温阳补肾法结合运动指导对预防卵巢低反应患者骨质疏松的效果
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摘要
目的:分析温阳补肾法结合运动指导对预防卵巢低反应(poor ovarian response,POR)患者骨质疏松的效果。方法:选取140例POR患者使用随机数字表法将其分为观察组、对照组各70例,均给予温阳补肾法联合碳酸钙D3咀嚼片治疗,观察组加用运动指导,记录2组患者治疗前后血清骨钙素、血小板源性生长因子(PDGF)、可溶性血管细胞间黏附分子-1(s VCAM-1)、胰岛素样生长因子-1(IGF-1)水平变化,骨密度(BMD)变化以及卵巢储备功能变化,并比较其2年随访期间骨质疏松发生率。结果:随访期间共有47例(33.57%)患者确诊骨质疏松,其中观察组、对照组骨质疏松发生率分别为12.86%、51.43%。与治疗前比较,2组患者骨钙素、PGDF、IGF-1、BMD均升高,s VCAM-1均降低,观察组变化更为明显。2组患者治疗前后基础FSH、基础E2及AMH均未见明显变化。结论:温阳补肾法结合运动指导能够明显降低POR患者骨质疏松发生风险,其作用机制与恢复血清骨钙素、PDGF、IGF-1水平及降低s VCAM-1水平、增加骨密度等作用有关。
Objective: To analyze the effect of Warming Yang and tonifying kidney method combined with exercise guidance on the prevention of osteoporosis in patients with Poor ovarian response( POR). Methods: A total of 140 patients with POR were selected and analyzed prospectively. They were randomly divided into observation group and control group,each of 70 cases,were treated with Wenyang Bushen recipe combined with calcium carbonate D3 chewable tablets treatment,the observation group added sports guidance,recording two groups of patients before and after treatment for 3 months,serum osteocalcin,platelet-derived growth factor( PDGF),soluble vascular cell adhesion molecule-1( s VCAM-1),insulin-like growth factor-1( IGF-1) levels,bone mineral density( BMD) and the changes of ovarian reserve,and record the incidence of osteoporosis during 2 years of follow-up,clinical value analysis combined with exercise guidance warming Yang and Tonifying krdney method. Results The follow-up period there were 47 cases( 33. 57%) patients diagnosed with osteoporosis,9 cases in the observation group,38 cases in the control group,the incidence of osteoporosis was 12. 86% and 51. 43%. Compared with before treatment,the osteocalcin,PGDF,IGF-1 and BMD in the two groups increased,and s VCAM-1 decreased,but the change in the observation group was more obvious. There were no significant changes in basal FSH,basic E2 and AMH before and after treatment in the two groups. Conclusion: The Wenyangbushen method combined with exercise instruction can significantly reduce the risk of the occurrence of osteoporosis in patients with POR,its mechanism may be related to the recovery of serum osteocalcin,PDGF,IGF-1 level and decrease s VCAM-1 level,increase bone density and so on.
Objective: To analyze the effect of Warming Yang and tonifying kidney method combined with exercise guidance on the prevention of osteoporosis in patients with Poor ovarian response( POR). Methods: A total of 140 patients with POR were selected and analyzed prospectively. They were randomly divided into observation group and control group,each of 70 cases,were treated with Wenyang Bushen recipe combined with calcium carbonate D3 chewable tablets treatment,the observation group added sports guidance,recording two groups of patients before and after treatment for 3 months,serum osteocalcin,platelet-derived growth factor( PDGF),soluble vascular cell adhesion molecule-1( s VCAM-1),insulin-like growth factor-1( IGF-1) levels,bone mineral density( BMD) and the changes of ovarian reserve,and record the incidence of osteoporosis during 2 years of follow-up,clinical value analysis combined with exercise guidance warming Yang and Tonifying krdney method. Results The follow-up period there were 47 cases( 33. 57%) patients diagnosed with osteoporosis,9 cases in the observation group,38 cases in the control group,the incidence of osteoporosis was 12. 86% and 51. 43%. Compared with before treatment,the osteocalcin,PGDF,IGF-1 and BMD in the two groups increased,and s VCAM-1 decreased,but the change in the observation group was more obvious. There were no significant changes in basal FSH,basic E2 and AMH before and after treatment in the two groups. Conclusion: The Wenyangbushen method combined with exercise instruction can significantly reduce the risk of the occurrence of osteoporosis in patients with POR,its mechanism may be related to the recovery of serum osteocalcin,PDGF,IGF-1 level and decrease s VCAM-1 level,increase bone density and so on.
