补肾祛痰法联合达英-35治疗高雄激素血症型PCOS及其对AMH影响的临床研究

发布时间：2018-03-15 17:52

本文选题：多囊卵巢综合征　切入点：高雄激素血症　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过临床研究,观察补肾祛痰法联合达英-35治疗高雄激素血症型PCOS的临床疗效;观察联合用药的临床优效性及其能否降低单独达英-35治疗所产生的不良反应及复发率;初步探索本方案对AMH的影响及AMH在PCOS中的作用机制,为本病诊断、治疗、预测的探索打下基础。方法:本研究分为理论研究和临床研究两部分。理论研究:通过文献研究,从中医学及现代医学对PCOS的认识、AMH在PCOS中的研究进展三个方面进行综述。临床研究:收集就诊于南京中医药大学第三附属医院妇科门诊符合肾虚痰湿型PCOS伴HA的患者60例,按对照原则分为试验组(30例)和对照组(30例),试验组予补肾祛痰方+达英-35、对照组予达英-35,治疗3个月,随访3个月;观察两组患者治疗前后月经情况、排卵情况、中医证候评分、多毛、痤疮、BMI、卵巢体积、AFC、肝肾功能、血脂及血清激素水平。记录随访期间的排卵、妊娠情况及以上各指标以评价复发情况。结果:两种方案治疗PCOS均有疗效,试验组总有效率86.67%,对照组总有效率73.33%,试验组疗效优于对照组(P=0.025)。两组均能有效改善PCOS的中医证候评分,试验组总有效率达90%,对照组50%,试验组优于对照组(P=0.000)。两组对于本病月经紊乱、痤疮、肥胖、排卵障碍均有不同程度的改善作用,且试验组优于对照组(P0.05);两组均未改善患者多毛的体征。两组均能明显降低LH、T水平、LH/FSH比值及AMH水平,明显提高SHBG水平,且试验组疗效更佳(P＜0.05);随访三个月期间两组均有复发,但对照组明显高于试验组(P=0.001）。PCOS体内AMH水平与雄激素水平及AFC呈正相关,r 值分别为 0.906、0.763。结论:补肾祛痰法联合达英-35治疗高雄激素血症型PCOS的作用优于单独达英-35治疗,不仅在总疗效、改善中医证候评分及激素水平等方面效果更佳,且随访期间患者的妊娠数更多,复发率更低。AMH与雄激素水平及AFC呈正相关,可能为PCOS排卵障碍的机制所在。由于治疗时间短,治疗多毛和缓解不良反应的优势未显示。
[Abstract]:Objective: through clinical research, to observe the clinical efficacy of bushenqutan method combined with -35 in the treatment of Kaohsiung hormones PCOS; observe the combination of adverse reaction and recurrence of clinical superiority and can reduce the production of -35 with single treatment rate; preliminary explore the mechanism of the influence of AMH and AMH of the scheme in PCOS. For the diagnosis, treatment, lay the foundation for prediction of exploration. Methods: This study is divided into two parts: theoretical research and clinical research. The theoretical research: through literature research, from the traditional Chinese medicine and modern medicine on PCOS, reviewed the research progress in the three aspects of PCOS AMH in clinical research: collected. The Third Affiliated Hospital of Nanjing University of Chinese Medicine from gynecology outpatient department in accordance with the 60 cases of patients with kidney deficiency and phlegm type PCOS with HA, according to the control principle is divided into test group (30 cases) and control group (30 cases), treatment group were treated with Tonifying the kidney and Eliminating Phlegm Decoction + Diane -35, The control group was treated with -35 for 3 months, 3 months of follow-up observation, menstruation; two groups of patients before and after ovulation, TCM syndrome score, hirsutism, acne, BMI, ovarian volume, AFC, liver and kidney function, blood lipid and serum hormone levels recorded during the follow-up. The ovulation, pregnancy and above the index to evaluate the condition of recurrence. Results: two treatment schemes of PCOS have the curative effect, the total efficiency of the test group 86.67%, control group total effectiveness 73.33%, the treatment group and the control group (P=0.025). The two groups can effectively improve the TCM syndrome score of PCOS, the experimental group total effective rate was 90%, 50% in the control group, the experimental group than the control group (P=0.000). The two groups for the disease, menstrual disorders, acne, obesity, improve ovulation disorder in different degrees, and the experimental group than the control group (P0.05); the two groups were no improvement in patients with hairy symptoms. The two groups can obviously reduce the level of T, LH, LH/F The ratio of SH and AMH levels, significantly increase the SHBG level, and better effect in experimental group (P < 0.05); follow-up period of three months two group had recurrence, but the control group was significantly higher than the experimental group (P=0.001) and.PCOS AMH levels were positively in vivo androgen levels and AFC, R = 0.906,0.763. conclusion: kidney and phlegm combined with -35 in the treatment of hyperlipidemia type PCOS Kaohsiung hormone function is better than that of single Diane -35 treatment, not only in the total effect, improvement of TCM syndrome score and hormone level, better effect, and the number of patients during the follow-up period of pregnancy more, the recurrence rate was lower.AMH and androgen levels and AFC, PCOS may be located mechanism for ovulation disorders because of short treatment time, treatment of hirsutism and alleviate adverse reactions showed that there was no advantage.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.75

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