补肾活血方干预多囊卵巢综合征患者INH-ACT-FS系统的临床研究
|
摘要
目的:观察补肾活血方治疗多囊卵巢综合征(PCOS)的临床疗效,分析补肾活血方对PCOS患者下丘脑-垂体-卵巢轴(HPO轴)及抑制素(INH)-激活素(ACT)-卵泡抑素(FS)系统的影响。方法:纳入61例PCOS患者,采用完全随机方法分为中药组31例和西药组30例。中药组患者给予补肾活血方颗粒口服,西药组患者给予炔雌醇环丙孕酮片口服,两组治疗周期均为3个月。评价两组患者的中医证候疗效及多毛、痤疮的改善情况,检测患者的血清促黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_2)、睾酮(T)、抗苗勒氏管激素(AMH)、INH、ACT、FS水平及B超下测定患者的卵巢体积(OV)、窦卵泡计数(AFC)。结果:①治疗后,中药组的中医证候疗效总有效率为83.87%,西药组为76.67%,两组中医证候疗效比较,差异无统计学意义(P>0.05)。②治疗后,两组患者的多毛情况与治疗前比较,差异无统计学意义(P>0.05);两组患者的痤疮情况均明显改善(P<0.01),但组间比较差异无统计学意义(P>0.05)。③治疗后,两组患者的LH、T水平及LH/FSH比值均明显降低(P<0.01),且西药组患者的T水平低于中药组(P<0.05)。④治疗后,两组患者的AMH、INH、FS水平均明显降低(P<0.01),ACT水平明显升高(P<0.01);且中药组患者的INH水平低于西药组、ACT水平高于西药组(P<0.05)。⑤治疗后,两组患者的OV均明显减小(P<0.01)、AFC明显减少(P<0.05,P<0.01),但组间OV、AFC比较差异无统计学意义(P>0.05)。结论:补肾活血方能有效改善PCOS患者的临床症状,并可通过下调性激素水平调节HPO轴功能;通过降低AMH、INH、FS水平及升高ACT水平,改善卵巢局部环境,促进卵泡生长发育;通过缩小OV、减少AFC,恢复卵巢形态和排卵功能。
Objective: To observe the clinical efficacy of Bushen Huoxue Recipe in the treatment of polycystic ovary syndrome(PCOS),and analyze the effects of Bushen Huoxue Recipe on the hypothalamic-pituitary-ovarian axis(HPO axis) and inhibin(INH)-activin(ACT)-follistatin(FS) system in patients with PCOS. Methods: Sixty-one patients with PCOS were included,and were divided into the Chinese medicine group( 31 cases) and the western medicine group( 30 cases) by a completely randomized method. The patients in the Chinese medicine group were orally treated with Bushen Huoxue Recipe granules,and the patients in the western medicine group were orally treated with ethylestradiol cycloproprogesterone tablets,with a course of 3 months. The Chinese medical syndromes efficacy and the improvement on crinosity and acne were evaluated,the serum levels of luteinizing hormone( LH),follicle stimulating hormone( FSH),estradiol( E2),testosterone( T),anti-Mullerian hormone( AMH),INH,ACT and FS were detected,and the ovarian volume( OV) and antral follicle count( AFC) were measured by B-ultrasound. Results:(1) After treatment,the total effective rate on Chinese medical syndromes of the Chinese medicine group was 83.87%,and that of the western medicine group was 76.67%,with no statistically significant difference between the two groups( P>0.05).(2)In both groups,there was no statistically significant difference on the degree of crinosity between treatment before and after( P>0.05). After treatment,the acne condition was significantly improved in both groups( P<0.01),but with no statistically significant difference between the two groups( P>0.05).(3)After treatment,the serum levels of LH and T and the LH/FSH ratio were significantly decreased in the two groups( P<0.01),and the level of T in the western medicine group was lower than that in the Chinese medicine group( P<0.05).(4)After treatment,the serum levels of AMH,INH and FS were significantly decreased( P<0.01),and the level of ACT was significantly increased( P<0.01) in both groups. The level of INH in the Chinese medicine group was lower than that in the western medicine group,and the level of ACT in the Chinese medicine group was higher than that in the western medicine group( P<0.05).(5)After treatment,the OV was significantly decreased in both groups( P<0.01) and the AFC was also decreased( P<0.05,P<0.01),but there were no statistically significant differences on the OV and AFC between the two groups( P>0.05). Conclusion:Bushen Huoxue Recipe can effectively improve the clinical symptoms of patients with PCOS,and regulate the function of HPO axis by down-regulating the sex hormone levels. It can improve the ovarian local environment and promote the follicular growth and development by decreasing the AMH,INH and FS levels and increasing the ACT level; and can restore the ovarian morphology and ovulation by lessening OV and reducing AFC.
