健脾补肾方联合克罗米芬治疗脾肾阳虚型多囊卵巢综合征不孕症的临床观察
发布时间：2018-08-12 10:37
【摘要】：目的:观察自拟健脾补肾方联合克罗米芬治疗脾肾阳虚型多囊卵巢综合征(polycystic ovarian syndrome,PCOS)所致不孕症的临床疗效,初步探讨其可能的作用机理。方法:将所收集的2013年6月至2014年12月到青岛市海慈医疗集团中医妇科门诊因不孕症来就诊,并确诊多囊卵巢综合征辨证属脾肾阳虚型患者随机分为观察组40例、对照组30例,观察组应用健脾补肾方,同时月经周期第5天起服克罗米芬(CC),每次50mg,每日1次,连续服5天,于月经周期8-10天时做B超监测卵泡直径在18-22mm时,肌注绒毛膜促性腺激素(HCG)5000~10000 U。对照组应用上述治疗除外健脾补肾方,连续观察临床疗效3个月经周期。观察两组患者治疗前后中医症状改善、周期排卵率、妊娠率、及黄体生成素(luteinizing hormone LH)/卵泡刺激素(follicle-stimulating hormone,FSH)值、睾酮(testosterone,T)值和空腹胰岛素变化情况。结果1.治疗3个月经周期后,观察组和对照组患者综合疗效的总有效率分别87.50%、60.0%,两组综合疗效比较,差异有极显著性(P0.01),观察组综合疗效优于对照组。两组中医证候积分和中医主症积分随着治疗周期的延续,积分下降越明显(P0.05或P0.01),且观察组中医证候积分和中医主症积分改善情况优于对照组(P0.05或P0.01)。2.观察组患者周期排卵率为75.44%,对照组患者周期排卵率为48.19%,两组相比差异有极显著性(P0.01)。观察组妊娠率为52.50%,对照组妊娠率为23.33%,两组相比差异显著(P0.05)。3.两组治疗后LH/FSH值较治疗前下降,有极显著性差异(P0.01),且组间比较,差异显著(P0.05),治疗组T值较治疗前下降,差异显著(P0.05)。两组治疗后空腹胰岛素较治疗前下降,差异显著(P0.05)。结论:自拟健脾补肾方联合克罗米芬治疗脾肾阳虚型多囊卵巢综合征所致不孕症取得了较为满意的临床疗效。中西医结合疗法能明显的改善脾肾阳虚型PCOS不孕症患者的中医临床症状,提高周期排卵率、妊娠率、降低患者血清LH/FSH值、T值、空腹胰岛素值。研究提示,中西医结合治疗此病是一种行之有效的方法,可能通过低LH、FSH比值、T值及空腹胰岛素水平,改善内分泌环境而发挥临床治疗作用。
[Abstract]:Objective: to observe the clinical effect of Jianpi Bushen prescription combined with clomiphene in the treatment of infertility caused by polycystic ovary syndrome (polycystic ovarian syndrome) with deficiency of spleen and kidney yang, and to explore its possible mechanism. Methods: from June 2013 to December 2014, 40 patients with polycystic ovary syndrome (PCOS) were randomly divided into observation group (n = 40) and control group (n = 30). The observation group was treated with Jianpi Bushen recipe and clomiphene (CC), 50mg once a day for 5 days from the 5th day of menstrual cycle. B ultrasound was used to monitor follicle diameter in 18-22mm at 8-10 days of menstrual cycle, and chorionic gonadotropin (HCG) 5000,10000U) was injected intramuscularly. The control group was treated with the above treatment except the prescription of invigorating spleen and tonifying the kidney, and observed the clinical curative effect for 3 consecutive menstrual cycles. The changes of TCM symptoms, periodic ovulation rate, pregnancy rate, luteinizing hormone (luteinizing hormone LH) / follicle stimulating hormone (follicle-stimulating), testosterone (T) and fasting insulin were observed before and after treatment. Result 1. After three menstrual cycles, the total effective rates of the observation group and the control group were 87.50 and 60.0, respectively. There was a significant difference between the two groups (P0.01). The comprehensive curative effect of the observation group was better than that of the control group. With the continuation of treatment cycle, the scores of TCM syndromes and main symptoms of the two groups decreased significantly (P0.05 or P0.01), and the improvement of TCM syndromes and TCM main symptoms in the observation group was better than that in the control group (P0.05 or P0.01) .2. The rate of periodic ovulation was 75.44 in the observation group and 48.19 in the control group. There was a significant difference between the two groups (P0.01). The pregnancy rate in the observation group was 52.50, and the pregnancy rate in the control group was 23.330.The difference between the two groups was significant (P0.05). After treatment, the LH/FSH value of the two groups was significantly lower than that before treatment (P0.01), and the difference between the groups was significant (P0.05), the T value of the treatment group was lower than that before treatment, the difference was significant (P0.05). Fasting insulin decreased significantly after treatment in both groups (P0.05). Conclusion: the prescription of invigorating spleen and tonifying kidney combined with clomiphene in the treatment of infertility caused by polycystic ovary syndrome with deficiency of spleen and kidney yang has obtained satisfactory clinical curative effect. The combination of traditional Chinese and western medicine can obviously improve the clinical symptoms of PCOS infertility patients with deficiency of spleen and kidney yang, increase the rate of periodic ovulation, pregnancy rate, reduce the serum LH/FSH value of T value, fasting insulin value. It is suggested that the combination of traditional Chinese and western medicine is an effective method for the treatment of this disease. It may play a clinical role by improving the endocrine environment and improving the endocrine environment by low LHH-FSH / T value and fasting insulin level.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R711.6
