针药并用治疗脾肾亏虚型无排卵型功能失调性子宫出血的疗效观察
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摘要
目的观察针灸配合固冲四草汤治疗脾肾亏虚型无排卵型功能失调性子宫出血的临床疗效。方法将116例脾肾亏虚型无排卵型功能失调性子宫出血患者随机分为治疗组和对照组,每组58例。治疗组采用针灸配合固冲四草汤治疗,对照组采用单纯口服固冲四草汤治疗。观察两组治疗前后各项性激素[促黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_2)]、凝血功能各项指标[凝血酶原时间(PT)、部分凝血酶原时间(APTT)和纤维蛋白原(FIB)]及子宫内膜B淋巴细胞瘤-2(Bcl-2)、Bax评分的变化情况,并比较两组临床疗效。结果治疗组总有效率为93.1%,对照组为77.6%,两组比较差异具有统计学意义(P<0.05)。两组治疗后E_2、PT、APTT及子宫内膜Bcl-2、Bax评分与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后E_2、PT、APTT及子宫内膜Bcl-2、Bax评分与对照组比较,差异均具有统计学意义(P<0.05)。结论针灸配合固冲四草汤治疗脾肾亏虚型无排卵型功能失调性子宫出血疗效确切,能明显调节患者凝血功能,改善子宫内膜Bcl-2、Bax表达水平。
Objective To observe the clinical efficacy of acupuncture-moxibustion plus Gu Chong Si Cao decoction in treating anovulatory dysfunctional uterine bleeding due to spleen-kidney deficiency. Method One hundred and sixteen patients with anovulatory dysfunctional uterine bleeding due to spleen-kidney deficiency were randomized into treatment and control groups, with 58 cases in each group. The treatment group was intervened by acupuncturemoxibustion plus Gu chong si cao decoction, while the control group was intervened by oral administration of Gu chong si cao decoction alone. Sex hormones [luteinizing hormone(LH), follicle stimulating hormone(FSH) and estradiol(E_2)], indicators of coagulation function [prothrombin time(PT), activated partial thrombopladtin time(APTT)and fibrinogen(FIB)], endometrial B-cell lymphoma-2(Bcl-2) score and Bcl-2 associated X protein(Bax) score in the two groups were observed before and at the end of the treatment, and the clinical efficacies were compared. Result The total effective rate was 93.1% in the treatment group and 77.6% in the control group, and there was a statistically significant difference between the two groups(P<0.05). The indicators of E_2, PT and APTT, endometrial Bcl-2 score and Bax score all showed a significant change after the treatment in the two groups(P<0.05). After the treatment, the indicators of E_2, PT and APTT, endometrial Bcl-2 score and Bax score in the treatment group were significantly different from those in the control group(P<0.05). Conclusion Acupuncture-moxibustion plus Gu chong si cao decoction can produce valid efficacy in treating anovulatory dysfunctional uterine bleeding due to spleen-kidney deficiency. It can obviously regulate the coagulation function in the patients and improve the expression levels of Bcl-2 and Bax in endometrium.
Objective To observe the clinical efficacy of acupuncture-moxibustion plus Gu Chong Si Cao decoction in treating anovulatory dysfunctional uterine bleeding due to spleen-kidney deficiency. Method One hundred and sixteen patients with anovulatory dysfunctional uterine bleeding due to spleen-kidney deficiency were randomized into treatment and control groups, with 58 cases in each group. The treatment group was intervened by acupuncturemoxibustion plus Gu chong si cao decoction, while the control group was intervened by oral administration of Gu chong si cao decoction alone. Sex hormones [luteinizing hormone(LH), follicle stimulating hormone(FSH) and estradiol(E_2)], indicators of coagulation function [prothrombin time(PT), activated partial thrombopladtin time(APTT)and fibrinogen(FIB)], endometrial B-cell lymphoma-2(Bcl-2) score and Bcl-2 associated X protein(Bax) score in the two groups were observed before and at the end of the treatment, and the clinical efficacies were compared. Result The total effective rate was 93.1% in the treatment group and 77.6% in the control group, and there was a statistically significant difference between the two groups(P<0.05). The indicators of E_2, PT and APTT, endometrial Bcl-2 score and Bax score all showed a significant change after the treatment in the two groups(P<0.05). After the treatment, the indicators of E_2, PT and APTT, endometrial Bcl-2 score and Bax score in the treatment group were significantly different from those in the control group(P<0.05). Conclusion Acupuncture-moxibustion plus Gu chong si cao decoction can produce valid efficacy in treating anovulatory dysfunctional uterine bleeding due to spleen-kidney deficiency. It can obviously regulate the coagulation function in the patients and improve the expression levels of Bcl-2 and Bax in endometrium.
引文
[1]李宇彬,罗灿峤,肖珊,等.功能失调性子宫出血158例临床表现分析[J].中国实用妇科与产科杂志,2015,31(7):645-648.
[2]李雪萍,罗菊玉.去氧孕烯炔雌醇联合米非司酮治疗围绝经期无排卵型功能失调性子宫出血的临床观察[J].中国药房,2016,27(14):1981-1983.
[3]柯忠妹,董新珍.中医药辨证论治功能失调性子宫出血[J].中华中医药学刊,2016,34(6):1514-1516.
[4]谢幸,苟文丽.妇产科学[M].第8版,北京:人民卫生出版社,2013:344.
[5]中华中医药学会.中医妇科常见病诊疗指南[S].北京:中国中医药出版社,2012:96-100.
[6]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:239-243.
[7]Hokenstad AN,El-Nashar SA1,Khan Z,et al.Endometrial Ablation in Women With Abnormal Uterine Bleeding Related to Ovulatory Dysfunction:A Cohort Study[J].J Minim Invasive Gynecol,2015,22(7):1225-1230.
