补肾填精方治疗阴虚火旺型围绝经期综合征的临床观察

发布时间：2018-01-01 22:31

本文关键词：补肾填精方治疗阴虚火旺型围绝经期综合征的临床观察　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:女性在围绝经期,随着卵巢功能的逐渐减退,激素水平出现变化,围绝经期综合征(perimenopausal syndrome,PMS)随之出现。PMS是妇科临床的常见疾病,其临床表现多见月经紊乱、烘热汗出、烦躁失眠、心悸、眩晕等症状,可严重降低围绝经期女性生活质量。因此,对PMS的治疗不容忽视。雌激素水平下降是PMS的重要原因,但雌激素替代疗法存在诱发癌症的风险,临床上治疗PMS需要新思路。传统中医称PMS为经断前后诸证,认为其病机为肾虚为本,分为肾阴虚型、肾阳虚型及肾阴阳俱虚型。导师刘昭阳主任中医师结合多年临床实践经验及中医古籍的论述,认为PMS除上述分型外,还分为阴虚火旺型,并独创补肾填精方以治疗阴虚火旺型PMS。本研究通过应用补肾填精方治疗阴虚火旺型PMS,观察补肾填精方对阴虚火旺型PMS的临床症状影响,及治疗前后机体雌二醇(estrogen,E2)、卵泡刺激素(follicle-stimulating hormone,FSH)、促黄体生成素(luteinizing hormone,LH)水平的变化。方法:本研究患者均为2016年6月至2016年11月就诊于北京中医药大学第三附属医院妇科门诊的患者。参考PMS相关中西医诊断标准,并根据相关标准排除相应病例后,选取中医辨证为阴虚火旺型PMS患者55例,按随机对照试验分为补肾填精方治疗组(n=28例)和坤泰胶囊对照组(n=27例)。口服用药,以8周为一个疗程,填写研究观察表,观察比较各组患者治疗前后的国内改良Kupperman积分、中医证候积分和E2、FSH、LH水平的变化情况。结果:1.综合疗效:补肾填精方治疗组:28例,痊愈2例(7.14%),显效14例(50%),有效10例(35.71%),无效2例(7.14%),总有效率92.86%;坤泰胶囊对照组:27例,治疗后痊愈1例(3.70%),显效5例(18.52%),有效13例(48.15%),无效8例(29.63%),总有效率70.37%;治疗组疗效优于对照组(P0.05)。2.国内改良Kupperman评分结果:治疗组评分均值标准差由29.79±7.52下降到8.79±4.69,对照组均值标准差由27.33±8.75下降至14.52±9.35,两组患者治疗后均有效果,且补肾填精方疗效优于对照组(P0.05)。3.中医症状评分结果:两组症状比较,治疗组评分均值标准差由17.32±6.41下降到4.79±2.85,对照组均值标准差由16.74±7.19下降到9.63±6.82,两组患者治疗后均有效果,治疗组较对照组评分降低明显(P0.05),其中治疗组在改善患者烘热汗出、心烦易怒、手足心热、大便秘结、心悸气短及失眠中医症候方面疗效优于对照组。4.血清激素水平结果:两组患者治疗后E2水平均有所上升,治疗组均值标准差由30.26±19.56 上升到 46.66±33.81,较对照组 28.18±17.74 增至 34.75±26.73 上升明显,(P0.05)说明存在差异;FSH、LH均有下降,治疗后两组组间比较,(P0.05)说明存在差异,治疗组效果高于对照组。结论:补肾填精方治疗阴虚火旺型围绝经期综合征临床疗效显著,能够明显改善阴虚火旺型PMS患者的临床症状及性激素水平,具有较好临床应用价值。
[Abstract]:Objective: during the peri-menopausal period, with the gradual decline of ovarian function, hormone level changes, peri-menopausal syndrome perimenopausal syndrome. PMS.PMS is a common gynecological clinical disease, its clinical manifestations are more menstrual disorders, hot sweating, restless insomnia, palpitations, vertigo and other symptoms. Therefore, the treatment of PMS can not be ignored. The decrease of estrogen level is an important cause of PMS, but estrogen replacement therapy has the risk of inducing cancer. Clinical treatment of PMS needs a new way of thinking. Traditional Chinese medicine call PMS as the syndrome before and after meridian break, think that its pathogenesis is kidney deficiency, divided into kidney yin deficiency type. Director Liu Zhaoyang combined with many years of clinical experience and the discussion of ancient Chinese medicine books, think that PMS in addition to the above classification, but also divided into Yin deficiency fire flourishing type. In this study, the effect of Bushen filling essence prescription on the clinical symptoms of Yin deficiency and fire flourishing type PMS was observed through the application of Bushen filling essence recipe in treating Yin deficiency Fire and flourishing PMSs. And before and after treatment, estradiol estradiol estrogenin E2N, follicle-stimulating hormone follicle-stimulating hormone (FSHs). Luteinizing hormone. LH). Changes in levels-methods:. All the patients in this study were admitted to the gynecological clinic of the third affiliated Hospital of Beijing University of traditional Chinese Medicine from