当归芍药散配合穴位埋线治疗肝郁肾虚型卵巢储备功能下降
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摘要
目的:探讨当归芍药散加减配合穴位埋线治疗肝郁肾虚型卵巢储备功能下降的临床疗效及其对FSH、AMH、LH、E2水平及妊娠率结局等的影响。方法:选取符合纳入标准的肝郁肾虚型卵巢储备功能下降患者63例,随机分为治疗组31例和对照组32例。治疗组在经后开始口服当归芍药散配合穴位埋线治疗,中药经期停服,每月穴位线埋1次。对照组采用戊酸雌二醇片联合地屈孕酮片进行人工周期治疗。两组均连续治疗3个月经周期。观察两组患者治疗前后月经情况,临床症状,妊娠率结局和卵泡刺激素(FSH)、苗勒管抗激素(AMH),黄体生成素(LH)、雌二醇(E2)水平的改善状况。结果:两组在改善月经情况及临床相关症状、FSH、AMH、LH、E2水平方面较本组治疗前改善(P <0. 05);与对照组治疗后比较,治疗组治疗后月经情况及临床相关症状、妊娠率结局、FSH、AMH、LH、E2水平明显改善(P <0. 05)。结论:当归芍药散配合穴位埋线能够有效改善患者卵巢储备功能,增加妊娠率。
Objective: To explore the clinical effect of Danggui Shaoyao Powder combined with acupoint catgut embedding in the treatment of diminished ovarian reserve( DOR) of liver-depression and kidney-deficiency,and to investigate its effect on the levels of FSH,AMH,LH and E2,as well as on pregnancy outcome.Methods: 63 DOR cases of liver-depression and kidney-deficiency were randomly divided into the treatment group( n = 31) and the control group( n = 32). The treatment group was treated with Danggui Shaoyao Powder combined with acupoint catgut embedding after the menstruation. Stop taking Chinese medication during menstruation,and acupoint catgut embedding was once a month. The control group was treated with artificial cycle treatment of estradiol valerate and dydrogesterone. Both groups were treated for three continuous menstrual cycles. The improvement of menstruation and clinical symptoms,rate of pregnancy,and the changes of FSH,AMH,LH and E2 were observed before and after the treatment in the two groups. Results: The treatment group was better than the control group in improving menstrual condition and clinical symptoms,rate of pregnancy and in the improvements of FSH,AMH,LH and E2( P < 0. 05). Conclusion: Danggui Shaoyao Powder combined with acupoint catgut embedding can effectively improve the function of ovarian reserve in patients.
Objective: To explore the clinical effect of Danggui Shaoyao Powder combined with acupoint catgut embedding in the treatment of diminished ovarian reserve( DOR) of liver-depression and kidney-deficiency,and to investigate its effect on the levels of FSH,AMH,LH and E2,as well as on pregnancy outcome.Methods: 63 DOR cases of liver-depression and kidney-deficiency were randomly divided into the treatment group( n = 31) and the control group( n = 32). The treatment group was treated with Danggui Shaoyao Powder combined with acupoint catgut embedding after the menstruation. Stop taking Chinese medication during menstruation,and acupoint catgut embedding was once a month. The control group was treated with artificial cycle treatment of estradiol valerate and dydrogesterone. Both groups were treated for three continuous menstrual cycles. The improvement of menstruation and clinical symptoms,rate of pregnancy,and the changes of FSH,AMH,LH and E2 were observed before and after the treatment in the two groups. Results: The treatment group was better than the control group in improving menstrual condition and clinical symptoms,rate of pregnancy and in the improvements of FSH,AMH,LH and E2( P < 0. 05). Conclusion: Danggui Shaoyao Powder combined with acupoint catgut embedding can effectively improve the function of ovarian reserve in patients.
引文
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[13]刘继龙,陈枚燕,林春莲,等.以血型联合卵泡刺激素预测女性卵巢储备功能的初步研究[J].贵州医药,2013,37(6):498-500.
[14]龚瑜,周黎明,蔡捷,等.脱氢表雄酮对卵巢储备功能下降患者卵巢反应性和IVF-ET结局的影响[J].生殖医学杂志,2017,26(7):675-678.
[15]张丽霞,何健.中药周期疗法联合针灸治疗肾虚型卵巢储备功能下降不孕症临床观察[J].浙江中西医结合杂志,2016,26(12):1111-1113.
[16]乐杰.妇产科学[M]. 7版.北京:人民卫生出版社,2008:322.
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[18]秦佳佳,吴倩,杨静,等.卵巢早衰的病因病机及中医药干预策略[J].中国老年学杂志,2014,34(16):4720-4721.
[19] WISER A,GONEN O,GHETLER Y,et al. Addition of dehydroepiandrosterone(DHEA)for poor-responder patients before and during IVF treatment improves the pregnancy rate:a randomized prospective study[J]. Hum Reprod,2010,25(10):2496.
