针刺人工周期法治疗排卵障碍型异常子宫出血(脾虚证)临床观察
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摘要
目的:比较针刺人工周期法与西药人工周期法治疗排卵障碍型异常子宫出血(脾虚证)的临床疗效。方法:将60例患者随机分为观察组与对照组,每组30例,观察组脱落3例,最终27例;对照组脱落2例,最终28例。观察组采用针刺人工周期法治疗,即按照经后期、经间期及经前期不同特点分别选穴,留针30min,隔日1次,行经期不予针刺;经后期取穴:血海、三阴交、太溪、关元、气海、足三里、章门;经间期取穴:太冲、合谷、腰阳关、膈俞、肝俞、三阴交、脾俞;经前期取穴:百会、肾俞、腰阳关、膈俞、三阴交、足三里、公孙。对照组采用西药人工周期法,口服芬吗通(雌二醇片/雌二醇地屈孕酮片复合包装):白色片为雌二醇(1 mg)片,灰色片为雌二醇(1 mg)地屈孕酮(10 mg)片。每日口服1片,前14天口服白色片,后14天口服灰色片。连续服用28 d为1个周期,1个月经周期为一疗程。两组均连续治疗3个疗程。观察两组治疗前后及随访时(治疗结束后第3个月)临床症候积分变化,并从临床总体疗效、主要症状(包括月经周期、月经经期、月经量)的显效率、基础体温(BBT)曲线呈双相率3个方面评价临床疗效。结果:①与治疗前比较,两组治疗后、随访时临床症候积分均下降(均P<0.05);与对照组比较,治疗后及治疗前后差值差异均无统计学意义(P>0.05);与对照组比较,随访时及(治疗前-随访时)差值均有统计学意义(P<0.05,P<0.01),观察组优于对照组。②观察组总有效率为81.5%(22/27),对照组为85.7%(24/28),两组差异无统计意义(P>0.05)。③治疗后两组月经周期、月经经期、月经量显效率比较差异均无统计学意义(P>0.05);随访时观察组月经周期显效率优于对照组(P<0.01),而两组月经经期及月经量显效率比较差异均无统计学意义(P>0.05)。④治疗后两组BBT曲线双相率差异无统计学意义(P>0.05);随访时观察组高于对照组(P<0.05)。结论:针刺人工周期法治疗排卵障碍型异常子宫出血(脾虚证)具有较好临床疗效,与西药人工周期法总体疗效相当,在调节月经周期及改善机体排卵方面具有一定优势,且疗效较稳定持久。
Objective To compare the clinical efficacy between acupuncture artificial menstrual cycle method and medication artificial menstrual cycle method for abnormal uterine bleeding-ovulatory(AUB-O) dysfunction(spleen deficiency syndrome). Methods Sixty patients were randomly assigned into an observation group and a control group, 30 cases in each one. 3 cases dropped out in the observation group and 27 cases were included into analysis; 2 cases dropped out in the control group and 28 cases were included into analysis. The patients in the observation group were treated with acupuncture artificial menstrual cycle method. The acupoints were selected according to different stages of menstrual cycle. The acupuncture was given for 30 min per treatment, once every other day; no treatment was given during menstrual period.Xuehai(SP 10), Sanyinjiao(SP 6), Taixi(KI 3), Guanyuan(CV 4), Qihai(CV 6), Zusanli(ST 36) and Zhangmen(LR 13) were selected after menstrual period. Taichong(LR 3), Hegu(LI 4), Yaoyangguan(GV 3), Geshu(BL 17), Ganshu(BL 18),Sanyinjiao(SP 6), Pishu(BL 20) were selected in ovulaton periods. Baihui(GV 20), Shenshu(BL 23), Yaoyangguan(GV 3),Geshu(BL 17), Sanyinjiao(SP 6), Zusanli(ST 36), Gongsun(SP 4) were selected before menstrual period. The patients in the control group were treated with medication artificial menstrual cycle method. Femoston(estradiol tablets/estradiol dydrogesterone tablets) was taken orally. The white tablets were estradiol(1 mg), while the gray tablets were estradiol(1 mg)and dydrogesterone(10 mg). The Femoston was taken once a day, white tablets for the first 14 days, then gray tablets for the last 14 days. The 28-day treatment was taken as one session, and one cycle menstrual was taken as one treatment course, and totally 3 courses were given in the two groups. The clinical symptom score was observed before and after treatment as well as in follow-up visit(3 months after treatment). The clinical efficacy was evaluated based on the total effective rate, the marked effective rate of main symptoms(including menstrual cycle, menstrual period, menstrual volume) and basal body temperature(BBT). Results ① Compared before treatment, the clinical symptom score in the two groups was decreased after treatment and in the follow-up visit(P<0.05). Compared with the control group, the clinical symptom score after treatment as well as the difference of that before and after