黄连阿胶汤合百合地黄汤加减对绝经综合征神经内分泌网络的调节作用

Study on Addition and Subtraction Syndrome Differentiation Method of Huanglian Ejiaotang and Baihe Dihuangtang in Regulation of Neuroendocrine Network for Menopausal Syndrome

目的:观察黄连阿胶汤合百合地黄汤加减辨治对绝经综合征(MPS)阴虚火旺证的临床疗效及对神经内分泌网络调节效果。方法:将148例患者按随机数字表法分为对照组和观察组74例。对照组口服雌二醇/醋酸炔诺酮片,3 mg/次,1次/d;观察组西医治疗同对照组,并内服黄连阿胶汤合百合地黄汤加减,1剂/d。两组疗程均为连续治疗3个月。评价治疗前、治疗后1,2,3个月Kupperman指数(KI)评分;评价治疗前后绝经期生存质量量表(MENQOL),抑郁自评量表(SAS),焦虑自评量表(SDS),匹兹堡睡眠质量指数量表(PSQI)和阴虚火旺证评分;检测治疗前后血清雌二醇(E2),促卵泡生成素(FSH),促黄体生成素(LH),去甲肾上腺素(NE),5-羟色胺(5-HT),一氧化氮(NO),内皮素-1(ET-1)和降钙素基因相关肽(CGRP)水平。结果:观察组临床疗效优于对照组(Z=2.115,P<0.05);观察组治疗后1,2,3个月KI评分均低于同期对照组(P<0.01),治疗后观察组KI评分下降幅度多于对照组(P<0.01);观察组MENQOL量表各个维度评分均低于对照组(P<0.01);观察组患者阴虚火旺证,SAS,SDS和PSQI评分均低于对照组(P<0.01);治疗后观察组患者E2水平高于对照组(P<0.01),FSH,LH水平均低于对照组(P<0.01);观察组患者5-HT和NE水平均高于对照组(P<0.01);观察组患者NO水平高于对照组(P<0.01),CGRP,ET-1水平均低于对照组(P<0.01)。研究期间对照组脱落、失访5例,剔除2例,完成67例;观察组脱落、失访7例,剔除1例,完成66例。结论:在激素替代治疗的基础上,黄连阿胶汤合百合地黄汤加减治疗MPS阴虚火旺证患者可明显改善临床症状,减轻抑郁、焦虑程度,改善睡眠质量,提高生活质量,临床疗效优于单纯的激素替代疗法,并能调节内分泌激素、血管舒缩因子和单胺类神经递质,从而起到改善临床症状的效果。

Objective: To observe the clinical efficacy of addition and subtraction syndrome differentiation method of Huanglian Ejiaotang and Baihe Dihuangtang in the treatment of menopausal syndrome(MPS)and symptoms of deficiency of yin and hyperactivity of fire,and investigate its regulation effects on neuroendocrine network. Method: One hundred and forty-eight patients were divided into control group(74 cases)and observation group(74 cases)according to the random number table method. The patients in control group received estradiol/norethisterone acetate tablets,3 mg/time,1 time/day,while the patients in observation group received addition and subtraction of Huanglian Ejiaotang and Baihe Dihuangtang based on the same western medicine treatment as control group,orally 1 dose/day,with a treatment course of 3 months in both groups. Kupperman index(KI)score was evaluated before treatment and at 1 month,2 months and 3 months after treatment. The Menopausal Quality of Life(MENQOL),self-rating depression scale(SDS),Self-rating Anxiety Scale(SAS),Pittsburgh Sleep Quality Index(PSQI)and score of deficiency of yin and hyperactivity of fire were evaluated before and after treatment. The levels of serum estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),norepinephrine(NE),5-hydroxytryptamine(5-HT),nitric oxide(NO),endothelin-1(ET-1)and calcitonin gene-related peptide(CGRP)were detected before and after treatment. Result:The clinical efficacy in observation group was better than that in control group(Z=2.115,P<0.05),and the KI scores in observation group at 1 month,2 months and 3 months after treatment were lower than those in control group(P<0.01),and the decrease of KI score in observation group after treatment was larger than that in control group(P<0.01). The scores of various dimensions of MENQOL scale in observation group were lower than those in control group(P<0.01). The scores of deficiency of yin and hyperactivity of fire,SAS,SDS and PSQI in observation group were all lower than those in control group(P<0.01),and the level of E2 in observation group after treatment was higher than that in control group(P<0.01),while the levels of FSH and LH were lower than those in control group(P<0.01).The levels of 5-HT and NE in observation group were higher than those in control group(P<0.01). The NO level in observation group was higher than that in control group(P<0.01),while the levels of CGRP and ET-1 were lower than those in control group(P<0.01). During the study period,there were 5 drop-out cases,2 excluded cases,and 67 completed cases in the control group.There were 7 drop-out cases,1 excluded case,66 completed cases in the observation group. Conclusion: On the basis of hormone replacement therapy,addition and subtraction of Huanglian Ejiaotang and Baihe Dihuangtang for patients with MPS(with symptom of deficiency of yin and hyperactivity of fire)can improve clinical symptoms,relieve depression and anxiety,improve sleep quality and enhance quality of life,and its clinical efficacy is superior to hormone replacement therapy alone. It can also regulate endocrine hormones,vasomotor factors and monoamine neurotransmitters,thereby improving clinical symptoms.