滋肾疏肝法治疗卵巢储备功能下降的临床观察
发布时间：2018-12-14 23:07
【摘要】：目的:观察滋肾疏肝法治疗肾虚肝郁型卵巢储备功能下降(decreased ovarian reserve,DOR)的临床疗效,探索中医药治疗该病的思路及方法,促进中医药的传承和发展。方法:将符合纳入标准的60例病例,按照随机分配原则分为两组。(1)治疗组30例采用中药治疗(滋肾调肝方)。(2)对照组30例单纯西药治疗(戊酸雌二醇片/雌二醇环丙孕酮片)。以一个月经周期为一疗程,连续服用三个疗程。观察两组患者治疗前后患者的月经情况、临床症状的变化,以中医证候积分表统计评分;记录妊娠情况;月经周期第2-3天基础性激素水平、窦卵泡数目、卵巢体积;并观察药物不良反应。采用自身前后对照与组间对照进行统计分析,以观察不同治疗方法对DOR患者卵巢功能的影响。结果:(1)调经疗效:经过3个月经周期治疗,治疗组有效率88.00%,对照组有效率42.31%。两组患者治疗后的调经疗效比较,经X2检验,P0.01,差异具有显著性。(2)临床症状疗效:治疗后,治疗组有效率86.67%,对照组有效率66.67%。两组患者治疗后疗效相比,经X2检验,P0.01,差异具有显著性。(3)妊娠疗效:治疗结束,两组有效率均为16.67%。两组相比,经Fisher确切概率法检验,P0.05,差异无统计学意义。(4)临床总疗效:治疗组30例,总有效率93.33%;对照组30例,总有效率70.00%。治疗后两组总疗效比较,经X2检验,P0.01,差异具有显著性。(5)生殖激素水平:疗后组内比较:治疗组与对照组对基础卵泡刺激素(b-FSH)、基础黄体生成激素(b-LH)、正常区FSH/LH及基础雌二醇(b-E2)均有明显效果(P值均0.01);但二者对高区FSH/LH无效(P0.05)。组间比较,治疗组对FSH/LH的调整显著(P0.01);其他方面均无统计学意义(P0.05)。(6)卵巢体积:治疗结束后,组内比较,治疗组对缩小的卵巢体积改善有效(P0.05);对照组对缩小及正常的卵巢体积改变均无效(P0.05)。组间比较,两者疗效相当(P0.05)。(7)基础窦卵泡数目:疗后组内比较,服用中药与克龄蒙均能明显增加基础窦卵泡的数目(P0.05)。组间比较差异无统计学意义(P0.05)。结论:滋肾调肝方改善DOR的疗效显著,能明显调整月经,改善肾虚肝郁症状,可明显降低过高的b-FSH及b-LH水平,调整FSH/LH的比值,对于b-E2具有双向调节作用,能降低过高的b-E2,升高过低的b-E2;还能增大已缩小的卵巢体积;增加基础窦卵泡数。总有效率达93.33%,疗效明显优于对照组。说明中药可以有效改善DOR患者的卵巢功能,临床值得推广应用与进一步研究。
[Abstract]:Objective: to observe the clinical effect of nourishing the kidney and soothing the liver on the decline of ovarian reserve function in the type of kidney deficiency and liver depression (decreased ovarian reserve,DOR), to explore the ideas and methods of TCM treatment of the disease and to promote the inheritance and development of traditional Chinese medicine (TCM). Methods: 60 patients who met the inclusion criteria were selected. According to the principle of random distribution, the treatment group was divided into two groups. (1) 30 cases in the treatment group were treated with traditional Chinese medicine (Zishen Tiaogan recipe). (2) and 30 cases in the control group were treated with western medicine (estradiol valerate / estradiol cycloproprogesterone tablet). Take a menstrual cycle as a course of treatment, three consecutive courses of treatment. The changes of menstruation and clinical symptoms were observed before and after treatment. The scores of TCM syndromes score were used to record the pregnancy, the level of basic sex hormone, the number of antral follicles, the volume of ovaries in the 2-3 days of menstrual cycle. Adverse drug reactions were observed. To observe the effect of different treatment methods on ovarian function of DOR patients. Results: (1) effect of menstrual regulation: after three menstrual cycles, the effective rate of treatment group was 88.00 and that of control group was 42.31. There was significant difference between the two groups after treatment. (2) Clinical symptom effect: after treatment, the effective rate of the treatment group was 86.67 and that of the control group was 66.67. Compared with the two groups after treatment, X2 test, P0.01, the difference was significant. (3) pregnancy effect: the end of treatment, the effective rate of both groups were 16.6767. There was no significant difference between the two groups by Fisher's exact probability test (P0.05). (4) the total clinical efficacy: the treatment group (30 cases), the total effective rate was 93.33%; the control group (30 cases), the total effective rate (70.005). After treatment, there was significant difference in the total curative effect between the two groups by X2 test (P0.01). (5) the level of reproductive hormone: the comparison between the treatment group and the control group on basal follicle stimulating hormone (b-FSH), Basal luteinizing hormone (b-LH), normal area FSH/LH and basal estradiol (b-E2) were all effective (P < 0. 01). But both of them had no effect on FSH/LH in high area (P0.05). The adjustment of FSH/LH in the treatment group was significant (P0.01). There was no significant difference in other aspects (P0.05). (6) ovarian volume: after treatment, compared with the treatment group, the treatment group was effective in improving the reduced ovarian volume (P0.05); The control group had no effect on the change of ovarian volume (P0.05). The number of basic antral follicles was similar between the two groups (P0.05). (7): after treatment, the number of basic antral follicles was significantly increased by taking Chinese medicine and Ke Ling Meng (P0.05). There was no significant difference between the two groups (P0.05). Conclusion: Zishen Tiaogan recipe can significantly improve DOR, regulate menstruation, improve the symptoms of kidney deficiency and liver depression, decrease the excessive levels of b-FSH and b-LH, adjust the ratio of FSH/LH, and can regulate b-E2 in both directions. It can reduce the high b-E _ 2 and increase the low b-E _ 2; It can also increase the reduced ovarian volume and increase the number of basal antral follicles. The total effective rate was 93.33, and the curative effect was obviously superior to that of the control group. It shows that Chinese medicine can effectively improve the ovarian function of patients with DOR, and it is worth popularizing and further studying.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.9