引文
[1]LA MARCA A,DONDI G,SIGHINOLFI G,et al.The ovarian response to controlled stimulation in IVF cycles may be predictive of the age at menopause[J].Human Reproduction,2014,29(11):2530-2535.
[2]BROER S L,BROEKMANS F J M,LAVEN J S E,et al.AntiMüllerian hormone:ovarian reserve testing and its potential clinical implications[J].Human reproduction update,2014,20(5):688-701.
[3]宋红梅,吴斌,魏迎辰,等.温阳补肾方对激素性股骨头坏死模型兔股骨头形态学的影响[J].中国中医骨伤科杂志,2014,22(3):1-3.
[4]KALINCHENKO S,TYUZIKOV I,MSKHALAYA G,et al.Testosterone Therapy:Oral Androgens[M].Testosterone.Springer International Publishing,2017:203-224.
[5]陈泽荣,邱慈鑫,陈晨,等.温阳补肾方含药血清对破骨细胞骨吸收功能的影响[J].中华中医药杂志,2015,30(4):1245-1248.
[6]SAVVAS M,HAMODA H.Premature Ovarian Insufficiency and Its Fertility Implications.Frontiers in Gynecological Endocrinology[M].Springer International Publishing,2014:119-125.
[7]DENG J,JIA M,CHENG X,et al.ABO blood group and ovarian reserve:a meta-analysis and systematic review[J].Oncotarget,2017,8(15):25628.
[8]陈景伟,仝瑞晓,杨剑,等.补肾温阳化瘀方对实验性子宫内膜异位症TRPV1及其致敏因子NGF的影响[J].中国中西医结合杂志,2015,35(6):717-723.
[9]HOHAT-TAL A,SEN A,BARAD D H,et al.Genetics of androgen metabolism in women with infertility and hypoandrogenism[J].Nature Reviews Endocrinology,2015,11(7):429-441.
[10]HIPP H S,CHAREN K H,SPENCER J B,et al.Reproductive and gynecologic care of women with fragile X primary ovarian insufficiency(FXPOI)[J].Menopause,2016,23(9):993-999.
[11]宋红梅,魏迎辰,吴斌,等.温阳补肾方对兔激素性股骨头坏死组织RANKL/RANK/OPG通路的影响[J].中华中医药杂志,2016,31(1):302-305.
[12]NOTO V,HARRITY C,WALSH D,et al.The impact of FMR1gene mutations on human reproduction and development:a systematic review[J].Journal of assisted reproduction and genetics,2016,33(9):1135-1147.
[13]JACOB G P,ORAIF A,POWER S.When helping hurts:the effect of surgical interventions on ovarian reserve[J].Human Fertility,2016,19(1):3-8.
[14]TUCKER E J,GROVER S R,BACHELOT A,et al.Premature ovarian insufficiency:new perspectives on genetic cause and phenotypic spectrum[J].Endocrine reviews,2016,37(6):609-635.
[15]刘菊,梅群超,谢先龙.温阳补肾方对去卵巢大鼠骨钙素及股骨显微结构的影响[J].中医学报,2014,29(8):1165-1167.
[16]KERMACK A J,VAN RIJN B B,HOUGHTON F D,et al.The‘Developmental Origins’Hypothesis:relevance to the obstetrician and gynecologist[J].Journal of developmental origins of health and disease,2015,6(5):415-424.
