中西医结合治疗PCOS排卵障碍临床研究

Clinical Study on the Treatment of PCOS Ovulation Disorder with Combination of TCM and Western Medicine

目的:观察补肾活血方联合枸橼酸氯米芬胶囊周期疗法治疗多囊卵巢综合征(polycystic ovary syndrome,PCOS)肾虚血瘀证排卵障碍的临床疗效。方法:将140例PCOS肾虚血瘀证排卵障碍患者,采用数字随机法分为对照组和观察组,每组70例。对照组采用一般治疗及枸橼酸氯米芬胶囊治疗,观察组在对照组治疗基础上加用补肾活血方周期疗法治疗。补肾活血方药物组成:菟丝子10 g,淫羊藿10 g,枸杞子15 g,熟地黄10 g,山药10 g,山茱萸10 g,杜仲10 g,牛膝10 g,当归15 g,川芎10 g,郁金10 g,鸡血藤10g。根据月经周期加减用药:卵泡期,重用熟地,加墨旱莲、女贞子;排卵期,重用菟丝子、淫羊藿,加路路通、威灵仙;黄体期,加五味子、覆盆子。两组患者均以1个月经周期为1个疗程,共治疗3个疗程。观察两组患者治疗前后性激素水平、中医症状积分变化、比较治疗后排卵及妊娠情况、临床疗效并评估临床用药安全性。结果:经不同治疗后,两组患者性激素黄体生成素((luteotropic hormone,LH)、雌二醇(estradiol,E2)、睾酮(testosterone,T)水平均较同组治疗前明显下降(P<0.01),而两组性激素促卵泡激素(follicle-stimulating hormone,FSH)、促卵泡激素(follicle-stimulating hormone,FSH)水平较同组治疗前明显升高,差异有统计学意义(P<0.01);治疗后观察组性激素LH、T水平低于对照组,差异有统计学意义(P<0.05),而性激素FSH水平高于对照组,差异有统计学意义(P<0.05)。两组治疗后中医症状积分均明显低于同组治疗前,差异有统计学意义(P<0.01);而观察组治疗后中医症状积分低于对照组,差异有统计学意义(P<0.05)。对照组排卵人数25例(占35.7%),观察组排卵人数43例(占61.4%),差异有统计学意义(P<0.01);对照组妊娠人数6例(占8.6%),观察组妊娠人数15例(占21.4%),差异有统计学意义(P<0.05)。对照组有效率为61.4%,观察组有效率为81.4%,差异有统计学意义(χ2=6.860,P=0.009<0.01)。两组治疗过程中未见严重不良反应,肝肾功能未见明显异常。结论:补肾活血方联合枸橼酸氯米芬胶囊周期治疗PCOS肾虚血瘀证排卵障碍疗效显著,能有效改善卵巢功能,促进排卵。

Objective： To observe the effect of Bushen Huoxue Decoction combined with Clomifene Citrate Capsules cycle therapy in the treatment of polycystic ovary syndrome（ polycystic ovary,syndrome,PCOS） the clinical curative effect of kidney deficiency and blood stasis syndrome of ovulation disorders. Methods： 140 cases of PCOS patients with kidney deficiency and blood stasis syndrome of ovulation,divided into the observation group and the control group by random with 70 cases in each group. The control group the general treatment and Clomifene Citrate Capsules treatment,the observation group in the control group treated with BSHX cycle therapy. Composition of Bushen Huoxue Prescription： Dodder 10 g,Epimedium 10 g,Medlar 15 g,Radix Rehmanniae10 g,Yam 10 g,Cornus 10 g,Eucommia 10 g,Achyranthes 10 g,Angelica 15 g,Chuanxiong 10 g. Turmeric 10 g,Spatholobus 10 g. According to the menstrual cycle prescription： follicular phase,and the reuse of rehmannia,Eclipta,Ligustrum lucidum; ovula-tion,reuse of epimedium,dodder,Caroline Road,weilingxian; Luteal phase,plus Schisandra,raspberry. Two groups of patients with1 menstrual cycles for 1 course,a total of 3 courses of treatment. To observe and compare the sex hormone levels in two groups before and after treatment,as well as the TCM symptoms integral change,ovulation and pregnancy after treatment,as well as the clinical efficacy and the safety assessment of clinical medication. Results： After treatment,two groups of patients with sex hormone luteinizing hormone（ luteotropic（ hormone,LH）,estradiol（ estradiol,E2）,testosterone（ testosterone,T） levels were significantly decreased compared with before treatment（ P〈0. 01）,while the two group of sex hormone and follicle stimulating hormone（ folliclestimulating,hormone,FSH） follicle hormone（ follicle-stimulating hormone,FSH） level was significantly elevated before treatment in the same group. The difference was statistically significant（ P〈0. 01）. The observation group sex hormone after LH treatment,T（ testosterone） was lower than control group,the difference was statistically significant（ P〈0. 05）,while the level of sex hormone FSH was higher than that of control Group. The difference was statistically significant（ P〈0. 05）. The two groups after treatment of TCM symptom scores were significantly lower than those of the same group before treatment. The difference was statistically significant（ P〈0. 01）,and lower than the control group of TCM symptom score after treatment in the observation group. The difference was statistically significant（ P〈0. 05）. The control group of 25 cases of ovulation the number of（ 35. 7%）,the observation group ovulation number in 43 cases（ 61. 4%）,the difference was statistically significant（ P〈0. 01）; control group pregnancy number in 6 cases（ 8. 6%）,15 cases in observation group were the number of pregnancy（ 21. 4%）,the difference was statistically significant（ P〈0. 05）. The control group was 61. 4%,observation group was 81. 4%,the difference was statistically significant（ χ2= 6. 860,P = 0. 009 0. 01）. The two groups during the treatment no serious adverse reactions,liver and kidney function had no obvious abnormalities. Conclusion： the curative effect of Bushen Huoxue Decoction Combined with Clomifene Citrate Capsules PCOS cycles of kidney deficiency and blood stasis syndrome of ovulation can effectively change significantly,which was able to promote ovulation and the function of ovary.