补肾疏肝方对卵巢早衰患者骨代谢及免疫功能的影响

Effect of Bushen Shugan Prescription on Bone Metabolism and Immune Function of Patients with Premature Ovarian Failure

目的:观察补肾疏肝方联合人工周期疗法对卵巢早衰患者骨代谢及免疫功能的影响。方法:将符合纳入标准的卵巢早衰患者78例,按随机数字表法以1∶1比例分为2组各39例,选择同年龄阶段本院健康体检女性39例作为正常组。治疗组采用人工周期疗法联合补肾疏肝方治疗,对照组采用人工周期疗法治疗,治疗1月为1疗程,连续治疗3疗程。检测患者治疗前后骨密度(BMD)及25-羟维生素D_3(25-OH-VD3)、骨钙素(BGP)、血清碱性磷酸酶(ALP)、降钙素(CT),性激素水平促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)和T淋巴细胞亚群的变化。结果:治疗前,治疗组及对照组卵巢早衰患者腰椎BMD、股骨颈BMD、25-OH-VD_3、CT的水平均低于正常组,BGP、ALP水平均高于正常组,差异均有统计学意义(P<0.01),提示治疗组与对照组各指标异常。治疗后,治疗组及对照组患者腰椎BMD、股骨颈BMD、25-OH-VD_3、CT的水平比治疗前升高,BGP、ALP水平比治疗前降低,差异均有统计学意义(P<0.05);治疗后,治疗组CT、股骨颈BMD水平高于对照组,ALP水平低于对照组,差异均有统计学意义(P<0.05)。治疗后,治疗组股骨颈BMD与正常组比较,差异无统计学意义(P>0.05),提示治疗后接近正常水平。治疗组CT、ALP水平与正常组比较,差异均有统计学意义(P<0.05),提示治疗后仍未达到正常水平。治疗前,治疗组及对照组FSH、LH、E2水平分别与正常组比较,差异均有统计学意义(P<0.01)。提示治疗组与对照组各指标异常。治疗后,治疗组及对照组患者血清FSH、LH、E_2水平均较治疗前改善,差异均有统计学意义(P<0.05)。治疗后,治疗组血清LH水平低于对照组,差异有统计学意义(P<0.05)。治疗前,治疗组及对照组免疫细胞相对数目与正常组相比,均下降,差异均有统计学意义(P<0.01),提示治疗组与对照组各指标异常。治疗后,治疗组CD3^+、CD4^+、CD8^+细胞数目有不同程度增加,与对照组比较,差异均有统计学意义(P<0.05),且与正常组比较,差异均无统计学意义(P>0.05),提示治疗后治疗组以上各指标接近正常组水平,CD4^+/CD8^+高于对照组和正常组,差异均有统计学意义(P<0.05)。对照组2例患者出现恶心呕吐,治疗组1例患者出现头痛,其余未发现有明显的不良反应。结论:补肾疏肝方可调节卵巢早衰患者骨代谢和免疫功能,可减少卵巢早衰患者骨质疏松的发生概率,对免疫性卵巢早衰起到预防和治疗作用。

Objective： To observe the effect of Bushen Shugan prescription combined with artificial cycle methods on bone metabolism and immune function of patients with premature ovarian failure. Methods： Divided 78 cases of patients with premature ovarian failure into two groups randomly, 39 cases in each group. 39 cases of healthy females at the same age in our hospital were selected as the normal group. The treatment group was treated with artificial cycle methods combined with Bushen Shugan prescription, and the control group was treated with artificial cycle methods. Both groups received treatment for one month as one course, three courses continuously. Detected changes of bone mineral density（BMD）, 25-hydroxyvitamin D_3（25-OH-VD_3）, bone gla protein（BGP）, alkaline phosphatase（ALP）, calcitonin（CT）, follicle stimulating hormone（FSH）,luteinizing hormone（LH）, estrogen（E2）, and T lymphocyte subsets in both groups. Results： Before treatment, in the treatment group and the control group, levels of lumbar BMD, femoral neck BMD, 25-OH-VD_3, and CT were all lower than those in the normal group, while levels of BGP and ALP were higher than those in the normal group, differences being significant（P〈0.01）,which indicated that the indexes in the treatment group and the control group were unusual. After treatment, in the treatment group and the control group, levels of lumbar BMD, femoral neck BMD, 25-OH-VD_3, and CT were all increased when compared with those before treatment, while levels of BGP and ALP were decreased when compared with those before treatment, differences being significant（P〈0.05）. After treatment, levels of CT and femoral neck BMD in the treatment group were both higher than those in the control group, while ALP level in the treatment group was lower than that in the control group, differences being significant（P〈0.05）. After treatment, compared the level of femoral neck BMD in the treatment group with that in the normal group, there was no significance being found in the difference（P〈0.05）, implying that the index was close to normal after treatment. Compared levels of CT and ALP in the treatment group with those in the normal group, the difference was significant（P〈0.05）, suggesting that the two indexes had not reached the normal level after treatment. Before treatment, compared levels of FSH, LH and E_2 in the treatment group and the control group with those in the normal group,differences were significant（P〈0.01）, which indicated that the indexes in the treatment group and the control group were unusual. After treatment, levels of FSH, LH and E2 in the treatment group and the control group were all improved when compared with those before treatment, differences being significant（P〈0.05）. After treatment, serum LH level in the treatment group was lower than that in the control group, the difference being significant（P〈0.05）. Before treatment, in the treatment group and the control group, the number of immune cells were both declined when compared with that in the normal group, differences being significant（P〈0.01）, which suggested that indexes in the treatment group and the control group were unusual. After treatment, comparing with those in the control group, the cell number of CD3~＋, CD4~＋ and CD8~＋ in the treatment group were all risen to different degree, differences being significant（P〈0.05）, but there was no significant difference being found in the comparison of the cell number of CD3~＋, CD4~＋ and CD8~＋ in the treatment group with those in the normal group（P〈0.05）, implying that indexes in the treatment group were near to normal after treatment. The level of CD4~＋/CD8~＋ in the treatment group was higher than that in the control group and the normal group, the difference being significant（P〈0.05）. There were two cases of nausea and vomiting in the control group and one case of headache in the treatment group. Besides, no other obvious adverse reaction was found among the patients. Conclusion： For patients with premature ovarian failure, Bushen Shugan prescription can regulate the bone metabolism and immune function as well as reduce the incidence of osteoporosis, with the effect of preventing and treating immune premature ovarian failure.