补肾疏肝膏方改善卵巢储备功能下降的临床观察

发布时间：2018-01-14 15:08

本文关键词：补肾疏肝膏方改善卵巢储备功能下降的临床观察　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究旨在通过收集分析2015年12月至2016年12月就诊禅城区中心医院中医妇科门诊,并符合入组标准的患者60例。通过运用中医学理论和中西医结合的方法,从理论和临床研究两方面探讨卵巢储备功能下降的病因病机及其防治问题。认为"肾虚肝郁"是当代社会卵巢储备功能下降常见的主要病机,故以补肾疏肝为治法,予膏方治疗,通过随机对照研究,观察膏方治疗卵巢储备功能下降的疗效及安全性,为膏方防治卵巢储备功能下降提供临床医学证据,以期为卵巢储备功能下降患者早发现、早诊断、早治疗、有效改善卵巢功能,提高生活质量提供一套有效安全的治疗方案。方法:采用随机对照的方法,将60例卵巢储备功能下降(diminished ovarian reserve DOR)患者随机分为膏方组、汤剂组以及空白组。膏方组予补肾疏肝膏、汤剂组予补肾疏肝汤口服,治疗3个月经周期,空白组不予药物干预。观察并比较3组患者治疗前后的中医证候评分、基础卵泡刺激素(bFSH)、基础雌二醇(bE2)、抗苗勒管激素(AMH)、窦卵泡数、肝肾功能。结果:中医证候量表评分:①组内比较结果显示:膏方组及汤剂组治疗后经前乳房胀痛、腰膝酸软、月经量、月经周期、月经色质、头晕耳鸣、夜尿频多、情志抑郁或烦躁、经行下腹胀痛及症状总分均较治疗前有明显下降。差异均有统计学意义(P0.05);空白组治疗前后中医证候评分差异无统计学意义(P0.05)。②组间比较结果显示:膏方组及汤剂组治疗后中医证候量表评分均低于空白组,两两比较显示:膏方组与空白组、汤剂组与空白组组间差异有统计学意义(P0.05),膏方组与汤剂组组间差异无统计学意义(P0.05)。bFSH、bE2、AMH 水平①组内比较结果显示:膏方组及汤剂组治疗后bFSH均呈下降趋势,AMH水平上升,差异均有统计学意义(P0.05),膏方组及汤剂组治疗前后bE2差异无统计学意义(P0.05);空白组治疗前后bFSH、bE2、AMH水平差异均无统计学意义(P0.05)。②组间比较结果显示:膏方组及汤剂组较空白组bFSH明显更低,而AMH水平上升,膏方组与空白组、汤剂组与空白组组间差异有统计学意义(P0.05),膏方组与汤剂组组间差异无统计学意义(P0.05)。三组进行两两比较,治疗后bE2差异均无统计学意义(P0.05)。基础窦卵泡数分析①组内比较结果显示:膏方组及汤剂组治疗后患者基础窦卵泡数均明显增加,差异均有统计学意义(P0.05);空白组治疗前后患者基础窦卵泡数差异无统计学意义(P0.05)。②组间比较结果显示:膏方组及汤剂组较空白组基础窦卵泡数增多,膏方组与空白组、汤剂组与空白组组间差异有统计学意义(P0.05),膏方组与汤剂组组间差异无统计学意义(P0.05)。结论:在卵巢储备功能下降的治疗上,补肾疏肝膏与补肾疏肝汤,均能有效改善患者临床症状、降低血清bFSH水平、提高AMH水平,增加窦卵泡数目,但因缺乏停药后随访,其治疗持续效应有待进一步探索。膏方和汤剂在卵巢储备功能下降治疗上总体疗效相当,且治疗期间未发现明显不良反应,说明补肾疏肝膏与补肾疏肝汤临床安全性好,与汤剂相比,膏方口感好,携带方便,患者依从性提高,值得进一步推广应用。但膏方制作成本较汤剂增加,因此膏方与汤剂在疗效相当的前提下各有优势。
[Abstract]:Objective: This study aimed to collect analysis from December 2015 to December 2016 from the center of Chancheng District Hospital of TCM gynecology clinic, and 60 patients met the inclusion criteria. By combining the theory of traditional Chinese medicine and Western medicine and the use of traditional Chinese medicine, etiology and pathogenesis and control of ovarian function decreased from two aspects of theory and clinical research. "Shenxu Ganyu" is a contemporary social decline in ovarian reserve main pathogenesis common, so as to extract the effect of Bushen Shugan therapy, treatment by randomized control study to evaluate the efficacy and safety of herbal paste treatment of ovarian reserve function decline, provide evidence for clinical medicine cream in treating ovarian function decline, in order to a decline in ovarian reserve function in patients with early detection, early diagnosis, early treatment, improve ovarian function, provide a safe and effective treatment to improve the quality of life. Methods: random Machine control method, 60 patients with diminished ovarian reserve (diminished ovarian reserve DOR) were randomly divided into paste group, decoction group and control group. The paste group was treated with Bushen Shugan decoction group was treated with ointment, Bushen Shugan decoction, treatment of 3 menstrual cycles, the blank group were given drug intervention and observation of traditional Chinese medicine. The syndrome before and after treatment were compared between the 3 groups score, basal follicle stimulating hormone (bFSH), basic estradiol (bE2), anti Mullerian hormone (AMH), liver and kidney function of antral follicle number. Results: the TCM Syndrome Scale scores: group comparison shows: Cream group and Decoction group after the treatment of premenstrual breast pain, Yaoxisuanruan, menstruation, menstrual cycle, menstruation