本文编号：2178795
[Abstract]:Objective: to observe the clinical effect of Jianpi Bushen prescription combined with clomiphene in the treatment of infertility caused by polycystic ovary syndrome (polycystic ovarian syndrome) with deficiency of spleen and kidney yang, and to explore its possible mechanism. Methods: from June 2013 to December 2014, 40 patients with polycystic ovary syndrome (PCOS) were randomly divided into observation group (n = 40) and control group (n = 30). The observation group was treated with Jianpi Bushen recipe and clomiphene (CC), 50mg once a day for 5 days from the 5th day of menstrual cycle. B ultrasound was used to monitor follicle diameter in 18-22mm at 8-10 days of menstrual cycle, and chorionic gonadotropin (HCG) 5000,10000U) was injected intramuscularly. The control group was treated with the above treatment except the prescription of invigorating spleen and tonifying the kidney, and observed the clinical curative effect for 3 consecutive menstrual cycles. The changes of TCM symptoms, periodic ovulation rate, pregnancy rate, luteinizing hormone (luteinizing hormone LH) / follicle stimulating hormone (follicle-stimulating), testosterone (T) and fasting insulin were observed before and after treatment. Result 1. After three menstrual cycles, the total effective rates of the observation group and the control group were 87.50 and 60.0, respectively. There was a significant difference between the two groups (P0.01). The comprehensive curative effect of the observation group was better than that of the control group. With the continuation of treatment cycle, the scores of TCM syndromes and main symptoms of the two groups decreased significantly (P0.05 or P0.01), and the improvement of TCM syndromes and TCM main symptoms in the observation group was better than that in the control group (P0.05 or P0.01) .2. The rate of periodic ovulation was 75.44 in the observation group and 48.19 in the control group. There was a significant difference between the two groups (P0.01). The pregnancy rate in the observation group was 52.50, and the pregnancy rate in the control group was 23.330.The difference between the two groups was significant (P0.05). After treatment, the LH/FSH value of the two groups was significantly lower than that before treatment (P0.01), and the difference between the groups was significant (P0.05), the T value of the treatment group was lower than that before treatment, the difference was significant (P0.05). Fasting insulin decreased significantly after treatment in both groups (P0.05). Conclusion: the prescription of invigorating spleen and tonifying kidney combined with clomiphene in the treatment of infertility caused by polycystic ovary syndrome with deficiency of spleen and kidney yang has obtained satisfactory clinical curative effect. The combination of traditional Chinese and western medicine can obviously improve the clinical symptoms of PCOS infertility patients with deficiency of spleen and kidney yang, increase the rate of periodic ovulation, pregnancy rate, reduce the serum LH/FSH value of T value, fasting insulin value. It is suggested that the combination of traditional Chinese and western medicine is an effective method for the treatment of this disease. It may play a clinical role by improving the endocrine environment and improving the endocrine environment by low LHH-FSH / T value and fasting insulin level.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R711.6
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