treatment had no significant difference in the observation group(P>0.05). Compared with the control group, the clinical symptom score in the follow-up visit as well as the difference of that between pre-treatment and follow-up visit had significant difference in the observation group(P<0.05, P<0.01). ② The total effective rate was81.5%(22/27) in the observation group and 85.7%(24/28) in the control group, without significant difference between the two groups(P>0.05). ③ After treatment, the marked effective rate of menstrual cycle, menstrual period, menstrual volume had no significant difference between the two groups(P>0.05); during the follow-up visit, the marked effective rate of menstrual cycle in the observation group was superior to that in the control group(P<0.05), but that of menstrual period and menstrual volume had no significant difference between the two groups(P>0.05). ④ After treatment, the diphasic curve rate of BBT had no significant difference between the two groups(P>0.05); during the follow-up visit, the diphasic curve rate of BBT in the observation group was higher than that in the control group(P<0.05). Conclusion Acupuncture artificial menstrual cycle method has superior efficacy for AUB-O dysfunction(spleen deficiency syndrome), which has similar efficacy with medication artificial menstrual cycle method. Moreover, acupuncture has advantages in regulating menstrual cycle and improving ovulation, and has a longer curative effect.
Objective To compare the clinical efficacy between acupuncture artificial menstrual cycle method and medication artificial menstrual cycle method for abnormal uterine bleeding-ovulatory(AUB-O) dysfunction(spleen deficiency syndrome). Methods Sixty patients were randomly assigned into an observation group and a control group, 30 cases in each one. 3 cases dropped out in the observation group and 27 cases were included into analysis; 2 cases dropped out in the control group and 28 cases were included into analysis. The patients in the observation group were treated with acupuncture artificial menstrual cycle method. The acupoints were selected according to different stages of menstrual cycle. The acupuncture was given for 30 min per treatment, once every other day; no treatment was given during menstrual period.Xuehai(SP 10), Sanyinjiao(SP 6), Taixi(KI 3), Guanyuan(CV 4), Qihai(CV 6), Zusanli(ST 36) and Zhangmen(LR 13) were selected after menstrual period. Taichong(LR 3), Hegu(LI 4), Yaoyangguan(GV 3), Geshu(BL 17), Ganshu(BL 18),Sanyinjiao(SP 6), Pishu(BL 20) were selected in ovulaton periods. Baihui(GV 20), Shenshu(BL 23), Yaoyangguan(GV 3),Geshu(BL 17), Sanyinjiao(SP 6), Zusanli(ST 36), Gongsun(SP 4) were selected before menstrual period. The patients in the control group were treated with medication artificial menstrual cycle method. Femoston(estradiol tablets/estradiol dydrogesterone tablets) was taken orally. The white tablets were estradiol(1 mg), while the gray tablets were estradiol(1 mg)and dydrogesterone(10 mg). The Femoston was taken once a day, white tablets for the first 14 days, then gray tablets for the last 14 days. The 28-day treatment was taken as one session, and one cycle menstrual was taken as one treatment course, and totally 3 courses were given in the two groups. The clinical symptom score was observed before and after treatment as well as in follow-up visit(3 months after treatment). The