加味二仙汤治疗肾阴虚型绝经综合征及对心血管系统影响的临床研究

发布时间：2018-04-15 21:17

本文选题：绝经综合征 + 中医药治疗　；参考：《湖北中医药大学》2016年硕士论文

【摘要】：目的观察加味二仙汤治疗肾阴虚型绝经综合征的临床疗效,并结合血压、血脂、血管内皮因子等指标评估该方对绝经后妇女心血管系统的影响,为中医药治疗绝经综合征及对绝经后心血管病变的一级预防提供科学的理论依据和参考。方法将90例符合纳入、排除标准的绝经综合征患者随机均分为两组,治疗组给予加味二仙汤治疗,对照组给予克龄蒙治疗,两组均连续用药3个疗程(4周为1个疗程)。结合改良Kupperman量表及中医证候评分表,观察两组患者症状、体征的改善情况,并检测两组患者治疗前后卵泡刺激素(FSH)、雌二醇(E2)、L1~L4腰椎和股骨颈骨密度(BMD)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、一氧化氮(NO)、内皮素(ET)、24h平均收缩压(24h SBP)、24h平均舒张压(24h DBP)、24h收缩压变异性(24h SSD)、24h舒张压变异性(24h DSD)等指标水平。采用SPSS17.0统计软件处理分析数据。结果1.临床疗效:治疗组和对照组临床综合疗效总有效率分别为93.33%和77.78%,差异有显著性(P0.05);治疗组和对照组中医证侯疗效总有效率分别为95.56%和75.56%,差异有高度显著性(P0.01);两组患者各项中医症状均有不同程度地改善,与对照组比较,治疗组对失眠多梦、五心烦热、头晕等症状的疗效显著,差异有显著性(P0.05),对烘热汗出、心烦易怒、腰膝酸痛、足跟痛等症状的疗效尤佳,两组间差异有高度显著性(P0.01)。2.实验室检查:治疗后,治疗组E2升高,FSH降低(P0.01);L1~L4腰椎和股骨颈BMD增强(P0.05);TG和LDL-C降低、HDL-C升高(P0.01),TC降低(P0.05);NO增高,ET降低(P0.01);24h SBP和24h SSD下降(P0.01),24h DBP下降(P0.05),24h DSD未见明显变化(P0.05)。3.安全性监测:两组患者在治疗过程中均未出现明显不良反应,身体健康状况评估各项目亦未见异常。结论加味二仙汤治疗肾阴虚型绝经综合征安全而有效,并对绝经后人群心血管系统有一定的保护作用,值得临床推广应用。初步推测该方可能通过调节患者的下丘脑-垂体-卵巢轴功能,提高机体雌激素水平,增强骨密度,改善血脂成分,调节血管内皮因子,降低血压及其变异性而发挥效应的。
[Abstract]:Objective to observe the clinical effect of Jiawei Erxian decoction on postmenopausal syndrome of kidney yin deficiency type, and to evaluate the effect of Jiawei Erxian decoction on the cardiovascular system of postmenopausal women combined with blood pressure, blood lipid and vascular endothelial factor.It provides a scientific theoretical basis and reference for the treatment of menopausal syndrome and the primary prevention of postmenopausal cardiovascular disease.Methods 90 patients with menopausal syndrome were randomly divided into two groups: the treatment group was treated with Jiawei Erxian decoction, the control group was treated with Ke Ling Meng, and the two groups were treated continuously for 3 courses of treatment for 4 weeks as a course of treatment.Combined with the modified Kupperman scale and TCM syndrome score, the improvement of symptoms and signs of the two groups was observed.The bone mineral density of lumbar vertebrae and femoral neck, total cholesterol, triglyceride, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), nitric oxide (no), endothelin (et) were detected before and after treatment.The mean systolic blood pressure was 24 h SBP + 24 h DBP + 24 h DBP + 24 h systolic pressure variability (24 h SSDN) and 24 h diastolic pressure variability (24 h DSDs).SPSS17.0 statistical software was used to process and analyze the data.Result 1.Clinical efficacy: the total effective rates of the treatment group and the control group were 93.33% and 77.78%, respectively, the difference was significant (P 0.05), the total effective rate of the treatment group and the control group was 95.56% and 75.56%, respectively, and the difference was highly significant (P 0.01).The symptoms of TCM were improved to some extent,Compared with the control group, the therapeutic effect of the treatment group on insomnia and dream, five upset heat, dizziness and other symptoms was significant (P 0.05). The treatment group had a better effect on the symptoms such as dry heat sweating, irritability, pain of waist and knee, heel pain and so on.There was a significant difference between the two groups (P 0.01).Laboratory examination: after treatment, the treatment group E _ 2 increased FSH decreased P0.01L _ 1 / L _ 4 lumbar spine and femoral neck BMD enhancement (P 0.05) TG and LDL-C decreased HDL-C increase (P _ (0.01)) / TC decreased P _ (0.05) no increased et decreased P _ (0.01) SSD decreased (P _ (0.01)) ~ (24) DBP decreased (P _ (0.05)) 24 h DSD did not show significant changes (P _ (0.05) 路3).Safety monitoring: there were no significant adverse reactions in both groups and no abnormality in the evaluation of health status.Conclusion Jiawei Erxian decoction is safe and effective in treating postmenopausal syndrome with deficiency of kidney yin, and has protective effect on cardiovascular system of postmenopausal population, which is worth popularizing in clinic.It is preliminarily speculated that the prescription may play an effect by regulating hypothalamus-pituitary-ovarian axis function, increasing the level of estrogen, enhancing bone mineral density, improving blood lipid composition, regulating vascular endothelial factor, lowering blood pressure and its variability.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R271.116

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