补肾活血汤联合定坤丹序贯治疗育龄期肾虚血瘀型PCOS的临床观察

发布时间：2018-05-26 07:35

本文选题：多囊卵巢综合征 + 补肾活血汤　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:探讨多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)在中医治疗方面的认识,通过临床研究,初步评价补肾活血汤(自拟经验方)联合定坤丹序贯治疗育龄期肾虚血瘀型多囊卵巢综合征的临床疗效及安全性,并分析其作用机理。从而为中医辩证论治育龄期肾虚血瘀型PCOS提供新的临床论证依据。方法:病例均来自于2016年2月至2016年11月在湖北省中医院妇科门诊就诊的患者,根据病例的纳入标准及排除标准,将列入临床研究的35例育龄期肾虚血瘀型PCOS患者,运用补肾活血汤联合定坤丹序贯治疗,采用自身前后对照法。于经期第5天或口服黄体酮撤退性出血第5天开始服药,经后期及排卵期予以自拟方补肾活血汤治疗,经前期口服中成药定坤丹治疗(经期停药,如经期未至则继续服药)。连续治疗3个月经周期。观察患者治疗前后的临床总有效率、月经改善情况、中医临床证候积分、中医证候总疗效、痤疮及多毛情况、睾酮(Testosterone,T)值、黄体生成素(Luteoinizing hormone,LH)值、卵泡刺激素(Follicle,FSH)值、LH/FSH值、雌二醇(Estradiol,E2)值、抗苗勒氏管激素(Anti-Mullerian Hormone,AMH)值、排卵期卵泡直径、排卵期子宫内膜厚度、基础体温(BBT)、体重指数及药物安全性。结果:临床总有效率方面:懫用补肾活血汤联合定坤丹治疗痊愈8例(22.86%),显效12例(34.29%),有效8例(22.86%),无效7例(20%),总有效率80%。中医证候疗效方面:治疗后患者月经周期明显好转,差异有统计学意义(P0.01);治疗后中医证候总积分较治疗前显著下降,差异有统计学意义(P0.01);治疗后中医证候疗效痊愈10例(28.57%),显效12例(34.29%),有效7例(20%),无效6例(17.14%),总有效率82.86%。治疗后痤疮、多毛的情况明显得到改善,差异有统计学意义(P0.01)。血清性激素方面:治疗后T、LH、LH/FSH、AMH值均较治疗前有所下降,差异有统计学意义(P0.01),FSH、E2、值较治疗前有所上升,差异有统计学意义(P0.01)。治疗后子宫内膜厚度明显增厚,差异有统计学意义(P0.01)。治疗后患者排卵期卵泡直径较治疗前明显增大,差异有统计学意义(P0.01)。治疗后患者BBT情况明显好转,治疗前单相者22例,双相者13例;治疗后单相者8例,双相者27例,差异有统计学意义(P0.01),有效率(双相及不典型双相)达57.14%。治疗后体重及体重指数(BMI)较治疗前有所下降,差异有统计学意义(P0.01)。治疗期间药物安全性指标方面:患者在临床治疗中均未出现明显毒副作用且血、尿、大便常规、肝肾功能、凝血功能及心电图,结果提示均无明显异常。结论:在补肾活血汤联合定坤丹治疗育龄期肾虚血瘀型PCOS上,临床总有效率80%,不仅能显著改善患者的临床症状,而且能调节患者的生殖内分泌激素水平,有助于子宫内膜增长,诱导卵泡的发育成熟,形成正常的月经周期,显著调节基础体温由单相型转变为双相型,还可改善患者的腰膝酸软、畏寒肢冷、经期夹血块等肾虚血瘀的中医临床症状。改善多毛、痤疮评分,降低体重指数。从安全性指标显示,患者在治疗期间均未出现明显的毒副作用且临床检验指标均正常,可见运用补肾活血汤联合定坤丹序贯治疗该病疗效确切,安全性较好,值得进一步深入研究和推广。
[Abstract]:Objective : To study the clinical efficacy and safety of polycystic ovary syndrome ( PCOS ) in the treatment of kidney - deficiency and blood stasis type polycystic ovary syndrome ( PCOS ) . Results : The clinical total effective rate was : the clinical total effective rate before and after treatment , the improvement of menstruation , the clinical symptom score of Chinese medicine , the total curative effect of TCM syndrome , the value of FSH , LH / FSH , the value of follicle stimulating hormone ( FSH ) , the total effective rate of 80 % , the curative effect of traditional Chinese medicine ( P0.01 ) , the curative effect of TCM syndrome after treatment was significantly improved ( P0.01 ) , the curative effect of TCM syndrome after treatment was 10 cases ( 28.57 % ) , and the effect was 12 cases ( 34.29 % ) . In the treatment period , there was no obvious toxic or side effect in the treatment of patients with kidney - deficiency and blood stasis type , and the difference was statistically significant ( P0.01 ) . The patient had no obvious toxic and side effects during the treatment period , and the clinical test indexes were normal , and it can be seen that the combination of Bushen and Huoxuhuoxu decoction for treating the disease has definite curative effect and good safety , and is worthy of further research and popularization .
【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】：2017
【分类号】：R271.9

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