June 2016 to November 2016. We refer to the diagnostic criteria of traditional Chinese and Western medicine related to PMS. And according to the relevant criteria exclude the corresponding cases, select Chinese medicine syndrome differentiation as Yin deficiency fire flourishing type of PMS patients 55 cases. According to the randomized controlled trial, 28 cases were divided into the treatment group of tonifying kidney and filling essence prescription (n = 28) and the control group of Kun Tai capsule (n = 27). Observe and compare the domestic improved Kupperman score, TCM syndrome score and E2FSH before and after treatment. Results 1. Comprehensive curative effect: 28 cases in the treatment group of tonifying kidney and filling essence prescription, 2 cases were cured 7.14%, 14 cases had remarkable effect, 10 cases were effective (35.71%). The total effective rate was 92.86%; There were 27 cases in the control group of Kun Tai capsule, 1 case was cured 3.70%, 5 cases had remarkable effect and 18.522%, 13 cases were effective and 48.15%, and 8 cases were ineffective (29.63%). The total effective rate was 70.37; The curative effect of the treatment group was better than that of the control group (P0.05). 2.The domestic modified Kupperman score: the standard deviation of the mean score of the treatment group decreased from 29.79 卤7.52 to 8.79 卤4.69. The mean standard deviation of the control group decreased from 27.33 卤8.75 to 14.52 卤9.35. Both groups were effective after treatment. The curative effect of tonifying kidney and filling essence prescription was better than that of control group (P 0.05N. 3). Results of TCM symptom score: the two groups were compared with each other. The mean standard deviation of score in the treatment group decreased from 17.32 卤6.41 to 4.79 卤2.85, and that in the control group decreased from 16.74 卤7.19 to 9.63 卤6.82. Two groups of patients after treatment were effective, the treatment group than the control group scores significantly decreased P0.05, which in the treatment group in the improvement of heat sweating, irritability, hot hands and feet, big constipation knot. The curative effect of TCM symptom of heart palpitation shortness of breath and insomnia was better than that of control group .4.The result of serum hormone level: after treatment, E2 level in both groups were increased. The mean standard deviation of the treatment group increased from 30.26 卤19.56 to 46.66 卤33.81. Compared with the control group (28.18 卤17.74, 34.75 卤26.73), the difference was significant (P 0.05). The decrease of FSHN LH in both groups showed that there was a difference between the two groups after treatment (P 0.05). Conclusion: the clinical effect of Bushen filling essence prescription in treating peri-menopausal syndrome of Yin deficiency and fire flourishing type is significant and can obviously improve the clinical symptoms and sex hormone level of PMS patients with Yin deficiency and fire flourishing type. It has good clinical application value.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.116

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