基于经前烦躁障碍症卵巢激素发病机制探讨中药激素样作用
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摘要
经前烦躁障碍症发病率日渐走高,造成患者情绪障碍、行为异常,并严重影响患者的生活与工作等,属于中医古籍所载"月经前后诸证"。患者限为育龄女性,始于月经初潮,而终于绝经期,被认为与卵巢激素水平变化状态存在密切联系。近些年,中药在经前烦躁症(PMDD)临床治疗中皆显示不错疗效,而中药的多成分、多把点的特性又使得其治疗机制研究复杂重重,但是基于PMDD卵巢激素发病机制,中药在发挥作用的过程中是否具有雌激素样作用,并参与部分靶腺轴的调控呢?目前,这方面研究匮乏,文章将从经前烦躁障碍症卵巢激素发病机制为出发点,通过对相关中药治疗概况的阐述,发现并总结雌激素样作用中药,揭示其调节机制,为疾病的诊疗提供借鉴。
The incidence of premenstrual affective disorder is getting higher and higher, resulting in patients with emotional disorders, abnormal behavior, and seriously affecting the patients' life and work, etc. Premenstrual affective disorder belongs to pre-menstrual syndrome in the ancient Chinese medicine classices. Patients who are restricted to women of childbearing age, beginning in menarche, and finally in menopause, are considered to be closely linked with changes in ovarian hormone levels. In recent years, the Chinese medicine in the clinical treatment of PMDD have shown good efficacy, while the traditional Chinese medicine, multi-component, multi-point features in turn makes the study of its mechanism of treatment complex, but based on the pathogenesis of PMDD ovarian hormones, Chinese medicine plays a role in the process. Is it estrogen-like and involved in the regulation of some of the target gland axis? At present, the research in this area is lacking. Based on the pathogenesis of PMDD ovarian hormones, this article would find and summarize the estrogen-like traditional Chinese medicine through the overview of traditional Chinese medicine treatment of PMDD, and tries to reveal the regulatory mechanism to provide reference for the diagnosis and treatment of the disease.
The incidence of premenstrual affective disorder is getting higher and higher, resulting in patients with emotional disorders, abnormal behavior, and seriously affecting the patients' life and work, etc. Premenstrual affective disorder belongs to pre-menstrual syndrome in the ancient Chinese medicine classices. Patients who are restricted to women of childbearing age, beginning in menarche, and finally in menopause, are considered to be closely linked with changes in ovarian hormone levels. In recent years, the Chinese medicine in the clinical treatment of PMDD have shown good efficacy, while the traditional Chinese medicine, multi-component, multi-point features in turn makes the study of its mechanism of treatment complex, but based on the pathogenesis of PMDD ovarian hormones, Chinese medicine plays a role in the process. Is it estrogen-like and involved in the regulation of some of the target gland axis? At present, the research in this area is lacking. Based on the pathogenesis of PMDD ovarian hormones, this article would find and summarize the estrogen-like traditional Chinese medicine through the overview of traditional Chinese medicine treatment of PMDD, and tries to reveal the regulatory mechanism to provide reference for the diagnosis and treatment of the disease.
引文
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[2] Zachar P.A diagnostic and statistical manual of mental disorders history of premenstrual dysphoric disorder[J].The Journal of nervous and mental disease,2014,202(4):346-352.
[3] Janda C,Kues JN,Andersson G,et al.A symptom diary to assess severe premenstrual syndrome and premenstrual dysphoric disorder[J].Women & health,2017,57(7):837-854.
[4] Pilver CE,Libby DJ.Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample[J].Social psychiatry and psychiatric epidemiology, 2013,48(3):437-446.
[5] Hong JP,Park S,Wang HR,et al.Prevalence, correlates, comorbidities, and suicidal tendencies of premenstrual dysphoric disorder in a nationwide sample of Korean women[J].Social psychiatry and psychiatric epidemiology,2012,47(12):1937-1945.
[6] Andreano JM, Cahill L. Menstrual cycle modulation of medial temporal activity evoked by negative emotion[J]. NeuroImage, 2010, 53: 1286-1293.
[7] Goldstein JM, Jerram M, Abbs B, et al. Sex differences in stress response circuitry activation dependent on female hormonal cycle[J]. J Neurosci, 2010, 30: 431-438.
[8] 魏政, 罗洪斌, 商楠,等. 脑雌激素的合成及其对阿尔兹海默病认知功能和发病机制的影响研究[J]. 湖北民族学院学报(医学版), 2017, 34(1):56-59.
[9] 曹扬, 朱辉, 吕春梅. 雌激素对中枢神经系统的作用研究进展[J]. 解剖科学进展, 2017(5):517-519.
[10] 刘建勋. 催乳素与精神病[J]. 国际内分泌代谢杂志, 1982(4):30-32.