clinical efficacy was evaluated based on the total effective rate, the marked effective rate of main symptoms(including menstrual cycle, menstrual period, menstrual volume) and basal body temperature(BBT). Results ① Compared before treatment, the clinical symptom score in the two groups was decreased after treatment and in the follow-up visit(P<0.05). Compared with the control group, the clinical symptom score after treatment as well as the difference of that before and after treatment had no significant difference in the observation group(P>0.05). Compared with the control group, the clinical symptom score in the follow-up visit as well as the difference of that between pre-treatment and follow-up visit had significant difference in the observation group(P<0.05, P<0.01). ② The total effective rate was81.5%(22/27) in the observation group and 85.7%(24/28) in the control group, without significant difference between the two groups(P>0.05). ③ After treatment, the marked effective rate of menstrual cycle, menstrual period, menstrual volume had no significant difference between the two groups(P>0.05); during the follow-up visit, the marked effective rate of menstrual cycle in the observation group was superior to that in the control group(P<0.05), but that of menstrual period and menstrual volume had no significant difference between the two groups(P>0.05). ④ After treatment, the diphasic curve rate of BBT had no significant difference between the two groups(P>0.05); during the follow-up visit, the diphasic curve rate of BBT in the observation group was higher than that in the control group(P<0.05). Conclusion Acupuncture artificial menstrual cycle method has superior efficacy for AUB-O dysfunction(spleen deficiency syndrome), which has similar efficacy with medication artificial menstrual cycle method. Moreover, acupuncture has advantages in regulating menstrual cycle and improving ovulation, and has a longer curative effect.
引文
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[8]Ravibabu K,Palla J,Chintada GS.A study of efficacy of ormeloxifene in the pharmacological management of dysfunctional uterine bleeding[J].Clin Diagn Res,2013,7(11):2534-2536.
[9]管枫,马淑兰,陈伯英.电针对去卵巢大鼠下丘脑神经内分泌信号传导的影响[J].中西医结合学报,2016,7(6):563-568.
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[12]吴节,杨丽洁,陈雅洁,等.针灸人工周期疗法治疗月经不调临床应用初探[J].中国针灸,2015,35(3):287-289.
[13]杨娟,许金榜,刘英,等.针灸人工周期疗法治疗多囊卵巢综合征卵泡发育不良的临床研究[J].时珍国医国药,2015,26(12):2954-2955.
[14]许素瑜,王权辉,叶旭挺,等.针灸人工周期疗法治疗精神应激性闭经34例[J].中医外治杂志,2016,25(2):35-37.
[15]中华医学会妇产科学分会内分泌学组,中华医学会妇产科学分会绝经学组.功能失调性子宫出血临床诊断治疗指南(草案)[J].中华妇产科杂志,2009,44(3):234-236.
[16]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:238-243.
[17]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:235-241.
[18]尤昭玲.中西医结合妇产科学[M].北京:中国中医药出版社,2006:425-441.
[19]马媛媛,曹立幸.功能失调性子宫出血中医证型分布情况分析[J].中医药学报,2015,43(1):36-39.
[20]李卫红,李文杰,李卫民,等.功能失调性子宫出血患者中医证候分布规律的研究[J].现代中西医结合杂志,2016,25(2):132-134.
[21]李卫红,尤昭玲,刘丹卓,等.功能失调性子宫出血证候要素分布规律的现代文献研究[J].辽宁中医杂志,2010,37(7):1266-1267.
[22]强素凤,付菲,支云清,等.芬吗通治疗异常子宫出血的临床观察[J].生殖医学杂志,2015(5):377-380.
[23]孙霞,张钰.芬吗通在PCOS患者促排卵周期中的应用[J].生殖医学杂志,2017,26(3):258-263.
[24]周莉,夏有兵,马翔,等.针灸序贯疗法在辅助生殖中的应用、优势与展望[J].中华中医药杂志,2016,31(7):2476-2478.
[25]周莉,王茵萍.针灸序贯疗法成功助孕反复IVF-ET失败13次病案1例[J].中国中医基础医学杂志,2016,22(11):1528-1529.
[26]周莉,夏有兵,卢静,等.序贯针灸治疗卵巢储备功能下降IVF-ET30例临床研究[J].江苏中医药,2015,47(8):58-60.
[27]周莉,夏有兵,马翔,等.针灸序贯疗法对卵巢储备功能下降IVF-ET的影响[J].中国针灸,2016,36(1):25-28.
