健脾补肾活血法治疗脾肾两虚兼痰瘀阻滞型多囊卵巢综合征临床研究

Clinical Study on Jianpi Bushen Huoxue Method for Polycystic Ovary Syndrome with Syndrome of Spleen-Kidney Deficiency and Phlegm-Stasis Obstruction

目的:观察健脾补肾活血法治疗脾肾两虚兼痰瘀阻滞型多囊卵巢综合征(PCOS)的临床疗效。方法:将80例脾肾两虚兼痰瘀阻滞型PCOS患者按随机数字表法分为观察组和对照组各40例。对照组给予炔雌醇环丙孕酮片治疗,观察组在对照组基础上给予健脾补肾活血方治疗,连续治疗3个月经周期,经期停用。检测2组治疗前后血清睾酮(T)、双氢睾酮(DHT)、促黄体生成素(LH)、卵泡刺激素(FSH)、空腹血糖(FBG)和空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR)。检测并记录2组卵巢体积、卵泡数目及排卵恢复情况,记录治疗前后痤疮严重情况和多毛评分,记录月经恢复正常率,测量治疗前后腰围、臀围、体质量、身高,计算腰臀比(WHR)、体质量指数(BMI)。结果:经秩和检验,治疗后观察组临床疗效优于对照组(Z=2.014,P<0.05)。治疗后,2组T、DHT、LH、FSH水平较治疗前降低(P<0.05),治疗后观察组T、DHT、LH、FSH水平低于对照组(P<0.05)。治疗后,2组卵泡数目、卵巢体积较治疗前减少(P<0.05),观察组卵泡数目、卵巢体积低于对照组(P<0.05)。治疗后观察组月经恢复率为75.00%,高于对照组52.50%,差异有统计学意义(P<0.05)。治疗后观察组排卵恢复率为57.50%,高于对照组35.00%,差异有统计学意义(P<0.05)。治疗后,2组FBG、HOMA-IR、BMI、WHR水平较治疗前降低(P<0.05),观察组FBG、HOMA-IR、BMI、WHR水平低于对照组(P<0.05)。治疗后,2组痤疮评分及多毛评分较治疗前降低(P<0.05),观察组痤疮评分及多毛评分低于对照组(P<0.05)。结论:健脾补肾活血方治疗脾肾两虚兼痰瘀阻滞型PCOS患者,能改善高雄激素和胰岛素抵抗,调节内分泌激素水平,缩小卵巢体积,减少卵泡数目,促进月经和排卵的恢复,改善了多毛、痤疮、肥胖等症状,提高了临床治疗效果。

Objective:To observe the clinical effect of Jianpi Bushen Huoxue method for polycystic ovary syndrome(PCOS)with syndrome of the spleen-kidney deficiency and phlegm-stasis obstruction.Methods:A total of 80 cases of PCOS patients with syndrome of the spleen-kidney deficiency and phlegm-stasis obstruction were divided into the observation group and the control group according to the random number table method,40 cases in each group.The control group was treated with ethinylestradiol and cyproterone acetate tablets,and the observation group was additionally treated with Jianpi Bushen Huoxue prescription based on the treatment of the control group.Both groups were treated for continuously three menstrual cycles,and the treatment was stopped during period.Before and after treatment,testosterone(T),dihydrotestosterone(DHT),luteinizing hormone(LH),follicle stimulating hormone(FSH),fasting blood glucose(FBG),and fasting insulin(FINS)in serum were detected in the two groups,and insulin resistance index(HOMA-IR)was calculated.Ovarian volume,number of follicle,and recovery of ovulation were detected and recorded in the two groups.Acne severity and hirsutism score before and after treatment were recorded,and the rate of return to normal menstruation was recorded.Waist circumference,hip circumference,weight and height were measured before and after treatment,and waist to hip ratio(WHR)and body mass index(BMI)were calculated.Results:After treatment,the clinical effect in the observation group was better than that in the control group(Z=2.014,P<0.05).After treatment,levels of T,DHT,LH and FSH in the two groups were decreased when compared with those before treatment(P<0.05),and the four levels in the observation group were lower than those in the control group(P<0.05).After treatment,number of follicle and ovarian volume in the two groups were decreased when compared with those before treatment(P<0.05),and the number and the volume in the observation group were smaller than those in the control group(P<0.05).After treatment,the rate of return to normal menstruation was 75.00% in the observation group,higher than that of 52.50% in the control group,the difference being significant(P<0.05).After treatment,the rate of ovulation recovery was 57.50% in the observation group,higher than that of 35.00% in the control group,the difference being significant(P<0.05).After treatment,levels of FBG,HOMA-IR,BMI and WHR in the two groups were decreased when compared with those before treatment(P<0.05),and the four levels in the observation group were lower than those in the control group(P<0.05).After treatment,scores of acne and hirsutism in the two groups were decreased when compared with those before treatment(P<0.05),and the two scores in the observation group were lower than those in the control group(P<0.05).Conclusion:In the treatment of PCOS patients with syndrome of the spleen-kidney deficiency and phlegm-stasis obstruction,the therapy of Jianpi Bushen Huoxue method can improve high androgen and insulin resistance,regulate levels of endocrine hormones,reduce ovarian volume and follicle number,promote the recovery of menstruation and ovulation,improve hirsutism,acne,obesity and other symptoms,and enhance the clinical effect.