[11] Rubinow DR, Schmidt PJ. Gonadal steroid regulation of mood: the lessons of premenstrual syndrome[J]. FrontNeuroendocrinol, 2006, 27:210-216.
[12] Wyatt KM, Dimmock PW, Ismail KM, et al. The effectiveness of GnRHa with and without ‘add-back’ therapy in treating premenstrual syndrome: a meta analysis[J]. Bjog An International Journal of Obstetrics & Gynaecology, 2004, 111(6):585.
[13] Schmidt PJ,NiemanLK, DanaceauMA,et al. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome[J]. N Engl J Med, 1998, 338:209-216.
[14] 牛聪慧. 经前期综合征(重度,PMDD)证型分布及症状与女性激素间关系分析[D].济南:山东中医药大学,2014.
[15] 乔明琦, 张惠云, 于艳红,等. 经前期综合征肝气逆证患者月经周期血清雌二醇、孕酮含量的动态变化[J]. 中医杂志, 2006, 47(4):295-297.
[16] Martinez PE, Rubinow DR, Nieman LK, et al. 5ɑ-Reductase Inhibition Prevents the Luteal Phase Increase in Plasma Allopregnanolone Levels and Mitigates Symptoms in Women with Premenstrual Dysphoric Disorder[J]. Neuropsychopharmacology Official Publication of the American College of Neuropsychopharmacology, 2016, 41(4):1093.
[17] Schmidt PJ,Martinez PE,Nieman LK,et al.Premenstrual Dysphoric Disorder Symptoms Following Ovarian Suppression: Triggered by Change in Ovarian Steroid Levels But Not Continuous Stable Levels[J].The American journal of psychiatry,2017,174(10):980-989.
[18] Schmidt PJ, Nieman LK, Danaceau MA, et al. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome[J]. New England Journal of Medicine, 1998, 338(4):209-216.
[19] Henshow C, Foreman D, Belcher J, et al. Can one induce premenstrual symptomatology in women with prior hysterectomy and bilateral oophorectomy?[J]. Journal of Psychosomatic Obstetrics & Gynecology, 1996, 17(1):21-28.
[20] Segebladh B, Borgstr?m A, Nyberg S, et al. Evaluation of different add-back estradiol and progesterone treatments to gonadotropin-releasing hormone agonist treatment in patients with premenstrual dysphoric disorder[J]. American Journal of Obstetrics & Gynecology, 2009, 201(2):1-8.
[21] Qiao M, Sun P, Wang H, et al. Epidemiological Distribution and Subtype Analysis of Premenstrual Dysphoric Disorder Syndromes and Symptoms Based on TCM Theories[J]. BioMed Research International,2017, 2017(7):1-9.
[22] 梁洁莎. 从肝论治经前期综合征的临床疗效和机制研究[D].广州:广州中医药大学,2016.
[23] 薛晓丽. 柴胡疏肝散加减治疗肝郁气滞型经前期综合征的临床观察[D].哈尔滨:黑龙江中医药大学,2017.
[24] 唐丽丽. 疏肝安郁汤治疗肝郁气滞型经前期综合征的临床研究[D].济南:山东中医药大学,2004.
[25] 连永祥. 柴胡加龙骨牡蛎汤治疗肝郁气滞型经前期综合征的临床研究[D].广州:广州中医药大学,2016.
[26] 杨芳. 半夏白术天麻汤加减治疗经前期综合征临床观察[C]. 全国土家族苗族医药学术会议论文专辑,中国民族医药学会,2002:1.
[27] 秦佳佳. 调肝汤治疗经前期综合征的临床观察[D].哈尔滨:黑龙江中医药大学,2002.
[28] 傅赛萍,王贤斌,申艳梅.经前安泰汤治疗经前期紧张综合征228例[J].陕西中医,1997(6):241.
[29] 许茹,钟凤林.经前期紧张综合征治疗方剂组方用药规律分析[J].亚太传统医药,2016,12(21):124-125.
[30] 陈梦, 赵丕文, 赵笛,等. 中药植物雌激素的药理作用研究进展[J]. 江苏中医药, 2017, 49(4):82-85.
[31] 赵元, 郑红霞, 徐颖,等. 中药植物雌激素的研究进展[J]. 中国中药杂志, 2017, 42(18):1801-1805.
[32] 陈小平, 谢波, 郑洁莉,等. 补肾疏肝汤对肾虚肝郁型多囊卵巢综合征患者临床症状及性激素的影响[J]. 中国中医药信息杂志, 2008, 15(5):17-19.
[33] 桑霞, 张玉珍. 青春期多囊卵巢综合征从肝论治体会[J]. 湖南中医杂志, 2008, 24(1):51-52.
[34] 严灿, 徐志伟. 肝主疏泄调畅情志功能的中枢神经生物学机制探讨[C]. 中国中西医结合学会基础理论研究专业委员会学术研讨会, 2006:459-462.
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