针刺疏肝调气法治疗多囊卵巢综合征临床研究

发布时间：2018-01-18 06:40

  本文关键词：针刺疏肝调气法治疗多囊卵巢综合征临床研究　出处：《北京中医药大学》2016年博士论文　论文类型：学位论文

  更多相关文章： 达因-35 多囊卵巢综合征(PCOS) 肝郁证候 疏肝调气法 针刺疗法 证型 症状自评量表(SCL-90)

【摘要】：1.基于SCL-90量表的多囊卵巢综合征临床调查目的通过对多囊卵巢综合征(polycystic ovary syndrome, PCOS)月经稀发或不孕患者进行SCL-90问卷调查,探讨其心理健康问题及证型分布特点,初步探讨肝失疏泄、气机失调与PCOS的关系。方法采用问卷调查形式,被调查对象为2012年6月至2014年9月间中医科学院针灸医院就诊、符合2003年欧洲人类生殖和胚胎学会与美国生殖医学学会(ESHRE/ASRM)鹿特丹专家会议推荐的PCOS诊断标准、并以月经稀发或不孕为主诉(症)的PCOS患者。调查问卷分为患者填写部分和医生填写部分。研究人员发放调查问卷的患者填写部分,内容包括一般因素及症状自评量表(SCL-90),令患者现场填写并收回。SCL-90量表共有90个项目,内容包括9个因子,分别为躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性。记录人员完成调查问卷的医生填写部分,对患者进行中医辨证分型。结果1)共发放调查问卷143份,收回140份,回收率为97.9%。被调查对象平均年龄(28.09±4.07)岁,月经不调年限平均(7.71±4.90)年；其中已婚者91例,占65.0%；有生育要求者90例,占64.3%。2) PCOS患者的总分,以及躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、偏执及精神病性等8个因子评分显著高于国内标准常模组(P0.01)。被调查对象中SCL-90量表总分GSIt≥153分、具有明显心理问题的患者占总数的41.43%。3)本研究中,PCOS患者的证型分布以肝经郁热证最多,占36.4%,其后依次为：痰湿阻滞证(占25.0%),肾虚证者(占22.9%),气滞血瘀证(占15.7%)。结论1) PCOS月经稀发或不孕患者存在明显的心理健康问题。2) PCOS月经稀发或不孕患者中,肝经郁热证所占比例最高。3)肝失疏泄、全身气机失调,可能是PCOS患者身心同病的主要病机。2.针刺疏肝调气法治疗PCOSI临床观察目的1)通过临床对照试验,对比西药达因-35,探讨针刺疏肝调气法治疗PCOS的疗效及其对患者心理健康的影响。2)挖掘针灸治疗PCOS的优势,探索身心同调PCOS的针灸治疗思路。方法通过中国中医科学院针灸医院门诊,收集年龄在18-35岁、以月经稀发或不孕为主诉(症)、符合2003年欧洲人类生殖和胚胎学会与美国生殖医学学会(ESHRE/ASRM)鹿特丹专家会议推荐的PCOS诊断标准、肝郁证候评分≥3分,并符合其它各项纳入标准的PCOS患者,共72例,随机分为西药组和针刺组,两组各36例。西药组服用达因-35,自月经第5天开始,连续服用21天,共服用3个月。针刺组以疏肝调气为主要治则制订处方,选用膻中、期门(双)、肝俞(双)、中脘、天枢(双)、关元、子宫(双)、三阴交(双)、足三里(双)、太冲(双)穴。针刺得气后,在中脘与关元穴、同侧天枢与子宫穴连接电针,连续波,频率20Hz,强度以患者耐受为度,留针30分钟。每周治疗3次,连续治疗3个月,月经期间停止治疗。治疗结束后,观察和测评两组患者的以下指标：1)中医症状积分：根据月经不调中医症状评分分级量化标准,由专人进行评分并记录。2)一般测量学指标：专人测量身高、体重、腰围、臀围,计算体质量指数(BMI)、腰臀比(WHR)。3)血清性激素水平：于月经周期第2-4天采集空腹静脉血,测定促卵泡激素(FSH)、黄体生成素(LH)、睾酮(T)、雌二醇(E2)、孕酮(P)、催乳素(PRL)水平,并计算LH/FSH。4)痤疮评分：用Rosenfield评分方法。5)多毛评分：用F-G评分方法。6)心理健康评分：采用症状白评量表(SCL-90),由患者填写问卷。治疗结束3个月后随访,记录两组患者月经恢复及排卵情况。结果1)西药组完成试验共33例,脱落3例；针刺组完成试验35例,脱落1例。患者平均年龄(28.16±3.76)岁；平均月经不调年限(7.26±3.83)年；平均病程(2.88±1.76)年,两组治疗前的基线资料无统计学差异(P0.05)。2)治疗后两组的症状积分较同组治疗前显著下降(均为P=0.000),治疗后针刺组症状积分显著低于西药组(P=0.004)。3)治疗后,针刺组体重(P=0.016)、BMI (P=0.004)、腰围(P=0.035)、臀围(P=0.000)均显著低于西药组。4)治疗后,两组血清LH、T及LH/FSH值均较同组治疗前显著下降(均为P=0.000),两组间无统计学差异(PO.05)。5)治疗后两组痤疮评分均较同组治疗前显著下降(均为P=0.000)；两组多毛评分在治疗前后均未见统计学差异(P0.05)。6)治疗后针刺组SCL-90总分较治疗前显著下降(P=0.006),并显著低于西药组治疗后(P=0.021)。治疗后,针刺组的躯体化、人际关系、抑郁、焦虑、敌对因子评分较治疗前显著下降(P0.05),针刺组躯体化、人际关系、抑郁、焦虑、敌对、恐怖因子的评分显著低于西药组(P0.05)。7)西药组总有效率为81.8%,针刺组总有效率88.6%,两组间无统计学差异(P=0.308),两组的月经恢复率及排卵率均无统计学差异(P0.05)。结论1)在总有效率、月经恢复率、排卵率方面,针刺疏肝调气治疗与西药达因-35的疗效相近。2)针刺疏肝调气治疗与达因-35,均可调节PCOS患者血清性激素水平,有效缓解高雄激素血症。3)在改善PCOS患者的中医症状、调节体重、BMI等代谢指标方面,针刺疏肝调气治疗的作用优于达因-35。4)针刺疏肝调气法治疗PCOS具有身心同调作用,其降低SCL-90评分、改善心理健康的作用优于达因-35。
