超声诊断在多囊卵巢综合征中的应用价值[J].实用临床医药杂志,2016,20(13):77-79.
[3] Francesca,Teede. Mental health and physical activity in women with polycystic ovary syndrome:A brief review[J]. Sports Med,2015,45(4):497-504.
[4] 杨丹红,赵美,谈佳红.针刺调周法治疗多囊卵巢综合征的临床疗效分析[J].中国针灸,2017,37(8):825-829.
[5] 寇丽辉,侯丽辉,王颖.非药物治疗多囊卵巢综合征的研究进展[J].现代中西医结合杂志,2018,27(2):226-228.
[6] Niraj K,Sirisha.Outcome of ovarian drilling in women with polycystic ovary syndrome[J].Journal of clinical and diagnostic research,2015,9(2):QC01-QC03.
[7] 虞莉青,曹莲瑛,谢菁,等.电针联合克罗米芬干预多囊卵巢综合征促排卵助孕的疗效研究[J].中国针灸,2018,38(3):263-268.
[8] 薛晓蕊,范春艳.多囊卵巢综合征的超声检查研究进展[J].医学综述,2016,22(19):3863-3867.
[9] Subarna,Prasanta,Sarita. Laparoscopic ovarian drilling:An alternative but not the ultimate in the management of polycystic ovary syndrome[J].Journal of Natural Science Biology and Medicine,2015,6(1):40-48.
[10] Rajan RK,M SS,Balaji B. Soy isoflavones exert beneficial effects onletrozole-induced rat polycystic ovary syndrome(PCOS)model through anti-androgenic mechanism[J].Pharm Biol,2017,55(1):242-251.
[11] 秦张艳,俞而慨.针灸结合补肾方对多囊卵巢综合征患者促排卵作用和性激素水平的影响[J].中国妇幼保健 ,2018,33(5):1162-1164.
[12] 吴朝霞,吴才标,周运专,等.多普勒超声在多囊卵巢综合征中的影像学特征及诊断价值[J].中国性科学,2017,26(2):25-27.
[13] Mahalingaiah S,Diamanti-Kandarakis E. Targets to treat metabolic syndrome in polycystic ovary syndrome[J].Expert Opin Ther Targets,2015,19(11):1561-1574.
[14] 寇丽辉,王颖,孙淼,等.中药复方治疗脾虚痰湿型多囊卵巢综合征疗效观察[J].世界中西医结合杂志,2018,13(1):8-11.
[15] 薛春芬,陈莲萍.多囊卵巢综合征的药物治疗进展[J].医学综述,2018,24(1):144-149.
[16] Jensterle M,Goricar K,Janez A. Metformin as an initial adjunct to low-dose liraglutide enhances the weight-decreasing potential of liraglutide in obese polycystic ovary syndrome:Randomized control study[J].Exp Ther Med,2016,11(4):1194-1200.
[17] 吕云,刘素琴,古咏梅.阴道超声检查多囊卵巢综合征所致不孕症的诊断价值分析[J].山西医药杂志,2018,47(1):37-38.
[18] 王金玲.多囊卵巢综合征患者彩色多普勒超声血流变化及其与内分泌参数的相关性[J].实用临床医药杂志,2016,20(17):81-84.
[19] 黄泽健,阚娜.多囊卵巢综合征患者经阴道彩色超声检查研究[J].中国全科医学,2016,19(12):401.
[20] 张美微,侯丽辉,刘颖华.中医药治疗痰湿型多囊卵巢综合征的研究进展[J].世界中西医结合杂志,2017,12(2):287-289.
[21] 滕杨,陈丽羽,侯丽辉.中医药治疗多囊卵巢综合征研究进展[J].辽宁中医药大学学报,2018,20(4):127-129.
[22] 姚凌,金修才,王萃,等.彩色多普勒超声在多囊卵巢综合征患者中医证候分型中的应用价值[J].中医药导报,2016,22(23):107-110.
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