中药周期疗法治疗脾肾阳虚型黄体功能不全所致月经失调的临床研究

  本文关键词：中药周期疗法治疗脾肾阳虚型黄体功能不全所致月经失调的临床研究，，由笔耕文化传播整理发布。

        黄体功能不全(LPD)是一种妇科常见病,其主要以月经周期缩短、经期延长、月经量或多或少、经前点滴出血等月经失调为特点,常可导致不孕不育、自然流产,甚则复发性流产。古代医籍并无“黄体功能不全”的记载,根据它所表现出来的症状将其归属于中医“月经先期”、“经期延长”、“不孕不育”、“胎漏”、“胎动不安”等范畴,中医多认为其病机在于肾虚、脾肾阳虚、肝肾阴虚、肝郁脾虚、血瘀等。本文包括文献综述和临床观察二部分,其中文献综述包括黄体功能不全的中西医研究进展。中医研究概况侧重于它的病因病机、辨证分型及治疗,而西医研究概况则从病因、诊断及治疗方面着手；临床观察研究从中药周期疗法的角度治疗脾肾阳虚型黄体功能不全所致月经失调,采取受试者自身前后对照的方法,观察受试者临床症状的变化,并将其BBT升高7-8天的血清孕酮值、雌二醇值、HPS评分、高温相持续时间、高低温差、移行期及中医症状积分进行统计学分析,判断差异的意义,评价疗效并进一步探讨脾肾阳虚型黄体功能不全所致月经失调的发病机理。希望通过中药周期疗法为黄体功能不全所致月经失调的患者提供一个可行有效的方法,从而证明传统中医药在治疗黄体功能不全所致月经失调的患者方面有明显的优势和特点。方法收集40例符合脾肾阳虚型黄体功能不全所致月经失调的受试者,填写知情同意书后开始中药周期疗法。具体方案如下：月经第1-3天予养血调经汤加减,月经第4天起予育胞汤加减,服至见透明拉丝白带停；后服促排卵汤4付；继服两固汤加减至月经来潮停；循环治疗3个月经周期,期间随症稍作加减,观察治疗前后其月经周期、量、色、质、基础体温等,根据疗效评价标准判断疗效；并判断年龄及病程是否与疗效相关；比较治疗前后中医症状积分、单项中医症状、HPS评分、高温相持续天数、高低温差、移行期天数、基础体温升高7-8天血清孕酮值及雌二醇值、并用配对t检验判定其差异是否具有统计学意义。结果本研究中治疗前后受试者的月经先期、经期延长等月经失调的情况均得到明显改善。其中经治疗后临床症状明显减轻,P<0.05,差异有统计学意义,说明此研究可减轻经期或经期前后的一些症状；HPS评分经过3个月经周期的治疗后较治疗前明显增加,P<0.05,差异有统计学意义,且治疗后HPS的均值大于5,说明此方法可改善黄体功能,提高HPS评分；基础体温高温相持续时间经治疗后延长,P<0.05,差异有统计学意义,说明该研究可增加高温相持续时间；移行期天数经治疗后呈下降趋势,但P>0.05,差异无统计学意义,说明此方法使移行期天数下降的幅度不明显；高低温差经治疗后明显提高,P<0.05,差异有统计学意义,说明该研究可使基础体温高低温差加大；黄体中期血清孕酮值(BBT上升7-8天)在治疗后显著增加, P<0.05,差异有统计学意义,说明该研究可提高黄体期血清孕酮值,使黄体功能得到改善；治疗后黄体中期血清雌二醇值呈上升趋势,P<0.05,差异有统计学意义,说明中药周期疗法可提高黄体中期血清雌二醇水平。结论对于脾肾阳虚型黄体功能不全所致月经失调的患者,中药周期疗法可有效减轻经期或经期前后的一些症状,中医症状积分也得到了提高,升高HPS评分,延长基础体温高温相持续时间,使基础体温高低温差加大,也可使黄体中期血清孕酮值和雌二醇水平显著提高,且通过统计学分析,其疗效与年龄与病程无明显相关性。

    Luteal phase defect (LPD) is a gynecology department common disease. It can shorten menstrual cycles, prolong period, have a hemorrhage before menstrual cramps and so on. Belong to the Chinese medicine "advanced menstruation","menstrual extension","threatened abortion","habitual abortion". The Chinese medicine believes that its pathogenesis is deficiency of the kidney, stagnation of liver qi and spleen deficiency, phlegmatic hygrosis and soon.Object:40patients with luteal phase defect menstrual disorder, TCM differentiation for yang deficiency of spleen and kidney were volunteers to participate in the study. The total course lasted for three months. Symptorm score of TCM, the amelioration of clinical symptom, the sex hormone:estradiol (E2), progesterone (P), and the change of basal body temperature. We compared the results before and after the treatments in order to observe the effect of the cycle treatment with TCM.Methods:We provide self-made Yangxue Tiaojing Decoction on the one from three days menstrual period, self-made Yubao Decoction on the fourth day until you found that the leucorrhea could be drawing, self-made Cu Pailuan Decoction4pairs, self-made Lianggu Decoction until menstrual cramps. We compared with their results by setting a self control group before and after, such as progesterone and estradiol values in serum after the BBT curve rising7-8days, HPS and the TCM symptoms integral.Results:In this study, before and after treatment, progesterone and estradiol values in serum after the BBT curve rising7-8days were increased, indicating that the cycle treatment with TCM on luteal phase defect menstrual disorder had curative effect. The scores of HPS also had been improved after the therapy of3months, P<0.05, it suggested that this therapy had an important positive effects on luteal phase defect. The high temperature phase had been prolongated after the therapy, the temperature difference of the BBT also had been widened. However, the time from high to low temperature phase was decreased, P>0.05, it showed that the effect for this was not very good.At the same time, the TCM symptoms integral became decreased after the therapy, P<0.05, demonstrating that it could improve the symptoms of luteal phase defect menstrual disorder.Conelus i on:The cycle treatment with TCM in the treatment of obese patients with luteal phase defect menstrual disorder, can effectively improve the level of progesterone and estradiol in serum after the BBT curve rising7-8days, increase the score of HPS, moreover, widen the high temperature phase and the temperature difference, it also can reduce the TCM symptoms integral after the therapy of3months.

中药周期疗法治疗脾肾阳虚型黄体功能不全所致月经失调的临床研究

中文摘要4-6ABSTRACT6第一部分 文献综述9-30    综述一9-20        1. 病因病机9        2. 主要证型9-10        3. 临床表现10-11        4. 治疗方法11-17        参考文献17-20    综述二20-30        1. 黄体功能不全的病因20-23        2. 诊断23-24        3. 治疗方案24-27        参考文献27-30第二部分：临床研究30-44    一、前言30    二、诊疗标准30-31    三、研究方案31-32    四、结果32-38    五、讨论38-43    参考文献43-44附表144-46附表246-48致谢48-49个人简历49

  本文关键词：中药周期疗法治疗脾肾阳虚型黄体功能不全所致月经失调的临床研究，由笔耕文化传播整理发布。