[2]Fraser IS,Critchley HO,Broder M,et al.The FIGOrecommendations on terminologies and definitions for normal and abnormal uterine bleeding[J].Semin Reprod Med,2011,29(5):383-390.
[3]张以文.FIGO关于月经异常相关术语的共识和异常子宫出血病因的新分类系统[J].国际妇产科学杂志,2013,40(2):105-107.
[4]中华医学会妇产科学分会内分泌学组.异常子宫出血诊断与治疗指南[J].中华妇产科杂志,2014,49(11):801-805.
[5]Khrouf M,Terras K.Diagnosis and management of formerly called“dysfunctional uterine bleeding”according to PALM-COEIN FIGO classification and the new guidelines[J].Obstetrics Gynecol Ind,2014,64(6):388-393.
[6]马宝璋.中医妇科学[M].北京:中国中医药出版社,2012:311-317.
[7]Gendron F,Berube J,Charbonneau L,et al.Irregular bleeding control of side effects of combination drugs[J].Perspect Infirm,2014,11(2):34-35.
[8]Ravibabu K,Palla J,Chintada GS.A study of efficacy of ormeloxifene in the pharmacological management of dysfunctional uterine bleeding[J].Clin Diagn Res,2013,7(11):2534-2536.
[9]管枫,马淑兰,陈伯英.电针对去卵巢大鼠下丘脑神经内分泌信号传导的影响[J].中西医结合学报,2016,7(6):563-568.
[10]张朝晖,崔毓桂.电针对下丘脑-垂体-性腺轴的调节[J].国外医学,2007,26(1):14-17.
[11]魏英俊,田永衍.中药人工周期疗法在月经病中的应用现状与启示[J].甘肃中医学院学报,2015,32(3):60-63.
[12]吴节,杨丽洁,陈雅洁,等.针灸人工周期疗法治疗月经不调临床应用初探[J].中国针灸,2015,35(3):287-289.
[13]杨娟,许金榜,刘英,等.针灸人工周期疗法治疗多囊卵巢综合征卵泡发育不良的临床研究[J].时珍国医国药,2015,26(12):2954-2955.
[14]许素瑜,王权辉,叶旭挺,等.针灸人工周期疗法治疗精神应激性闭经34例[J].中医外治杂志,2016,25(2):35-37.
[15]中华医学会妇产科学分会内分泌学组,中华医学会妇产科学分会绝经学组.功能失调性子宫出血临床诊断治疗指南(草案)[J].中华妇产科杂志,2009,44(3):234-236.
[16]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:238-243.
[17]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:235-241.
[18]尤昭玲.中西医结合妇产科学[M].北京:中国中医药出版社,2006:425-441.
[19]马媛媛,曹立幸.功能失调性子宫出血中医证型分布情况分析[J].中医药学报,2015,43(1):36-39.
[20]李卫红,李文杰,李卫民,等.功能失调性子宫出血患者中医证候分布规律的研究[J].现代中西医结合杂志,2016,25(2):132-134.
[21]李卫红,尤昭玲,刘丹卓,等.功能失调性子宫出血证候要素分布规律的现代文献研究[J].辽宁中医杂志,2010,37(7):1266-1267.
[22]强素凤,付菲,支云清,等.芬吗通治疗异常子宫出血的临床观察[J].生殖医学杂志,2015(5):377-380.
[23]孙霞,张钰.芬吗通在PCOS患者促排卵周期中的应用[J].生殖医学杂志,2017,26(3):258-263.
[24]周莉,夏有兵,马翔,等.针灸序贯疗法在辅助生殖中的应用、优势与展望[J].中华中医药杂志,2016,31(7):2476-2478.
[25]周莉,王茵萍.针灸序贯疗法成功助孕反复IVF-ET失败13次病案1例[J].中国中医基础医学杂志,2016,22(11):1528-1529.
[26]周莉,夏有兵,卢静,等.序贯针灸治疗卵巢储备功能下降IVF-ET30例临床研究[J].江苏中医药,2015,47(8):58-60.
[27]周莉,夏有兵,马翔,等.针灸序贯疗法对卵巢储备功能下降IVF-ET的影响[J].中国针灸,2016,36(1):25-28.
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