Objective: To observe the clinical efficacy of Bushen Huoxue Recipe in the treatment of polycystic ovary syndrome(PCOS),and analyze the effects of Bushen Huoxue Recipe on the hypothalamic-pituitary-ovarian axis(HPO axis) and inhibin(INH)-activin(ACT)-follistatin(FS) system in patients with PCOS. Methods: Sixty-one patients with PCOS were included,and were divided into the Chinese medicine group( 31 cases) and the western medicine group( 30 cases) by a completely randomized method. The patients in the Chinese medicine group were orally treated with Bushen Huoxue Recipe granules,and the patients in the western medicine group were orally treated with ethylestradiol cycloproprogesterone tablets,with a course of 3 months. The Chinese medical syndromes efficacy and the improvement on crinosity and acne were evaluated,the serum levels of luteinizing hormone( LH),follicle stimulating hormone( FSH),estradiol( E2),testosterone( T),anti-Mullerian hormone( AMH),INH,ACT and FS were detected,and the ovarian volume( OV) and antral follicle count( AFC) were measured by B-ultrasound. Results:(1) After treatment,the total effective rate on Chinese medical syndromes of the Chinese medicine group was 83.87%,and that of the western medicine group was 76.67%,with no statistically significant difference between the two groups( P>0.05).(2)In both groups,there was no statistically significant difference on the degree of crinosity between treatment before and after( P>0.05). After treatment,the acne condition was significantly improved in both groups( P<0.01),but with no statistically significant difference between the two groups( P>0.05).(3)After treatment,the serum levels of LH and T and the LH/FSH ratio were significantly decreased in the two groups( P<0.01),and the level of T in the western medicine group was lower than that in the Chinese medicine group( P<0.05).(4)After treatment,the serum levels of AMH,INH and FS were significantly decreased( P<0.01),and the level of ACT was significantly increased( P<0.01) in both groups. The level of INH in the Chinese medicine group was lower than that in the western medicine group,and the level of ACT in the Chinese medicine group was higher than that in the western medicine group( P<0.05).(5)After treatment,the OV was significantly decreased in both groups( P<0.01) and the AFC was also decreased( P<0.05,P<0.01),but there were no statistically significant differences on the OV and AFC between the two groups( P>0.05). Conclusion:Bushen Huoxue Recipe can effectively improve the clinical symptoms of patients with PCOS,and regulate the function of HPO axis by down-regulating the sex hormone levels. It can improve the ovarian local environment and promote the follicular growth and development by decreasing the AMH,INH and FS levels and increasing the ACT level; and can restore the ovarian morphology and ovulation by lessening OV and reducing AFC.
引文
[1] 乐杰. 妇产科学[M].7版. 北京:人民卫生出版社,2011:4- 721.
[2] LI R,ZHANG Q,YANG D,et al. Prevalence of polycystic ovary syndrome in women in China:a large community- based study[J].Hum Reprod,2013,28(9):2562- 2569.
[3] 崔琳琳,陈子江. 多囊卵巢综合征诊断标准和诊疗指南介绍[J].国际生殖健康/计划生育杂志,2011,30(5):405- 408.
[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,2002:240- 241.
[5] 罗颂平. 中医妇科学[M].北京:高等教育出版社,2008:268- 269.
[6] FERRIMAN D,GALLWEY J D. Clinical assessment of body hair growth in women[J].J Clin Endocrinol Metab,1961,21(11):1440- 1447.
[7] 张学军. 皮肤性病学[M].8版. 北京:人民卫生出版社,2013:175- 176.