[Abstract]:The 1. SCL-90 scale of polycystic ovary syndrome through clinical investigation of polycystic ovary syndrome based on (polycystic ovary syndrome, PCOS) oligomenorrhea or infertility SCL-90 questionnaire, investigate the distribution characteristic of the psychological health problems and syndromes, preliminary study of liver qi, Qi and PCOS. Methods the form of a questionnaire survey, respondents from June 2012 to September 2014, Chinese Academy of Sciences, acupuncture hospital, consistent with the 2003 European Society of human reproduction and embryology and the American Society for reproductive medicine (ESHRE/ASRM) PCOS diagnosis standard of Rotterdam expert meeting recommended, and with oligomenorrhea or infertility complaints (disease) in patients with PCOS. The questionnaire is divided for patients and doctors to fill in fill part of parts. The researchers questionnaires were fill part of the contents include the general factors, and symptom checklist (SCL-90), the trouble Live fill and recover the.SCL-90 scale consists of 90 items, including 9 factors, respectively, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia and psychosis. Records of personnel to complete the questionnaire doctor to complete the part, in patients with TCM syndrome type. Results 1) a total of 143 questionnaires were issued, 140 were recovered, the recovery rate of 97.9%. was the average age (28.09 + 4.07) years of age, menstruation period average (7.71 + 4.90) years; among them married in 91 cases, accounting for 65%; 90 cases have fertility requirements, accounting for 64.3%.2) in patients with PCOS the total score, and somatization, obsessive-compulsive symptoms, depression, anxiety, hostility, terror, 8 factors of paranoia and psychosis score significantly higher than that of the standard norm group (P0.01). SCL-90 was surveyed in the total scores of GSIt more than 153 points, with obvious psychological problems of patients accounted for 41.43%.3 of the total) In this study, patients with PCOS syndrome type distribution in liver heat stagnation of the most, accounting for 36.4%, followed by: phlegm dampness (25%), kidney deficiency syndrome who (22.9%), qi stagnation and blood stasis syndrome (15.7%). Conclusion: 1) PCOS oligomenorrhea or infertility patients have.2 mental health the obvious problem of PCOS) oligomenorrhea or infertility patients, liver meridian with the highest proportion of.3) of liver dysfunction, systemic disorder of Qi, may be the main pathogenesis of.2. in patients with PCOS disease and the acupuncture treatment of PCOSI liver qi) through clinical observation to 1 controlled clinical trials, compared with western medicine Diane -35. To investigate the efficacy of acupuncture treatment of PCOS liver qi and its effects on patients' mental health.2) mining of acupuncture in the treatment of PCOS, acupuncture treatment ideas body-mind PCOS. By homology Chinese hospital acupuncture clinic of Chinese Academy of Sciences, collected at age of 18-35 years, with oligomenorrhea or 涓嶅瓡涓轰富璇，

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