加味清心滋肾汤联合立普妥治疗绝经综合征（心肾不交型）合并血脂异常的临床研究

发布时间：2018-07-12 15:52

本文选题：绝经综合征 + 血脂异常　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:通过观察加味清心滋肾汤联合立普妥对绝经综合征(心肾不交型)合并血脂异常患者临床症状、性激素及血脂的影响,探究加味清心滋肾汤改善心肾不交型绝经综合征的临床疗效,及其在调节性激素紊乱、改善血脂代谢方面的干预作用及可能作用机制,为中医药防治绝经相关脂质代谢异常及心血管疾病提供依据。方法:2016年1月～2017年3月期间在江苏省中医院妇科、心内科门诊及住院部接受治疗的符合纳入及排除标准的心肾不交型绝经综合征合并脂质代谢异常患者,随机纳入治疗组(予加味清心滋肾汤+立普妥))及对照组(予立普妥)。治疗前评估患者一般情况、临床症状,完善性激素三项(雌二醇(E2)、黄体生成素(LH)、卵泡刺激素(FSH))及血脂四项(血清总胆固醇(TC)、甘油三醋(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C))的实验室检测。治疗12周后再次评估患者一般情况、临床症状,完善性激素三项及血脂四项的实验室检测。最终,对照组有2例研究对象因失访而脱落,2例研究对象因性激素三项结果缺失而剔除,最终本临床研究共纳入44例研究对象,治疗组24例,对照组20例。结果:(1)改善临床症状方面:12周后,治疗组绝经综合征患者临床症状程度定量及定性指标均较前改善(P0.05),Kupperman评分降低(P0.05);对照组除了出汗次数及程度较前减轻(P0.05),其余临床症状程度定量及定性指标均无明显改善(P0.05),且Kupperman评分升高(P0.05)。12周末,组间临床症状程度定量及定性指标均具有统计学差异(P0.05),治疗组临床症状程度定量及定性指标明显轻于对照组。(2)调节性激素紊乱方面:12周后,治疗组FSH、LH水平下降(P0.05),E2水平基本保持稳定(P0.05);对照组FSH、LH水平无明显变化(P0.05),E2水平下降(P0.05)。12周末,组间FSH水平比较具有统计学差异(P0.01),而E2、LH水平无明显统计学差异(P0.05)。(3)改善脂质代谢方面:12周后,在两组膳食评价积分均无明显改变的情况下(P0.05),两组TC、LDL-C水平均显著下降(P0.01),此外,治疗组TG水平下降、HDL-C水平升高(P0.05),而对照组TG、HDL-C水平未见改变(P0.05)。12周末,两组间TC、TG、HDL-C、LDL-C水平均有统计学差异(P0.05),治疗组TC、TG、LDL-C水平更低,HDL-C水平更高。(4)实验室疗效方面:两组在改善绝经综合征伴有血脂异常患者血脂水平方面的总有效率比较有统计学差异(P0.05),治疗组调脂总体疗效更好。(5)临床症候疗效方面:两组在改善绝经综合征伴有血脂异常患者临床症状方面的总有效率比较有显著统计学差异(P0.01),治疗组可明显缓解绝经综合征临床症候,而对照组对绝经综合征临床症候无明显疗效。(6)性激素与血脂水平的相关性探讨:初诊时患者FSH水平越高,TC、LDL-C水平也越高(P0.05);经加味滋肾清心汤治疗后的患者,其FSH下降越多,TC、LDL下降也越明显(P0.05),而与TG、HDL-C水平无明显相关性(P0.05)。结论:加味清心滋肾汤可明显改善绝经综合征伴有血脂异常患者的临床症状,下调FSH、LH水平,保持E2水平,不但可以增强调脂药物降低TC、LDL-C水平,还可降低TG水平、升高HDL-C水平。初诊时绝经综合征伴有血脂异常患者FSH水平与TC、LDL-C水平呈正相关,予加味清心滋肾汤治疗后,患者FSH下降程度与TC、LDL-C的下降程度呈正相关。初步猜想加味滋肾清心汤可能通过调节生殖性腺轴功能,延缓两侧性腺器官衰老,改善内分泌水平,从而达到调节脂质代谢的作用。
[Abstract]:Objective: To explore the clinical effect of Jiawei Qingxin Zi Shen Decoction in improving the heart and kidney non cross menopausal syndrome by observing the effect of Jiawei Qingxin Toni decoction combined with Lipitor on the clinical symptoms, sex hormone and blood lipid in the patients with dyslipidemia in the patients with menopause syndrome (heart kidney disjoint type) and dyslipidemia, and the intervention of the intervention of regulating sex hormone disorder and improving the metabolism of blood lipids. The mechanism of action and possible action is provided to provide basis for the prevention and treatment of menopause related lipid metabolism and cardiovascular diseases. Methods: during the period of January 2016 to March 2017, the treatment in Jiangsu Province Traditional Chinese Medicine Hospital, Department of Cardiology, outpatient and inpatient department was treated with the inclusion and exclusion criteria of cardiac and renal insufficiency menopause syndrome with lipid metabolism abnormality. The patients were randomly included in the treatment group (treated with modified Qingxin Toni Decoction + Lipitor) and the control group (Lipitor). Before treatment, the general condition, clinical symptoms, three items of perfect sex hormone (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH) and four blood lipids (serum total cholesterol (TC), glycerol three vinegar (TG), and high-density lipoprotein (HDL-C)) were evaluated. Laboratory tests of low density lipoprotein (LDL-C). After 12 weeks of treatment, the general situation, clinical symptoms, three items of perfect sex hormone and four items of blood lipid were tested. In the control group, 2 subjects fell off because of the loss of visits and 2 of the subjects were excluded because of the three loss of sex hormones, and the final clinical study included 4. 