[8] 茅春燕. 补肾活血调经汤治疗多囊卵巢综合征不孕40例疗效观察[J].新中医,2014,46(7):112- 113.
[9] 王萍,林辉,黄群,等. 补肾活络方治疗多囊卵巢综合征肾虚血瘀证的临床研究[J].北京中医药大学学报,2013,36(9):637- 639.
[10] 范毅南,王金权. 王金权治疗多囊卵巢综合征肾虚痰湿型经验[J].实用中医药杂志,2017,33(1):82- 83.
[11] 王颖,侯丽辉,匡洪影,等. 补肾化痰方联合地屈孕酮治疗肾虚痰湿证多囊卵巢综合征临床观察[J].山东中医药大学学报,2017,41(6):527- 530.
[12] 李瑞丽,傅金英,于胜男,等. 调经种玉汤治疗脾肾阳虚型多囊卵巢综合征疗效观察[J].山东中医药大学学报,2014,38(4):355- 357.
[13] 蒋文蔚,黄学锋. 补肾健脾方治疗脾肾不足型多囊卵巢综合征疗效及对血清内脂素及hs- CRP水平的影响[J].中华中医药学刊,2016,34(6):1482- 1485.
[14] 周芳芳,李兆艾. 甘芍汤加减治疗肝郁血瘀型多囊卵巢综合征36例疗效观察[J].山西中医学院学报,2015,16(1):54- 55,58.
[15] 梁雪雯,苏建芬. 益肾疏肝、活血调经法治疗青春期多囊卵巢综合征42例疗效观察[J].贵州医药,2007,31(10):937- 938.
[16] 林静,张艳玲. 中医药序贯疗法治疗多囊卵巢综合征临床观察[J].中国中医基础医学杂志,2014,20(12):1714- 1715.
[17] 谢蓬蓬. 中药序贯周期治疗多囊卵巢综合征40例[J].云南中医中药杂志,2017,38(3):103- 104.
[18] 张翠英,朱海燕,瞿惠珍,等. 中药序贯疗法结合“辨泡”治疗多囊卵巢综合征不孕症临床研究[J].河南中医,2017,37(6):1085- 1088.
[19] 宋玉荣,王文艳,卫兵. 定坤丹对多囊卵巢模型大鼠生殖功能的影响[J].安徽医科大学学报,2016,51(10):1473- 1477.
[20] 侯丽莹,邓丽玲,罗佩,等. 丹栀逍遥散对多囊卵巢大鼠血清T、AMH及卵巢局部AMH蛋白表达的影响[J].湖南中医药大学学报,2017,37(2):141- 144.
[21] 杨优洲,潘芳,俞瑾,等. 坤泰I号方预治疗在多囊卵巢综合征促排卵中的优势探析[J].时珍国医国药,2016,27(7):1666- 1668.
[22] 郭素璇,王文君,归绥琪. 中药天癸胶囊治疗多囊卵巢综合征的随机对照疗效观察[J].中西医结合学报,2011,9(9):965- 972.
[23] 曹于,张丽,赵丹阳,等. 董氏针灸改善多囊卵巢综合征患者卵巢功能:随机对照预试验[J].中国针灸,2017,37(7):710- 714.
[24] 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.
[25] 施茵,虞莉青,尹小君. 针灸治疗肥胖型多囊卵巢综合征的临床疗效观察[J].中华中医药学刊,2010,28(4):805- 807.
[26] 吴丹,丛慧芳. 穴位埋线联合穴位贴敷治疗多囊卵巢综合征(肾虚痰湿证)的临床研究[J].针灸临床杂志,2017,33(11):11- 15.
[27] 平瑜佳,董莉,朱南孙. 补肾活血方治疗肾虚血瘀型多囊卵巢综合征临床疗效观察[J].上海中医药杂志,2012,46(11):53- 55.
[2] LI R,ZHANG Q,YANG D,et al. Prevalence of polycystic ovary syndrome in women in China:a large community- based study[J].Hum Reprod,2013,28(9):2562- 2569.
[3] 崔琳琳,陈子江. 多囊卵巢综合征诊断标准和诊疗指南介绍[J].国际生殖健康/计划生育杂志,2011,30(5):405- 408.
[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,2002:240- 241.
