从肝论治经前期综合征的临床疗效和机制研究

发布时间：2018-06-27 02:30

本文选题：经前期综合征 + 从肝论治　；参考：《广州中医药大学》2016年博士论文

【摘要】：目的:经前期综合征(Premenstrual syndrome)发病率日趋升高,重度经前期综合征(PMDD)更是严重影响妇女的身心健康及日常生活工作。大量的临床研究表明,从肝论治PMS有较好的临床疗效,但其具体作用机制未明。本研究通过临床单盲随机研究,对比治疗前后患者神经递质(如单胺氧化酶、多巴胺、脑神经营养因子等)、内分泌激素等的变化,探讨从肝论治经前期综合征的临床疗效及可能的作用机制,为阐明从肝论治经前期综合征的作用疗效机制提供科学证据,促进中药的应用和推广。方法:本课题采取单盲随机对照临床试验方法,选择2014年12月-2016年3月门诊就诊的经前期综合征患者,辨证属肝郁气滞型患者共66例,随机分为中药组、西药组,经前10天开始服药,共治疗3个月经周期,通过填写《症状严重程度每日报告》(DRSP)、《PMDD证候严重程度测评表》;《汉密尔顿抑郁量表》等量表观察患者治疗前后的临床疗效。并于治疗前后的不同月经周期采血,内容包括神经递质、性激素及肾上腺激素等,探讨从肝论治治疗PMDD的可能作用机制。采用SPASS17.0对所得数据建立数据库并进行统计分析。两组自身治疗前后量表评分及采血指标的比较采用配对样本的t检验和秩和检验;组间比较采用t检验或秩和检验。结果:(1)治疗前,中药组、西药组在年龄、婚育情况、教育程度、职业、相关病史之间的比较差异无统计学意义,P0.05,具有可比性。治疗前,两组的《问题严重性每日记录表》(DRSP)、《PMDD证候严重程度测评表》、《汉密顿抑郁量表》(HAMD)评分之间以及神经递质、性激素、肾上腺激素等共13个指标间的比较差异无统计学意义,P0.05,具有可比性。(2)两组经前《症状严重程度每日报告》(DRSP)评分均在治疗前、治疗中、随访期逐渐下降,不同时期的经前DRSP评分比较差异有统计学意义,P0.01。治疗3个月经周期后,中药组有效29例,无效9例,总有效率76.5%;西药组有效17例,无效3例,总有效率85%。两组疗效比较,差异无统计学意义,P0.05;两组疗效相同。(3)两组《PMDD症状严重程度评价表》评分均在治疗前、治疗中、随访期逐渐下降,组内比较差异有统计学意义,P0.01。治疗3个月经周期后,中药组显效19例,有效14例,无效7例,总有效率83%;西药组显效9例,有效9例,无效2例,总有效率90%;两组疗效比较,差异无统计学意义,P0.05;两组疗效相同。但中药组治疗后评分的下降趋势稍优于西药组。(4)两组《汉密顿抑郁量表》(HAMD)评分均在治疗前、治疗中、随访期逐渐下降,组内比较差异有统计学意义,P0.01。治疗3个月经周期后,中药组治愈12例,显效9例,有效6例,无效2例,总有效率94.1%;西药组治愈6例,显效3例,有效2例,无效1例,总有效率93.7%;两组疗效比较,差异无统计学意义,P0.05;两组疗效相同。(5)组内同一月经期周期治疗前后比较发现,2组治疗后单胺氧化酶(MA0)在黄体期升高,在月经期下降,差异无统计学意义,P0.01;MA0在排卵期下降,差异有统计学意义,P0.01。组内不同月经周期间比较,2组治疗前,MAO月经期黄体期排卵期,差异有统计学意义,P0.01。组内不同月经周期间的两两比较发现,中药组能调节MAO在不同月经周期的差异,而西药组仅能调节MAO在黄体期与月经期、月经期与排卵期的差异。组间比较发现,两组在同一月经周期对MAO的调节作用相当,差异无统计学意义,P0.05。(6)组内同一月经期周期治疗前后比较发现,2组治疗后多巴胺(DA)在黄体期、排卵期升高,差异无统计学意义,P0.05;在月经期下降,差异有统计学意义,P0.01。组内不同月经周期间比较,2组治疗前,DA黄体期排卵期月经期,差异有统计学意义,P0.01。组内不同月经周期间的两两比较发现,中药组能调节月经期与排卵期间DA的差异,西药组能调节黄体期与月经期间、月经期与排卵期间DA的差异。组间比较发现,两组在同一月经周期对DA的调节作用相当,P0.05。(7)组内同一月经期周期治疗前后比较发现,2组治疗后脑源性神经营养因子(BDNF)在黄体期升高,在月经期下降,差异无统计学意义,P0.05;BDNF在排卵期升高,差异有统计学意义,P0.01。组内不同月经周期间的两两比较发现,中药组能调节黄体期与月经期间、黄体期与排卵期间的BDNF差异,而西药组不能调节不同月经周期间BDNF的差异。组间比较发现,两组在同一月经周期对BDNF的调节作用相当,P0.05。(8)组内不同月经周期间比较,提示两组泌乳素、孕酮在不同月经期间差异有统计学意义,P0.05。组内同一月经周期的比较,两组治疗前后的性激素比较差异无统计学意义,P0.05。(9)肾上腺激素比较,组内不同月经周期的比较,两组治疗前不同月经周期间的COR、ACTH差异无统计学意义,P0.05。组内同一月经周期治疗前后的比较,治疗后COR、ACTH在不同月经周期均下降,中药组黄体期、月经期治疗前后COR差异有统计学意义,P0.01;西药组各月经周期治疗前后COR差异无统计意义,P0.05。组间比较,2组治疗后的COR、ACTH比较差异无统计学意义,P0.05。结论:(1)中药组、西药组均能减轻经前期综合征患者的临床症状,疗效相同。从肝论治是一种治疗经前期综合征的有效方法。(2)经前期综合征患者MA0、DA、BDNF在不同月经周期的差异可能是该病发病的物质基础。中药组和西药组均能降低排卵期的MAO,降低月经期的DA和升高排卵期的BDNF。可见,从肝论治法能调节经前期综合征患者排卵期MA0、BDNF和月经期的DA。虽然,组间比较发现中药组和西药组在同一月经周期对上述神经递质的影响作用相当。但是,组内不同月经周期间的两两比较发现,中药组在调节MAO和BDNF上优于西药组,而西药组在调节DA上优于中药组。(3)经前期综合征患者孕酮、泌乳素在不同月经周期间的变化可能是PMDD发病机制之一。2组均未能改变经前期综合征患者月经周期的性激素。(4)经前期综合征患者COR在不同月经周期间无明显差异。中药组可降低经前期综合征患者黄体期、月经期COR,西药组不能调节经前期综合征患者的COR。中药在调节患者COR在不同月经期间的变化优于西药组。经前期综合征患者ACTH在不同月经周期间无明显差异。2组均未能调节经前期综合征患者的ACTH。
