辨证与辨病结合治疗多囊卵巢综合征临床研究
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摘要
目的观察辨证与辨病结合治疗多囊卵巢综合征(PCOS)的临床疗效。方法将88例PCOS患者按照随机数字表法分为2组。治疗组46例采用辨证与辨病结合方法,运用填精补肾方、疏肝化痰方、补肾活血方治疗;对照组42例予炔雌醇环丙孕酮片治疗。2组均3个月经周期为1个疗程,共治疗3个疗程。比较2组临床疗效及治疗前后中医症状积分,比较治疗组治疗前后体质量指数(BMI)、多毛评分、痤疮评分、性激素[睾酮(T)、黄体生成激素(LH)、卵泡刺激素(FSH)、雌二醇(E_2)]水平及空腹胰岛素(FINS)变化情况;停药3个月后监测比较2组卵巢面积及排卵情况。结果治疗后,治疗组中医症状积分均较本组治疗前及对照组治疗后降低(P<0.05)。治疗组总有效率(93.47%)高于对照组(71.43%,P<0.05)。治疗后,治疗组BMI、多毛评分及痤疮评分均较本组治疗前降低(P<0.05,P<0.01)。治疗后,治疗组LH、LH/FSH、T及FINS均较本组治疗前降低(P<0.05,P<0.01),E_2升高(P<0.05)。停药3个月,治疗组卵巢面积均较本组治疗前及对照组同期明显缩小(P<0.05),治疗组排卵率(60.87%)高于对照组(30.95%,P<0.01)。结论辨证与辨病结合,采用填精补肾方、疏肝化痰方、补肾活血方治疗PCOS有较好的临床疗效,能有效改善患者临床症状,提高疗效及排卵率。
Objective To observe the clinical efficacy of combination of syndrome differentiation and disease differentiation in the treatment of polycystic ovary syndrome(PCOS). Methods 88 PCOS patients were divided into two groups according to random number table method. 46 cases in treatment group were treated by the combination of syndrome differentiation and disease differentiation, they were treated by Tianjing Bushen recipe, Shugan Huatan recipe and Buqi Huoxue recipe. 42 cases in control group were treated by ethinyl estradiol progesterone tablets. Both groups were treated for 3 menstrual cycles as a course of treatment, a total of 3 courses of treatment. The clinical efficacy and TCM symptom scores of the two groups were compared before and after treatment. The changes of body mass index(BMI), hairy score, acne score, sex hormone [testosterone(T), luteinizing hormone(LH), follicle stimulating hormone(FSH), estradiol(E_2) ] and fasting insulin(FINS) were compared before and after treatment in the treatment group. The ovarian area and ovulation were monitored and compared between the two groups after 3 months of withdrawal. Results After treatment, the scores of TCM symptoms in the treatment group were lower than those before treatment and after treatment in the control group(P<0.05). The total effective rate of the treatment group(93.47%) was higher than that of the control group(71.43%, P<0.05). After treatment, the BMI, hairy score and acne score in the treatment group were lower than those before treatment(P<0.05, P<0.01). After treatment, the levels of LH, LH/FSH, T and FINS in the treatment group were lower than those before treatment(P<0.05, P<0.01), and E_2 was higher(P<0.05). After 3 months of withdrawal, the ovarian area of the treatment group was significantly smaller than that before treatment and in the control group at the same time(P<0.05), the ovulation rate of the treatment group(60.87%) was higher than that of the control group(30.95%,P<0.01). Conclusion Taking the combination of disease differentiation and syndrome differentiation, the treatment of PCOS with the combination of Tianjing Bushen recipe, Shugan Huatan recipe and Buqi Huoxue recipe has a good clinical effect.It can effectively improve the clinicalsymptoms,curative effect and ovulation rate of patient
Objective To observe the clinical efficacy of combination of syndrome differentiation and disease differentiation in the treatment of polycystic ovary syndrome(PCOS). Methods 88 PCOS patients were divided into two groups according to random number table method. 46 cases in treatment group were treated by the combination of syndrome differentiation and disease differentiation, they were treated by Tianjing Bushen recipe, Shugan Huatan recipe and Buqi Huoxue recipe. 42 cases in control group were treated by ethinyl estradiol progesterone tablets. Both groups were treated for 3 menstrual cycles as a course of treatment, a total of 3 courses of treatment. The clinical efficacy and TCM symptom scores of the two groups were compared before and after treatment. The changes of body mass index(BMI), hairy score, acne score, sex hormone [testosterone(T), luteinizing hormone(LH), follicle stimulating hormone(FSH), estradiol(E_2) ] and fasting insulin(FINS) were compared before and after treatment in the treatment group. The ovarian area and ovulation were monitored and compared between the two groups after 3 months of withdrawal. Results After treatment, the scores of TCM symptoms in the treatment group were lower than those before treatment and after treatment in the control group(P<0.05). The total effective rate of the treatment group(93.47%) was higher than that of the control group(71.43%, P<0.05). After treatment, the BMI, hairy score and acne score in the treatment group were lower than those before treatment(P<0.05, P<0.01). After treatment, the levels of LH, LH/FSH, T and FINS in the treatment group were lower than those before treatment(P<0.05, P<0.01), and E_2 was higher(P<0.05). After 3 months of withdrawal, the ovarian area of the treatment group was significantly smaller than that before treatment and in the control group at the same time(P<0.05), the ovulation rate of the treatment group(60.87%) was higher than that of the control group(30.95%,P<0.01). Conclusion Taking the combination of disease differentiation and syndrome differentiation, the treatment of PCOS with the combination of Tianjing Bushen recipe, Shugan Huatan recipe and Buqi Huoxue recipe has a good clinical effect.It can effectively improve the clinicalsymptoms,curative effect and ovulation rate of patient
引文
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[3] Ma YM,Li R,Qiao J,et al.Characteristics of abnormal menstrual cycle and polycystic ovary syndrome in community and hospital populations[J].Chin Med J(Engl),2010,123(16):2185-2189.
