肾精不足型多囊卵巢综合征高雄激素血症的中西医结合治疗观察

发布时间：2018-06-05 17:26

本文选题：多囊卵巢综合 + 高雄激素血症　；参考：《湖南中医药大学》2015年硕士论文

【摘要】：目的：通过临床研究,观察中药周期疗法联合胰岛素增敏剂对治疗肾精不足型多囊卵巢综合征(PCOS)高雄激素血症患者的临床疗效,探索中医药的作用机理,为临床治疗此病提供理论依据和治疗方法。方法：收集符合纳入标准的PCOS高雄激素血症患者108例,随机分为2组,每组各54例,中西医结合治疗组采用中药人工周期治疗,西医对照组采用达英-35治疗,对存在胰岛素抵抗(HR)或高胰岛素血症(HI)的患者两组同时予胰岛素增敏剂治疗。两组均治疗3个月,观察治疗前后患者中医证候、多毛、座疮、体重指数的改善情况,静脉抽血观察血清黄体生成素(LH)、卵泡刺激素(FSH)、泌乳素(PRL)、睾酮(T)、雌二醇(E2)、孕酮(P)、性激素结合蛋白(SHBG)、硫酸脱氢表雄酮(DHEAS)、雄烯二酮(A2)、LH/FSH的变化,观察B超卵巢体积的变化,观察两种治疗方案对PCOS高雄激素血症患者恢复排卵的临床疗效,所得的数据经统计学方法处理后进行判定。结果： 1.疗程治疗结束后,治疗后治疗组：痊愈12例,显效22例,有效11例,无效9例,总有效率为83.3%。对照组：痊愈7例,显效19例,有效10例,无效18例,总有效率66.7%,差异有显著性(P0.05)。 2.自身对照：治疗后两组患者中医证候均得到明显改善(P0.01)。治疗后两组患者多毛、座疮体征,体重指数均得到改善(PO.05)。治疗后两组血清T、LH、LH/FSH、A2值较治疗前均明显下降(P0.01),治疗组治疗后血E2、SHBG值上升,DHEAS下降(P0.05)均具有统计学意义。治疗后两组患者卵巢体积缩小,卵巢多囊样改变均得到改善(PO.05)具有统计学意义。 3.组间对照：两组治疗后的LH、LH/FSH水平、中医证候改善情况有明显差异(P0.01),两组治疗后T、E2、SHBG、DHEAS水平,多毛、座疮体征评分均有差异(P0.05)。结论：中医人工周期疗法是治疗PCOS高雄激素血症的有效方法之一,能有效地改善PCOS高雄激素血症患者血清内分泌水平,降低血T、LH、LH/FSH、DHEAS、A2的水平,有效提高E2的水平,改善患者多毛、座疮等临床高雄表现,同时可缩小卵巢的体积,改善卵巢多囊样改变。中医人工周期疗法可以改善肾精不足型患者的内分泌环境,重建月经周期,恢复排卵,值得临床推广。
[Abstract]:Objective: To observe the clinical effect of periodic therapy combined with insulin sensitizer in the treatment of hyperandrogenemia in patients with PCOS with deficiency of renal spermatozoa, and to explore the mechanism of traditional Chinese medicine in the treatment of hyperandrogenemia. To provide theoretical basis and treatment for clinical treatment of this disease. Methods: One hundred and eight patients with PCOS hyperandrogenemia were collected and randomly divided into two groups, 54 cases in each group. The treatment group was treated with traditional Chinese medicine artificial cycle therapy, while the western medicine control group was treated with Dain-35. Two groups of patients with insulin resistance or hyperinsulinemia were treated with insulin sensitizer at the same time. Both groups were treated for 3 months to observe the improvement of TCM syndromes, hirsutism, sores and body mass index before and after treatment. The changes of serum luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), testosterone (T), estradiol (E _ 2), progesterone (P), sex hormone binding protein (SHBG), dehydroepiandrosterone sulfate (DHEASA), androtenedione (A _ 2N) -LH- / FSH were observed. To observe the clinical effect of two treatment schemes on the recovery of ovulation in patients with PCOS hyperandrogenemia. Results: 1. After the treatment, 12 cases were cured, 22 cases were effective, 11 cases were effective, 9 cases were ineffective. The total effective rate was 83.3%. In the control group, 7 cases were cured, 19 cases were markedly effective, 10 cases were effective and 18 cases were ineffective. The total effective rate was 66.7% (P 0.05). 2. Self-control: after treatment, the TCM syndromes of the two groups were significantly improved. After treatment, the symptoms of hirsutism, sores and body mass index were improved in both groups. After treatment, the levels of serum THH / FSH / FSHA _ 2 in both groups were significantly lower than those before treatment (P 0.01), and the serum E _ 2H _ 2 SHBG increased and DHEAS decreased (P 0.05) in the treatment group. After treatment, the ovarian volume was reduced and the ovarian polycystic changes were improved in both groups (P < 0.05). 3. Control group: after treatment, the level of LHH / FSH and the improvement of TCM syndromes were significantly different between the two groups. After treatment, there were significant differences between the two groups in the level of SHBGN DHEAS, hirsutism, and signs of sores in the two groups (P 0.05). Conclusion: Chinese medicine artificial cycle therapy is one of the effective methods to treat PCOS hyperandrogenemia. It can effectively improve the serum endocrine level of patients with PCOS hyperandrogenemia, reduce the level of serum TLH / FSHH / DHEASA A 2, effectively raise the level of E2 and improve the hirsutism of patients. The clinical manifestation of Kaohsiung, such as sores, can reduce the volume of ovary and improve the polycystic change of ovary at the same time. Traditional Chinese medicine artificial cycle therapy can improve the endocrine environment of patients with deficiency of kidney essence, rebuild menstrual cycle and restore ovulation, which is worthy of clinical promotion.
【学位授予单位】：湖南中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R711.75

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