滋癸益经汤联合滋肾育胎丸治疗卵巢早衰的研究

Study on Treatment of Premature Ovarian Failure with Zigui Yijing Decoction Combined with Zishen Yutai Pills

【目的】观察滋癸益经汤联合滋肾育胎丸治疗卵巢早衰(POF)的临床疗效。【方法】将66例POF患者随机分为治疗组和对照组,每组各33例。治疗组给予口服滋癸益经汤加滋肾育胎丸治疗,对照组给予口服滋癸益经汤加维生素E胶囊治疗,3个月为1个疗程,共治疗2个疗程。观察2组患者治疗前、治疗3个月及6个月后的各项证候积分、月经情况、血清性激素水平[促卵泡生成激素(FSH)、促黄体生成激素(LH)、雌二醇(E2)、抗苗勒氏管激素(AMH)]及彩超检查指标[子宫内膜厚度、卵巢体积、卵泡数量、卵巢最大血流速度(PSV)和卵巢阻力指数(RI)]的变化情况,并评价2组患者的疗效。【结果】(1)疗效方面:治疗6个月后,治疗组的总有效率为63.6%,对照组为39.4%,治疗组的疗效明显优于对照组(P<0.05)。(2)证候方面:治疗3个月后,治疗组在改善心烦失眠、潮热盗汗、咽干口燥方面明显优于对照组(P<0.05);而治疗6个月后,治疗组在改善咽干口燥、大便异常方面明显优于对照组(P<0.05)。(3)月经方面:治疗3个月后,治疗组在改善月经周期和经质方面明显优于对照组(P<0.05);而治疗6个月后,治疗组在改善经量和痛经方面明显优于对照组(P<0.05)。(4)彩超方面:治疗3个月后,治疗组在降低RI和增加PSV方面明显优于对照组(P<0.05);而治疗6个月后,治疗组在增加子宫内膜厚度方面明显优于对照组(P<0.05)。(5)性激素水平方面:治疗3个月后,2组患者血清FSH、LH、E2、AMH水平差值比较,差异均无统计学意义(P>0.05);而治疗6个月后,治疗组在提高患者血清AMH水平方面明显优于对照组(P<0.05)。【结论】滋癸益经汤联合滋肾育胎丸治疗POF疗效确切,不仅能改善患者症状和月经情况,还可提高患者血清AMH水平,增加子宫内膜厚度,改善双侧卵巢血供,降低卵巢血流阻力。

Objective To observe the clinical efficacy of Zigui Yijing Decoction combined with Zishen Yutai Pills for the treatment of premature ovarian failure(POF).Methods Sixty-six POF patients were randomly assigned to treatment group and control group,33 cases in each group.The treatment group was treated with Zigui Yijing Decoction and Zhishen Yutai Pills orally,while the control group was treated with Zigui Yijing Decoction and vitamin E capsules orally.Three months constituted one treatment course,and the treatment covered 2 courses.Before treatment and after treatment for 3 and 6 months,we observed the scores of traditional Chinese medicine(TCM)syndrome manifestations,menstruation status,serum levels of sex hormones of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Mullerian hormone(AMH),and color Doppler ultrasonography parameters of endometrial thickness,ovarian volume,follicle count,ovarian peak systolic velocity(PSV)and ovarian resistance index(RI)in the two groups.After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After treatment for 6 months,the total effective rate in the treatment group was 63.6%and that in the control group was 39.4%,and the efficacy in the treatment group was superior to that in the control group(P<0.05).(2)After treatment for 3 months,the treatment group had stronger effect on improving the TCM symptoms of vexation and insomnia,tidal fever and night sweating,and dry mouth and throat than the control group(P<0.05).After treatment for 6 months,the treatment group had stronger effect on improving the symptoms of dry mouth and throat and abnormal defecation than the control group(P<0.05).(3)The treatment group had stronger effect on improving the menstrual cycle and menstrual blood after treatment for 3 months,and on improving the menstrual volume and dysmenorrhea after treatment for 6 months than the control group(P<0.05).(4)The color Doppler ultrasonography showed that the treatment group had stronger effect on decreasing RI and increasing RSV after treatment for 3 months,and on increasing the endometrial thickness after treatment for 6 months than the control group(P<0.05).(5)In respect of the serum levels of sex hormones,the differences of FSH,LH,E2 and AMH levels in the treatment group after treatment for 3 months did not differ from those in the control group(P>0.05);after treatment for 6 months,the treatment group had stronger effect on increasing AMH level than the control group(P<0.05).Conclusion Zigui Yijing Decoction combined with Zishen Yutai Pills exerts certain effect for the treatment of POF.The combination of the two formulae not only improves the symptoms and menstruation of POF patients,but also increases serum AMH level and endometrial thickness,improves the blood supply of bilateral ovaries,and decreases the ovarian blood flow resistance.