4 subjects, 24 cases in the treatment group and 20 cases in the control group. Results: (1) to improve the clinical symptoms: after 12 weeks, the quantitative and qualitative indexes of the clinical symptoms of the patients with menopause syndrome were all improved (P0.05) and the Kupperman score was reduced (P0.05); the control group was less than the number of sweating times and the degree of earlier reduction (P0.05), and the other clinical symptoms were quantified. There was no significant improvement (P0.05) and qualitative index (P0.05), and Kupperman score increased (P0.05).12 weekend, the quantitative and qualitative indicators of clinical symptoms were all statistically different (P0.05). The quantitative and qualitative indicators of clinical symptoms in the treatment group were significantly lighter than those in the control group. (2) the regulation of hormone disorder: after 12 weeks, the treatment group was FSH, LH level decreased (P0). .05), the level of E2 remained stable (P0.05), and there was no significant change in the level of LH in the control group (P0.05), E2 level decreased (P0.05) and.12 weekend, and the FSH level of the group was statistically different (P0.01), while E2, there was no significant difference in the level of FSH (P0.01). (3) the improvement of lipid metabolism: after 12 weeks, there was no obvious change in the two groups of dietary evaluation scores. In P0.05, the level of TC and LDL-C in the two groups decreased significantly (P0.01). In addition, the level of TG in the treatment group decreased and the level of HDL-C increased (P0.05), while the level of HDL-C was not changed in the control group (P0.05).12 weekend, and the level of the two groups was lower and the level was higher. (4) the therapeutic effect in the laboratory. Aspects: the total effective rate of the two groups in improving the blood lipid level of the patients with dyslipidemia was statistically different (P0.05), and the overall effect of the treatment group was better. (5) the clinical symptom effect: the total effective rate of the two groups in the improvement of the clinical symptoms in the patients with dyslipidemia with menopause syndrome was statistically significant The difference (P0.01), the treatment group can obviously relieve the clinical symptoms of menopause syndrome, and the control group has no significant effect on the clinical symptoms of menopause syndrome. (6) the correlation of sex hormone and blood lipid level: the higher the level of FSH, the higher the level of TC, and the higher the level of LDL-C (P0.05) in the first diagnosis; the more the decrease of FSH, TC, LD in the patients after the treatment of the decoction of added nourishing kidney and clearing heart. The decrease of L was also obvious (P0.05), but there was no significant correlation with TG and HDL-C level (P0.05). Conclusion: Jiawei Qingxin Zi Shen decoction can obviously improve the clinical symptoms of patients with dyslipidemia in menopause syndrome, down FSH, LH level, and E2 level, not only can increase the level of TC and LDL-C, but also reduce TG level and increase HDL-C level. The level of FSH in patients with dyslipidemia was positively correlated with the level of TC and LDL-C. After the treatment of Jiawei Qingxin Yishen soup, the degree of FSH decline was positively correlated with the decrease of TC and LDL-C. It was preliminarily assumed that the addition of the flavored kidney Qingxin decoction could delay the aging of the gonadal organs on both sides and improve the endocrine by regulating the reproductive gland axis power. The effect of lipid metabolism is regulated by the level.
【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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