中药序贯疗法治疗卵巢储备功能下降（肝郁肾虚证）的临床研究

发布时间：2018-03-18 08:14

本文选题：卵巢储备功能下降　切入点：肝郁肾虚证　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]:本课题旨在通过临床随机对照研究,对符合卵巢储备功能下降(肝郁肾虚证)的患者分别采用"滋肾养肝"中药序贯疗法和西医激素治疗,比较患者治疗前后中医证候积分和激素水平的变化,初步探讨"滋肾养肝"法系列方剂治疗卵巢储备功能下降(肝郁肾虚证)的临床疗效,为进一步研究中医药改善卵巢功能及郭志强教授学术思想提供前期基础。[方法]:本研究收集2015年12月～2016年12月就诊于北京中医药大学东直门医院本部和国际部妇科门诊并符合纳入标准的60例患者,通过随机数字表法分为治疗组("滋肾养肝"法系列方剂)和对照组(补佳乐+黄体酮胶囊)。分别治疗3个月经周期后,比较2组在治疗前后中医证候积分及月经第2～4天基础性激素水平改变:基础卵泡刺激素(FSH)、黄体生成素(LH)、雌激素(E2)、FSH/LH值,并观察计划妊娠者于治疗期间及停药后1个月内是否自然妊娠以及治疗过程中是否出现不良反应。[结果]:1.治疗组和对照组治疗前基线一致性比较:年龄段分布未见明显差异(P0.05);中医证候积分方面,月经量和主症总积分差异明显(P0.05),不具有可比性。其余主症单项积分、次症总积分及次症单项积分均未见明显差异(P0.05),具有可比性。FSH、LH、FSH/LH、E2水平差异均无统计学意义(P0.05),具有可比性。2.治疗组和对照组治疗前后组内对比提示经期未有明显变化(P0.05),而月经周期、经量、经色和经质、心烦易怒、腰骶酸痛症状经过治疗均有明显改善(P0.05);治疗后组间比较,治疗组仅在增加同房次数上有明显优势(P0.05),其余各项症状均无明显差异(P0.05)。3.治疗组治疗后FSH、FSH/LH均下降,与治疗前相比差异有统计学意义(P0.05),LH、E2均未见明显差异(P0.05);对照组治疗后FSH值下降,与治疗前相比差异有统计学意义(P0.05),LH、FSH/LH均未见明显差异(P0.05)。组间比较中,治疗组FSH/LH比值较对照组有显著改善,差异有统计学意义(P0.05),其余各项均为见明显差异(P0.05)。4.治疗组治疗期间有5例患者因个人原因未能完成治疗而退出临床研究,对照组治疗期间有4例患者因出现不良反应而退出临床研究。5.治疗过程中,治疗组未出现不良反应;对照组患者有4例出现明显恶心、乳房胀痛加重的情况,3例出现仅乳房胀痛加重的情况。[结论]:1."滋肾养肝"法系列方剂可以明显改善卵巢储备功能下降(肝郁肾虚证)患者月经周期、经量、心烦易怒、腰酸、乳房胀痛等症状。2."滋肾养肝"法系列方剂可以有效降低FSH水平和FSH/LH比值;与补佳乐+黄体酮胶囊治疗相比,更能有效改善FSH/LH比值。3."滋肾养肝"法系列方剂与西医"补佳乐+黄体酮胶囊"在改善DOR(肝郁肾虚证)患者的中医证候和激素水平方面疗效相当,且前者无明显副作用。4.卵巢储备功能下降(肝郁肾虚证)患者主诉以"月经量少"和"未避孕未孕1年以上"为主,但月经周期的改变并不明显。5.卵巢储备功能下降(肝郁肾虚证)患者的中医证候改善和激素水平改善并不存在同一性,猜测临床症状好转较激素水平的改善略有延迟性。
[Abstract]:[Objective]: this topic through randomized controlled clinical study, with diminished ovarian reserve (liver and kidney deficiency syndrome) patients were treated with "zishenyanggan" of traditional Chinese medicine and Western Medicine Sequential Therapy of hormone therapy, changes of TCM syndrome integral and hormone levels were compared before and after treatment, explore the "zishenyanggan" series decoction for the treatment of diminished ovarian reserve (liver and kidney deficiency syndrome) clinical curative effect, for the further study of traditional Chinese medicine on improving the academic thought of Professor Guo Zhiqiang ovarian function and provide a basis. Methods: This study collected from December 2015 to December 2016 in Dongzhimen Hospital of Beijing University of Chinese Medicine, the Department of the International Department of gynecology clinic and 60 cases and in accordance with the inclusion criteria were randomized by randomly divided into the treatment group ("zishenyanggan" series of prescriptions) and control group (progynova + progesterone capsules) respectively. After treatment for 3 menstrual cycles, The 2 groups were compared before and after treatment of TCM syndrome integral and menstruation second ~ 4 days of basic hormone level change: basal follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), FSH/LH value, and observe the plan of pregnancy during the treatment period and 1 months after drug withdrawal is natural pregnancy and adverse reactions. Results] whether there in the course of treatment: 1. treatment group and control group before baseline consistency: the age distribution showed no significant difference (P0.05); TCM syndrome score, menstrual volume