金季玲补肾调周法治疗卵巢早衰临床观察

Clinical Observation of Premature Ovarian Failure Treated by Jin ji Ling 's Method of Bushentiaozhou

目的：观察补肾调周法治疗卵巢早衰的临床疗效。方法：选符合标准的卵巢早衰患者76例,随机分为两组。治疗组经后期（卵泡期）治以滋肾养血为主,佐以助阳。经间期（排卵期）治以滋肾活血行气为主,加温肾壮阳药。经前期（黄体期）治以温补肾阳为主,佐以滋阴。肾阴虚者,平补阴阳。月经期以活血行气为主,因势利导,引血下行。兼有脾气虚弱者,在补肾调周基础上辅以健脾益气,兼有心肝火旺者,辅以疏肝清热宁心;兼有肝郁气滞者,辅以疏肝解郁。对照组予补佳乐配合安宫黄体酮行西药人工周期疗法,所有患者连续治疗三个月经周期,观察治疗前后月经变化以及潮热汗出,烦躁易怒,阴道干涩,乏力等症状的积分变化情况,并采用化学发光法测定两组治疗前后血清卵泡刺激素（FSH）和雌二醇（E2）水平。结果：治疗组总有效率为83.33%（95%CI=71.15%-95.51%）,对照组为66.67%（95%CI=51.27%-82.07%）,两组综合疗效比较（u=1.0200,P=0.3077）,差异无显著性意义,但显示出优势。结论：采用补肾调周分期论治治疗卵巢早衰的临床疗效优于西医疗法的证据不够充分,其收益为OR=0.40（95%CI=0.13-1.22,跨过1）,NNT=6（95%CI=2.73-35.84,其分布呈现偏态）。补肾调周法能显著改善POF患者的月经情况及潮热汗出,烦躁易怒,阴道干涩,酸软,失眠,乏力,心悸等一系列卵巢功能衰退的不适症状。

Objective：To observe the clinical effects of bushentiaozhou method on premature ovarian failure （POF）. Methods： The 76 selected patients with POF and met the standards were randomly divided into two groups. The treatment group was treated by the following mothods： during the late menstruation period （follicular phase） , mainly with nourishing kidney, replenishing blood, and invigorating yang; during the middle menstruation period （ovulation period）, mainly with nourishing kidney , tonifying qi, activating blood, and putting some medicines of warming kidney to invigorate yang;during the early menstruation period （luteal phase） , mainly with war- ming and recuperating the kidney-yang, combing nourishing yin, for the patients who was deficiency in kidney-yin, mainly with yin-yang mild tonification. During the menstruation period, mainly with activating blood and moving qi, and conducting blood to flow downwards. For the patients with spleen-qi deficiency, supplemented with invigorating spleen and benefiting qi on the basis of bushentiaozhou ; for the patients with hyperactivity of heart-and liverfire , supplemented with soothing liver, clearing heat and calming heart;for the patients combing qi stagnation Clue to liver depression, supplemented with dispersing the stagnated liver-qi to relieve the qi stagnation. The control group was treated artificially cyclically with estradiol valerate tabletes combined with medroxyprogesterone acetate, all patients were treated continuously for 3 menstrual cycles. The menstruation changes and the scores changes including hot flashes, diaphoresis, agitation, emotional lability, vagina dryness and fatigue etc. symptoms were evaluated before and after treatment. The serum levels of Follicle Stimulating Hormone （FSH） and estradiol （ E2 ） of two groups before and after treatment were determined by the chemistry luminescence method. Results：The total effective rate of treatment group was 83.33% （95% CI =71.15% -95.51% ） , the control group was 66. 67% （95% CI =51.27% -82.07%）.The comprehensive curative effects of two groups were compared （u = 1.246 3,P = 0. 212 4） , the difference was not statistically significant, but showed the superiority.Conclusion： It has not the sufficient evidences that the clinical effect of treating POF with staging discussion and treatment of bushentiaozhou is superior to western medicine therapy. Its benefits is OR = 0.40 （ 95% CI = 0. 13 - 1.22, crossing 1 ） NNT = 6 （ 95% CI = 2.73 - 35.84, its distribution presents the skewness）. The method of bushentiaozhou can significantly improve the menstrual situation and a series of discomfort symptoms due to POF , such ss hot flashes, sweating, emotional lability, vaginal dryness, musculoskeletal weakness, insomnia, fatigue, and palpitation.