[20]庞震苗,梁菁,邓高丕.卵巢早衰患者个性特征及心理健康状况调查[J].临床心身疾病杂志,2007,13(5):428-430.
[21]曹新民,魏国奇.加味当归芍药散对黄褐斑患者血清COX-2及Nrf2表达水平的影响[J].中国生化药物杂志,2017,37(6):94-96.
[22]徐海霞,胡国华,夏亦冬.育肾养血方治疗卵巢早衰的实验研究[J].上海交通大学学报(医学版),2011,31(5):571-575.
[23]张迎春,李芳园,李兰荣,等.针药对卵巢储备功能影响的临床研究[J].四川中医,2010,28(12):103-104.
[24]边心会,安云,陈佳杰.穴位埋线治疗卵巢早衰的临床观察[J].广西中医药大学学报,2016,19(4):19-21.
[25]齐凤军,李丹,阮祯,等.穴位埋线疗法不良反应的临床处理[J].针灸临床杂志,2015,31(1):33-34.
[2]于传鑫,李诵弦.实用妇科内分泌学[M]. 2版.上海:复旦大学出版社,2004:100.
[3]马灵芝,李爽,夏天.卵巢储备力降低的监测[J].现代中西医结合杂志,2010,19(11):1425-1427.
[4]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:239-243.
[5]谢幸,苟文丽.妇产科学[M]. 8版.北京:人民卫生出版社,2013:213-219.
[6]罗颂平.中医妇科学[M].北京:高等教育出版社,2008.
[7]杨冬梅,朱立春,张学新.子午流注法择时口服中药对卵巢储备功能下降月经周期延长的影响[J].中国中医基础医学杂志,2013,19(10):1159-1161.
[8] WELT C K. Primary ovarian insufficiency:a more accurate term for premature ovarian failure[J]. Clin En DORrinol(Oxf),2008,68(4):499-509.
[9] NELSON L M. Primary ovarian insufficiency[J]. N Engl J Med,2009,360(6):606-614.
[10] TULHY V K,ALTUNTAS C Z. Autoimmunity and premature ovarian failure[J]. Curr Opin Obstet Gynecol,2007,19(4):366-369.
[11]韩莹,张云山.卵巢储备功能下降相关因素的logistic回归分析[J].现代妇产科进展,2015,24(2):109-111.
[12]彭萍,马春玲,叶长烂,等.胎儿生长受限与成年后卵巢储备功能的关系[J].南方医科大学学报,2014,34(8):1217-1219.
[13]刘继龙,陈枚燕,林春莲,等.以血型联合卵泡刺激素预测女性卵巢储备功能的初步研究[J].贵州医药,2013,37(6):498-500.
[14]龚瑜,周黎明,蔡捷,等.脱氢表雄酮对卵巢储备功能下降患者卵巢反应性和IVF-ET结局的影响[J].生殖医学杂志,2017,26(7):675-678.
[15]张丽霞,何健.中药周期疗法联合针灸治疗肾虚型卵巢储备功能下降不孕症临床观察[J].浙江中西医结合杂志,2016,26(12):1111-1113.
[16]乐杰.妇产科学[M]. 7版.北京:人民卫生出版社,2008:322.
[17] GURBUZ B,YALTI S,FICICIOGLU C,et al. The relation of serum and follicular fluid leptin and ovarian steroid levels in response to induction of ovulation in in vitro fertilization cycles[J]. European Journal of Obstetrics&Gynecology and Rep roductive Biology,2005,118:214-218.
[18]秦佳佳,吴倩,杨静,等.卵巢早衰的病因病机及中医药干预策略[J].中国老年学杂志,2014,34(16):4720-4721.
[19] WISER A,GONEN O,GHETLER Y,et al. Addition of dehydroepiandrosterone(DHEA)for poor-responder patients before and during IVF treatment improves the pregnancy rate:a randomized prospective study[J]. Hum Reprod,2010,25(10):2496.
[20]庞震苗,梁菁,邓高丕.卵巢早衰患者个性特征及心理健康状况调查[J].临床心身疾病杂志,2007,13(5):428-430.
[21]曹新民,魏国奇.加味当归芍药散对黄褐斑患者血清COX-2及Nrf2表达水平的影响[J].中国生化药物杂志,2017,37(6):94-96.
[22]徐海霞,胡国华,夏亦冬.育肾养血方治疗卵巢早衰的实验研究[J].上海交通大学学报(医学版),2011,31(5):571-575.
[23]张迎春,李芳园,李兰荣,等.针药对卵巢储备功能影响的临床研究[J].四川中医,2010,28(12):103-104.
[24]边心会,安云,陈佳杰.穴位埋线治疗卵巢早衰的临床观察[J].广西中医药大学学报,2016,19(4):19-21.
[25]齐凤军,李丹,阮祯,等.穴位埋线疗法不良反应的临床处理[J].针灸临床杂志,2015,31(1):33-34.