color quality, dizziness and tinnitus, nocturia, emotional depression or irritability, menstrual abdominal pain and symptom score were markedly decreased. The differences were statistically significant (P0.05); control group before and after treatment of TCM syndrome. The difference was not statistically significant (P0.05). The comparison between groups showed: Cream group and decoction group after treatment of TCM Syndrome Scale scores were lower than the blank group, 22 comparison shows: Cream group and blank control group, the difference was statistically significant between group Decoction group and blank control group (P0.05), no statistical significance the difference between group and group Decoction extract (P0.05).BFSH, bE2, AMH levels of group comparison showed that herbal paste group and decoction group after treatment, bFSH decreased, AMH level increased, the differences were statistically significant (P0.05), paste group and decoction group before and after treatment no significant difference for bE2 the significance (P0.05); control group before and after treatment of bFSH, bE2, AMH levels were not significantly different (P0.05). The comparison between groups showed: Cream group and decoction group than the control group bFSH was significantly lower, while AMH levels rise, cream group and blank group, there are statistical differences between the group and the blank group between the Decoction Significance (P0.05), there was no significant difference between group and group Decoction extract (P0.05). The three groups were compared after treatment of bE2 22, there were no significant differences (P0.05). The number of antral follicle analysis within group comparison shows: Cream group and decoction group after treatment in patients with antral follicle the number was significantly increased, the differences were statistically significant (P0.05); control group had no statistical significance before and after treatment in patients with antral follicle number difference (P0.05). The comparison between groups showed: Cream group and decoction group compared with control group, the number of antral follicle increased, cream group and blank control group, there was statistically significant difference between the groups with the blank group, Decoction (P0.05) there was no significant difference between group and group Decoction paste (P0.05). Conclusion: the treatment of decline in ovarian reserve function, Bushen Shugan ointment and Bushen Shugan decoction, can effectively improve the clinical symptoms of patients, reduce the level of serum bFSH, Improve the level of AMH, increase the number of antral follicle, but due to lack of follow-up after discontinuation of the treatment effect, continue to be explored further. Extract and decoction treatment on overall curative effect in considerably decreased ovarian reserve, and no adverse reaction was found during treatment, that Bushen Shugan ointment and Bushen Shugan decoction clinical safety, and decoction compared to cream taste good, easy to carry, improve the compliance of patients, which is worthy of further application. But the paste production cost is increased and therefore Gaofang decoction, Decoction in the premise of a considerable effect of the advantage.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.9

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