[Abstract]:Objective: the incidence of premenstrual syndrome (Premenstrual syndrome) is increasing, and severe premenstrual syndrome (PMDD) is more serious affecting the physical and mental health of women and daily life work. A large number of clinical studies have shown that the treatment of PMS from the liver has better clinical efficacy, but the mechanism of its body action is not clear. This study has been studied by single blind randomized clinical study. To compare the changes of neurotransmitters (such as monoamine oxidase, dopamine, brain neurotrophic factor, etc.) and endocrine hormones before and after treatment, to explore the clinical efficacy and possible mechanism of the treatment of premenstrual syndrome from liver theory, and to provide scientific evidence to clarify the effect mechanism of the effect of liver theory on premenstrual syndrome, and to promote the application of Chinese medicine. Methods: a single blind, randomized controlled clinical trial was adopted to select the patients with premenstrual syndrome in the outpatient clinic in March -2016 December 2014. The patients were divided into 66 patients with stagnation of liver qi stagnation. They were randomly divided into Chinese medicine group, western medicine group, taking the medicine for the first 10 days and treating 3 menstrual cycles by filling in the symptom severity daily. Report > (DRSP), ; < Hamilton depression scale > scale > observe the clinical effect of patients before and after treatment, and collect blood in different menstrual cycles before and after treatment, including neurotransmitters, sex hormones and adrenaline, and explore the possible mechanism of treatment of PMDD from liver theory. The results of SPASS17.0 are used. Data set up and statistical analysis. The comparison of two groups before and after their own treatment was compared with paired sample t test and rank sum test; t test or rank sum test were used between groups. Results: (1) before treatment, Chinese medicine group and Western medicine group were compared between age, marriage, education, education, occupation, and related history. The difference was not statistically significant, P0.05 was comparable. Before treatment, the two groups of "serious daily record table" (DRSP), the Hamilton Depression Scale (HAMD) score and the comparison of neurotransmitters, sex hormones, adrenalin and so on were not statistically significant, P0.05, with comparability (2) before the treatment of the two groups, the scores of the daily report on symptom severity (DRSP) were all in the treatment, and the follow-up period decreased gradually. The difference of the pre menstrual DRSP scores at different periods was statistically significant. After P0.01. treatment 3 menstrual cycles, 29 cases were effective in the Chinese medicine group, 9 cases were invalid, the total effective rate was 76.5%, and 17 cases in the western medicine group, 3 cases ineffective, the total effective rate was 85%. The difference between the two groups was not statistically significant, the difference was not statistically significant, P0.05; the two groups had the same effect. (3) the scores of the 【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R271.115

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