[4] de ávila MA,Borges LP,Paez MS,et al.Acanthosis nigricans:metabolic interrelations inherent to the polycystic ovary syndrome[J].Rev Bras Ginecol Obstet,2014,36(9):410-415.
[5] 张涛,毛世华.炔雌醇环丙孕酮片在多囊卵巢综合征患者中的应用[J].中国妇幼保健,2015,30(21):3758-3760.
[6] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome[J].Fertil Steril,2004,81(1):19-25.
[7] 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.
[8] 曹泽毅.中华妇产科学[M].2版.北京:人民卫生出版社,2004:2375-2481.
[9] 王兴娟,曾晓聆,刘颖等.多囊卵巢综合征不同中医证型与内分泌代谢的相关性探索[J].中国中西医结合杂志,2011,31(8):1085-1089.
[10] Azziz R.Polycystic ovary syndrome,insulin resistance,and molecular defects of insulin signaling[J].J Clin Endocrinol Metab,2002,87(9):4085-4087.
[11] Moreira S,Soares E,Tomaz G,et al.Polycystic ovary syndrome:a psychosocial approach[J].Acta Med Port,2010,23(2):237-242.
[12] 许良智,张静.多囊卵巢综合征[J].现代临床医学,2006,32(4):311-314.
[13] 栾会娟,陈媛.二甲双胍联合炔雌醇环丙孕酮片治疗多囊卵巢综合征的临床研究[J].现代药物与临床,2014,29(9):1003-1006.
[14] 凌晓红,田兴中,潘琦虹,等.自拟补肾健脾疏肝方治疗多囊卵巢综合征30例临床疗效观察[J].贵阳中医学院学报,2015,37(1):31-34.
[15] 陈倩倩,叶平.中医辨体调质对排卵障碍性不孕症患者卵泡生长发育的影响[J].中医杂志,2014,55(24):2110-2113.
[16] 朱鸿秋,陈俊杰.青春期多囊卵巢综合征患者临床及内分泌代谢特征分析[J].河北中医,2012,34(8):1275-1276.
[2] Abdel-Rahman MY,Abdellah AH,Ahmad SR,et al.Prevalence of abnormal glucose metabolism in a cohort of Arab women with polycystic ovary syndrome[J].Int J Gynaeeol Obstet,2011,14(3):288-289.
[3] Ma YM,Li R,Qiao J,et al.Characteristics of abnormal menstrual cycle and polycystic ovary syndrome in community and hospital populations[J].Chin Med J(Engl),2010,123(16):2185-2189.
[4] de ávila MA,Borges LP,Paez MS,et al.Acanthosis nigricans:metabolic interrelations inherent to the polycystic ovary syndrome[J].Rev Bras Ginecol Obstet,2014,36(9):410-415.
[5] 张涛,毛世华.炔雌醇环丙孕酮片在多囊卵巢综合征患者中的应用[J].中国妇幼保健,2015,30(21):3758-3760.
[6] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome[J].Fertil Steril,2004,81(1):19-25.
[7] 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.
[8] 曹泽毅.中华妇产科学[M].2版.北京:人民卫生出版社,2004:2375-2481.
[9] 王兴娟,曾晓聆,刘颖等.多囊卵巢综合征不同中医证型与内分泌代谢的相关性探索[J].中国中西医结合杂志,2011,31(8):1085-1089.
[10] Azziz R.Polycystic ovary syndrome,insulin resistance,and molecular defects of insulin signaling[J].J Clin Endocrinol Metab,2002,87(9):4085-4087.
[11] Moreira S,Soares E,Tomaz G,et al.Polycystic ovary syndrome:a psychosocial approach[J].Acta Med Port,2010,23(2):237-242.
[12] 许良智,张静.多囊卵巢综合征[J].现代临床医学,2006,32(4):311-314.
[13] 栾会娟,陈媛.二甲双胍联合炔雌醇环丙孕酮片治疗多囊卵巢综合征的临床研究[J].现代药物与临床,2014,29(9):1003-1006.
[14] 凌晓红,田兴中,潘琦虹,等.自拟补肾健脾疏肝方治疗多囊卵巢综合征30例临床疗效观察[J].贵阳中医学院学报,2015,37(1):31-34.
[15] 陈倩倩,叶平.中医辨体调质对排卵障碍性不孕症患者卵泡生长发育的影响[J].中医杂志,2014,55(24):2110-2113.
[16] 朱鸿秋,陈俊杰.青春期多囊卵巢综合征患者临床及内分泌代谢特征分析[J].河北中医,2012,34(8):1275-1276.