[5] 罗颂平. 中医妇科学[M].北京:高等教育出版社,2008:268- 269.
[6] FERRIMAN D,GALLWEY J D. Clinical assessment of body hair growth in women[J].J Clin Endocrinol Metab,1961,21(11):1440- 1447.
[7] 张学军. 皮肤性病学[M].8版. 北京:人民卫生出版社,2013:175- 176.
[8] 茅春燕. 补肾活血调经汤治疗多囊卵巢综合征不孕40例疗效观察[J].新中医,2014,46(7):112- 113.
[9] 王萍,林辉,黄群,等. 补肾活络方治疗多囊卵巢综合征肾虚血瘀证的临床研究[J].北京中医药大学学报,2013,36(9):637- 639.
[10] 范毅南,王金权. 王金权治疗多囊卵巢综合征肾虚痰湿型经验[J].实用中医药杂志,2017,33(1):82- 83.
[11] 王颖,侯丽辉,匡洪影,等. 补肾化痰方联合地屈孕酮治疗肾虚痰湿证多囊卵巢综合征临床观察[J].山东中医药大学学报,2017,41(6):527- 530.
[12] 李瑞丽,傅金英,于胜男,等. 调经种玉汤治疗脾肾阳虚型多囊卵巢综合征疗效观察[J].山东中医药大学学报,2014,38(4):355- 357.
[13] 蒋文蔚,黄学锋. 补肾健脾方治疗脾肾不足型多囊卵巢综合征疗效及对血清内脂素及hs- CRP水平的影响[J].中华中医药学刊,2016,34(6):1482- 1485.
[14] 周芳芳,李兆艾. 甘芍汤加减治疗肝郁血瘀型多囊卵巢综合征36例疗效观察[J].山西中医学院学报,2015,16(1):54- 55,58.
[15] 梁雪雯,苏建芬. 益肾疏肝、活血调经法治疗青春期多囊卵巢综合征42例疗效观察[J].贵州医药,2007,31(10):937- 938.
[16] 林静,张艳玲. 中医药序贯疗法治疗多囊卵巢综合征临床观察[J].中国中医基础医学杂志,2014,20(12):1714- 1715.
[17] 谢蓬蓬. 中药序贯周期治疗多囊卵巢综合征40例[J].云南中医中药杂志,2017,38(3):103- 104.
[18] 张翠英,朱海燕,瞿惠珍,等. 中药序贯疗法结合“辨泡”治疗多囊卵巢综合征不孕症临床研究[J].河南中医,2017,37(6):1085- 1088.
[19] 宋玉荣,王文艳,卫兵. 定坤丹对多囊卵巢模型大鼠生殖功能的影响[J].安徽医科大学学报,2016,51(10):1473- 1477.
[20] 侯丽莹,邓丽玲,罗佩,等. 丹栀逍遥散对多囊卵巢大鼠血清T、AMH及卵巢局部AMH蛋白表达的影响[J].湖南中医药大学学报,2017,37(2):141- 144.
[21] 杨优洲,潘芳,俞瑾,等. 坤泰I号方预治疗在多囊卵巢综合征促排卵中的优势探析[J].时珍国医国药,2016,27(7):1666- 1668.
[22] 郭素璇,王文君,归绥琪. 中药天癸胶囊治疗多囊卵巢综合征的随机对照疗效观察[J].中西医结合学报,2011,9(9):965- 972.
[23] 曹于,张丽,赵丹阳,等. 董氏针灸改善多囊卵巢综合征患者卵巢功能:随机对照预试验[J].中国针灸,2017,37(7):710- 714.
[24] 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.
[25] 施茵,虞莉青,尹小君. 针灸治疗肥胖型多囊卵巢综合征的临床疗效观察[J].中华中医药学刊,2010,28(4):805- 807.
[26] 吴丹,丛慧芳. 穴位埋线联合穴位贴敷治疗多囊卵巢综合征(肾虚痰湿证)的临床研究[J].针灸临床杂志,2017,33(11):11- 15.
[27] 平瑜佳,董莉,朱南孙. 补肾活血方治疗肾虚血瘀型多囊卵巢综合征临床疗效观察[J].上海中医药杂志,2012,46(11):53- 55.