[8]陆丽霞,王军玲.清热祛瘀汤治疗围绝经期功能性子宫出血的疗效及对患者凝血机制和血红蛋白的影响[J].四川中医,2016,34(3):96-98.
[9]Kokawa K,Shikone T,Otani T,et al.Apoptosis and the expression of Bax and bcl‐2 in squamous cell carcinoma and adenocarcinoma of the uterine cervix[J].Cancer,1999,85(8):1799-1809.
[10]朱明玥,张媛媛,玛依努尔·尼牙孜,等.Bcl-xL、Bcl-2与维吾尔族妇女宫颈癌关系的研究[J].中国妇幼保健,2015,30(10):1586-1590.
[11]Karch J,Molkentin JD.Regulated necrotic cell death:the passive aggressive side of Bax and Bak[J].Circ Res,2015,116(11):1800-1809.
[12]崔淑英,刘素菊,李晓波.Bcl-2、bax、P53蛋白在无排卵型功能失调性子宫出血中的表达及意义[J].中国临床研究,2013,26(6):567-568.
[13]曾美玲,王烨,范小雪,等.魏绍斌治疗功能失调性子宫出血经验[J].中国中医基础医学杂志,2016,22(7):988-989.
[14]杨秀芳,李清雪,朱希慧,等.补肾固冲调经系列方治疗脾肾两虚型无排卵性功能失调性子宫出血近期和远期疗效及对凝血功能安全性的观察[J].中国妇幼保健,2017,32(2):236-238.
[15]杨江华,高琴,白帆,等.固冲汤加减方联合西药治疗无排卵性功能失调性子宫出血疗效观察[J].陕西中医,2017,38(7):819-820.
[16]张敏,敖田华,李莉,等.止崩汤加针灸治疗围绝经期功能失调性子宫大出血320例[J].四川中医,2014,32(8):129-131.
[17]王晓彤,林海雄,徐帅,等.针灸治疗功能失调性子宫出血有效性的系统评价及Meta分析[J].中华中医药学刊,2017,35(4):794-798.
[18]杨露,张鹏,尤璐,等.针刺组穴治疗原发性痛经临床研究[J].中医学报,2015,30(2):294-296.
[19]刘英含,钟峰,石文英,等.子宫穴在妇科疾病中的应用及现代理论依据[J].上海针灸杂志,2015,34(4):364-366.
[2]李雪萍,罗菊玉.去氧孕烯炔雌醇联合米非司酮治疗围绝经期无排卵型功能失调性子宫出血的临床观察[J].中国药房,2016,27(14):1981-1983.
[3]柯忠妹,董新珍.中医药辨证论治功能失调性子宫出血[J].中华中医药学刊,2016,34(6):1514-1516.
[4]谢幸,苟文丽.妇产科学[M].第8版,北京:人民卫生出版社,2013:344.
[5]中华中医药学会.中医妇科常见病诊疗指南[S].北京:中国中医药出版社,2012:96-100.
[6]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:239-243.
[7]Hokenstad AN,El-Nashar SA1,Khan Z,et al.Endometrial Ablation in Women With Abnormal Uterine Bleeding Related to Ovulatory Dysfunction:A Cohort Study[J].J Minim Invasive Gynecol,2015,22(7):1225-1230.
[8]陆丽霞,王军玲.清热祛瘀汤治疗围绝经期功能性子宫出血的疗效及对患者凝血机制和血红蛋白的影响[J].四川中医,2016,34(3):96-98.
[9]Kokawa K,Shikone T,Otani T,et al.Apoptosis and the expression of Bax and bcl‐2 in squamous cell carcinoma and adenocarcinoma of the uterine cervix[J].Cancer,1999,85(8):1799-1809.
[10]朱明玥,张媛媛,玛依努尔·尼牙孜,等.Bcl-xL、Bcl-2与维吾尔族妇女宫颈癌关系的研究[J].中国妇幼保健,2015,30(10):1586-1590.
[11]Karch J,Molkentin JD.Regulated necrotic cell death:the passive aggressive side of Bax and Bak[J].Circ Res,2015,116(11):1800-1809.
[12]崔淑英,刘素菊,李晓波.Bcl-2、bax、P53蛋白在无排卵型功能失调性子宫出血中的表达及意义[J].中国临床研究,2013,26(6):567-568.
[13]曾美玲,王烨,范小雪,等.魏绍斌治疗功能失调性子宫出血经验[J].中国中医基础医学杂志,2016,22(7):988-989.
[14]杨秀芳,李清雪,朱希慧,等.补肾固冲调经系列方治疗脾肾两虚型无排卵性功能失调性子宫出血近期和远期疗效及对凝血功能安全性的观察[J].中国妇幼保健,2017,32(2):236-238.
[15]杨江华,高琴,白帆,等.固冲汤加减方联合西药治疗无排卵性功能失调性子宫出血疗效观察[J].陕西中医,2017,38(7):819-820.
[16]张敏,敖田华,李莉,等.止崩汤加针灸治疗围绝经期功能失调性子宫大出血320例[J].四川中医,2014,32(8):129-131.
[17]王晓彤,林海雄,徐帅,等.针灸治疗功能失调性子宫出血有效性的系统评价及Meta分析[J].中华中医药学刊,2017,35(4):794-798.
[18]杨露,张鹏,尤璐,等.针刺组穴治疗原发性痛经临床研究[J].中医学报,2015,30(2):294-296.
[19]刘英含,钟峰,石文英,等.子宫穴在妇科疾病中的应用及现代理论依据[J].上海针灸杂志,2015,34(4):364-366.