[17]邱慈鑫,陈泽荣,陈晨,等.温阳补肾方含药血清对破骨细胞凋亡率及RANK蛋白的影响[J].风湿病与关节炎,2015,4(5):9-12.
[18]USLUOGULLARI B,DUVAN C Z,USLUOGULLARI C A.Use of aromatase inhibitors in practice of gynecology[J].Journal of ovarian research,2015,8(1):4.
[2]BROER S L,BROEKMANS F J M,LAVEN J S E,et al.AntiMüllerian hormone:ovarian reserve testing and its potential clinical implications[J].Human reproduction update,2014,20(5):688-701.
[3]宋红梅,吴斌,魏迎辰,等.温阳补肾方对激素性股骨头坏死模型兔股骨头形态学的影响[J].中国中医骨伤科杂志,2014,22(3):1-3.
[4]KALINCHENKO S,TYUZIKOV I,MSKHALAYA G,et al.Testosterone Therapy:Oral Androgens[M].Testosterone.Springer International Publishing,2017:203-224.
[5]陈泽荣,邱慈鑫,陈晨,等.温阳补肾方含药血清对破骨细胞骨吸收功能的影响[J].中华中医药杂志,2015,30(4):1245-1248.
[6]SAVVAS M,HAMODA H.Premature Ovarian Insufficiency and Its Fertility Implications.Frontiers in Gynecological Endocrinology[M].Springer International Publishing,2014:119-125.
[7]DENG J,JIA M,CHENG X,et al.ABO blood group and ovarian reserve:a meta-analysis and systematic review[J].Oncotarget,2017,8(15):25628.
[8]陈景伟,仝瑞晓,杨剑,等.补肾温阳化瘀方对实验性子宫内膜异位症TRPV1及其致敏因子NGF的影响[J].中国中西医结合杂志,2015,35(6):717-723.
[9]HOHAT-TAL A,SEN A,BARAD D H,et al.Genetics of androgen metabolism in women with infertility and hypoandrogenism[J].Nature Reviews Endocrinology,2015,11(7):429-441.
[10]HIPP H S,CHAREN K H,SPENCER J B,et al.Reproductive and gynecologic care of women with fragile X primary ovarian insufficiency(FXPOI)[J].Menopause,2016,23(9):993-999.
[11]宋红梅,魏迎辰,吴斌,等.温阳补肾方对兔激素性股骨头坏死组织RANKL/RANK/OPG通路的影响[J].中华中医药杂志,2016,31(1):302-305.
[12]NOTO V,HARRITY C,WALSH D,et al.The impact of FMR1gene mutations on human reproduction and development:a systematic review[J].Journal of assisted reproduction and genetics,2016,33(9):1135-1147.
[13]JACOB G P,ORAIF A,POWER S.When helping hurts:the effect of surgical interventions on ovarian reserve[J].Human Fertility,2016,19(1):3-8.
[14]TUCKER E J,GROVER S R,BACHELOT A,et al.Premature ovarian insufficiency:new perspectives on genetic cause and phenotypic spectrum[J].Endocrine reviews,2016,37(6):609-635.
[15]刘菊,梅群超,谢先龙.温阳补肾方对去卵巢大鼠骨钙素及股骨显微结构的影响[J].中医学报,2014,29(8):1165-1167.
[16]KERMACK A J,VAN RIJN B B,HOUGHTON F D,et al.The‘Developmental Origins’Hypothesis:relevance to the obstetrician and gynecologist[J].Journal of developmental origins of health and disease,2015,6(5):415-424.
[17]邱慈鑫,陈泽荣,陈晨,等.温阳补肾方含药血清对破骨细胞凋亡率及RANK蛋白的影响[J].风湿病与关节炎,2015,4(5):9-12.
[18]USLUOGULLARI B,DUVAN C Z,USLUOGULLARI C A.Use of aromatase inhibitors in practice of gynecology[J].Journal of ovarian research,2015,8(1):4.