and main symptoms total score difference (P0.05), not comparable. The rest of the main in a single score, total score of secondary symptoms and secondary symptoms of individual scores had no significant difference (P0.05), comparable to.FSH, LH, FSH/LH, E2 levels were not significantly different (P0.05), comparable to.2. treatment group and control group before and after treatment group compared with that period did not change significantly (P0.05), and The menstrual cycle, by volume, the color and the quality, irritability, lumbosacral pain symptoms were significantly improved after treatment (P0.05); comparison between groups after treatment, treatment group increased only in the same room number have an obvious advantage (P0.05), there was no significant difference of symptoms (P0.05) and.3. treatment group after treatment FSH and FSH/LH were decreased, compared with before treatment, the difference was statistically significant (P0.05), LH, E2 had no significant difference (P0.05); the control group after treatment FSH decreased, compared with before treatment, the difference was statistically significant (P0.05), LH, FSH/LH had no significant differences between two groups (P0.05). In the treatment group, the ratio of FSH/LH compared with the control group improved significantly, the difference was statistically significant (P0.05), the rest were all significantly difference (P0.05).4. treatment group during the treatment of 5 patients for personal reasons failed to complete treatment from the clinical study, the control group during the treatment in 4 cases because of not Exit and clinical study of.5. adverse reaction during the treatment, the treatment group did not appear adverse reaction; the control group had 4 cases of obvious nausea, breast pain worse, only 3 cases of breast pain worse. Conclusion: 1. "zishenyanggan" series of prescriptions can significantly improve the ovarian reserve function decline (liver and kidney deficiency syndrome) in patients with menstrual cycle, by volume, irritability, backache, breast pain and other symptoms of.2. "zishenyanggan" series of prescriptions can effectively reduce the FSH level and FSH/LH ratio; compared with progynova plus progesterone capsule treatment, can effectively improve the ratio of FSH/LH.3. "zishenyanggan" series of prescription and Western Medicine "progynova plus progesterone capsule in the improvement of DOR (liver and kidney deficiency syndrome) is the traditional Chinese medicine syndrome and hormone levels in patients with curative effect and no obvious side effects, the.4. diminished ovarian reserve (liver and kidney deficiency syndrome) patients complained to menstruation Less "and" no contraception not pregnant for more than 1 years ", but the menstrual cycle did not change significantly.5. diminished ovarian reserve (liver and kidney deficiency syndrome) patients with TCM symptoms and hormone level improvement does not exist in the same sex, guess the improvement of clinical symptoms improved slightly compared with hormone level delay.

【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】：R271.9

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