半夏泻心汤加减治疗多囊卵巢综合征胰岛素抵抗的时效关系研究

发布时间：2018-06-04 20:29

本文选题：多囊卵巢综合征 + 胰岛素抵抗　；参考：《北京中医药大学》2016年硕士论文

【摘要】：目的：探讨半夏泻心汤加减治疗多囊卵巢综合征(PCOS)胰岛素抵抗(IR)的临床疗效、时效关系及安全性。方法：选择2014年6月至2015年12月就诊于中国中医科学院广安门医院妇科门诊,符合纳入标准及排除标准的脾虚胃热型PCOS IR患者84例,以半夏泻心汤为基础方随证加减,治疗6个月,分别检测治疗前、治疗3个月、治疗6个月空腹、餐后1h、2h血糖和胰岛素(FPG、Plh-PG、P2h-PG、FINS、Plh-INS、P2h-INS)及空腹雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)、催乳素(PRL)、总胆固醇(CHO)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、丙氨酸氨基转移酶(ALT)、肌酐(Cr)、尿素氮(BUN),测量身高、体重、腰围、臀围,计算胰岛素和血糖曲线下面积、体重指数(BMI,体重kg/身高2m2)、腰臀比(WHR,腰围cm/臀围cm),统计治疗前、治疗3个月、治疗6个月月经周期评分、中医症状评分及治疗3月、6月妊娠率。结果：1.与治疗前相比,治疗3个月及6个月P2h-INS及胰岛素曲线下面积均明显下降(P0.05),其中,治疗6个月P2h-INS的下降幅度尤为显著(PO.01)；治疗6个月Plh-PG、 P2h-PG和葡萄糖曲线下面积较治疗前均降低(P0.05)。与治疗3个月相比,治疗6个月P2h-PG明显降低(P0.05)。2.与治疗前相比,治疗3个月及治疗6个月LH水平均明显降低(P0.05)；治疗3个月FSH、T水平均无明显差异(P0.05),但治疗6个月均明显降低(P0.05),其中T降低幅度更为显著(P0.01)。3.治疗第一个3个月的妊娠率为13.21%,治疗第二个3个月的妊娠率为41.30%,两者比较有明显差异(P0.05)。4.与治疗前相比,治疗3个月、6个月月经周期评分均明显降低(P0.01),但两者间相比无明显差异(P0.05)。5.与治疗前相比,治疗3个月、治疗6个月中医症状评分均明显降低(P0.05),其中治疗6个月降低幅度更为显著(P0.01)。6.与治疗前相比,治疗3个月、治疗6个月ALT、Cr、BUN均无明显变化(P0.05)。结论：1.半夏泻心汤加减能改善PCOS IR患者胰岛素敏感性及生殖内分泌状态,并存在时效关系。2.半夏泻心汤加减能改善PCOS IR患者临床症状,促进自主月经的恢复,提高妊娠率,并存在时效关系,其改善作用可能与纠正IR及生殖内分状态有关。3.半夏泻心汤加减治疗PCOS IR具有一定的安全性。
[Abstract]:Objective: to investigate the clinical efficacy, time-effect and safety of Banxia Xiexin decoction (Banxia Xexin decoction) in the treatment of insulin resistance (IRR) in patients with polycystic ovary syndrome (PCOS). Methods: from June 2014 to December 2015, 84 PCOS IR patients with spleen deficiency and stomach heat type were selected from the department of gynecology of Guang'an Men Hospital, Chinese Academy of traditional Chinese Medicine, who met the criteria of inclusion and exclusion. The basic prescription of Banxia Xiexin decoction was added and subtracted according to the syndrome. After 6 months of treatment, before treatment, 3 months of treatment, 6 months of treatment, 2 h postprandial blood glucose and insulin FPG Plh-PGh-PGN P2h-PGN FINSU Plh-INS (Plh-INS) and fasting estradiol (E2N), follicle stimulating hormone (FSHN), luteinizing hormone (LHH), testosterone (T), prolactin (PRLL), total cholesterol (Cho), triglyceride (TGN), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), alanine ammoxide (ADA), triglyceride (TGN), low density lipoprotein cholesterol (LDL-C) Metamyltransferase (alt), creatinine (Cr), bun (bun), measurement of height, Body weight, waist circumference, hip circumference, area under insulin and blood glucose curve, body mass index (BMI), weight, kg/ height, waist to hip ratio, waist circumference and hip circumference, waist circumference, hip circumference, waist circumference and hip circumference were calculated. TCM symptom score and pregnancy rate of 3 months and 6 months after treatment. The result is 1: 1. Compared with before treatment, the area under the curve of P2h-INS and insulin decreased significantly at 3 and 6 months after treatment, among which, the decrease of P2h-INS in 6 months was more significant than that before treatment, and the area under the planh-PGR, P2h-PG and glucose curves at 6 months was lower than that before treatment (P 0.05). Compared with the treatment for 3 months, P2h-PG decreased significantly at 6 months (P 0.05. 2). After 3 months and 6 months of treatment, the levels of LH were significantly lower than those before treatment, while there was no significant difference in the level of FSHT between 3 months and 6 months after treatment, but at 6 months of treatment, the level of LH decreased significantly, and the decrease of T was more significant than that of P0.01U. 3. The pregnancy rate was 13.21 in the first 3 months and 41.30 in the second 3 months. There was a significant difference between the two groups. Compared with before treatment, the scores of menstrual cycle in 3 months and 6 months were significantly lower than those before treatment, but there was no significant difference between the two groups. Compared with before treatment, the scores of TCM symptoms in 3 months and 6 months of treatment were significantly lower than that of before treatment, and the decrease range of symptoms of traditional Chinese medicine in 6 months of treatment was more significant than that of before treatment. Compared with before treatment, there was no significant change in alt Cr bun in 3 months and 6 months after treatment (P 0.05). Conclusion 1. Banxia Xiexin decoction can improve the insulin sensitivity and reproductive endocrine state of PCOS IR patients, and there is a time-effect relationship. 2. Banxia Xiexin decoction can improve the clinical symptoms of PCOS IR patients, promote the recovery of spontaneous menstruation, increase the pregnancy rate, and there is a time-effect relationship, its improvement may be related to the correction of IR and reproductive status. Banxia Xiexin decoction has certain safety in the treatment of PCOS IR.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R271.9

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