本文编号：2379475
[Abstract]:Objective: to observe the clinical effect of nourishing the kidney and soothing the liver on the decline of ovarian reserve function in the type of kidney deficiency and liver depression (decreased ovarian reserve,DOR), to explore the ideas and methods of TCM treatment of the disease and to promote the inheritance and development of traditional Chinese medicine (TCM). Methods: 60 patients who met the inclusion criteria were selected. According to the principle of random distribution, the treatment group was divided into two groups. (1) 30 cases in the treatment group were treated with traditional Chinese medicine (Zishen Tiaogan recipe). (2) and 30 cases in the control group were treated with western medicine (estradiol valerate / estradiol cycloproprogesterone tablet). Take a menstrual cycle as a course of treatment, three consecutive courses of treatment. The changes of menstruation and clinical symptoms were observed before and after treatment. The scores of TCM syndromes score were used to record the pregnancy, the level of basic sex hormone, the number of antral follicles, the volume of ovaries in the 2-3 days of menstrual cycle. Adverse drug reactions were observed. To observe the effect of different treatment methods on ovarian function of DOR patients. Results: (1) effect of menstrual regulation: after three menstrual cycles, the effective rate of treatment group was 88.00 and that of control group was 42.31. There was significant difference between the two groups after treatment. (2) Clinical symptom effect: after treatment, the effective rate of the treatment group was 86.67 and that of the control group was 66.67. Compared with the two groups after treatment, X2 test, P0.01, the difference was significant. (3) pregnancy effect: the end of treatment, the effective rate of both groups were 16.6767. There was no significant difference between the two groups by Fisher's exact probability test (P0.05). (4) the total clinical efficacy: the treatment group (30 cases), the total effective rate was 93.33%; the control group (30 cases), the total effective rate (70.005). After treatment, there was significant difference in the total curative effect between the two groups by X2 test (P0.01). (5) the level of reproductive hormone: the comparison between the treatment group and the control group on basal follicle stimulating hormone (b-FSH), Basal luteinizing hormone (b-LH), normal area FSH/LH and basal estradiol (b-E2) were all effective (P < 0. 01). But both of them had no effect on FSH/LH in high area (P0.05). The adjustment of FSH/LH in the treatment group was significant (P0.01). There was no significant difference in other aspects (P0.05). (6) ovarian volume: after treatment, compared with the treatment group, the treatment group was effective in improving the reduced ovarian volume (P0.05); The control group had no effect on the change of ovarian volume (P0.05). The number of basic antral follicles was similar between the two groups (P0.05). (7): after treatment, the number of basic antral follicles was significantly increased by taking Chinese medicine and Ke Ling Meng (P0.05). There was no significant difference between the two groups (P0.05). Conclusion: Zishen Tiaogan recipe can significantly improve DOR, regulate menstruation, improve the symptoms of kidney deficiency and liver depression, decrease the excessive levels of b-FSH and b-LH, adjust the ratio of FSH/LH, and can regulate b-E2 in both directions. It can reduce the high b-E _ 2 and increase the low b-E _ 2; It can also increase the reduced ovarian volume and increase the number of basal antral follicles. The total effective rate was 93.33, and the curative effect was obviously superior to that of the control group. It shows that Chinese medicine can effectively improve the ovarian function of patients with DOR, and it is worth popularizing and further studying.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.9
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