中药补天葵方联合炔雌醇环丙孕酮片对脾虚痰湿证的多囊卵巢综合征患者卵巢功能及血清抗缪勒管激素的影响

Effects of Butiankui prescription combined with ethinylestradiol and cyproterone tablets on ovarian function and serum anti-Müllerian hormone in patients with polycystic ovarian syndrome of spleen deficiency and phlegm dampness syndrome

目的探讨中药补天葵方联合炔雌醇环丙孕酮片对脾虚痰湿证的多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者卵巢功能、抗苗勒管激素(anti-Müllerian hormone,AMH)的影响。方法纳入2017年6月至2019年9月我院收治的、中医辨证为脾虚痰湿证的PCOS患者120例,随机分为观察组及对照组,每组60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联用中药补天葵方,持续用药21 d,停药7 d,以30 d为1个疗程,两组均连续治疗3个疗程。比较两组治疗前后临床疗效、中医症候积分、性激素、AMH变化、排卵率、妊娠率及不良反应等。结果治疗后,观察组总有效率高于对照组(91.67%对78.33%,P<0.05)。在中医症候积分方面,观察组月经后期、神疲乏力、呕恶痰多、舌苔厚腻评分均低于对照组[(1.03±0.16)分对(1.74±0.32)分、(0.69±0.07)分对(1.13±0.10)分、(0.58±0.06)分对(0.91±0.08)分、(0.52±0.06)分对(0.79±0.05)分,P<0.05]。观察组黄体生成素(luteinizing hormone,LH)、LH/促卵泡雌激素、雌二醇、睾酮均低于对照组[(6.17±1.85)U/L 对(9.21±2.20)U/L、(1.14±0.18)pmol/L对(1.67±0.25)pmol/L、(101.21±16.34)pmol/L对(119.53±14.62)pmol/L、(1.45±0.34)nmol/L对(1.89±0.27)nmol/L,P<0.05]。观察组AMH低于对照组[(7.01±1.35)μg/L对(8.39±1.61)μg/L,P<0.05]。随访期间,观察组排卵率、妊娠率均高于对照组(78.33%对60.00%、36.67%对20.00%,P<0.05)。两组不良反应总发生率差异无统计学意义(P>0.05)。结论中药补天葵方联合炔雌醇环丙孕酮片治疗脾虚痰湿证PCOS患者效果显著,可有效改善卵巢功能,调节血清AMH表达,提高排卵率、妊娠率,且安全性较佳,值得应用推广。

Objective To investigate the effects of Butiankui prescription combined with ethinylestradiol and cyproterone tablets on ovarian function and anti-Mu?llerian hormone(AMH) in patients with polycystic ovarian syndrome(PCOS) with spleen deficiency and phlegm dampness syndrome.Methods A total of 120 PCOS patients with spleen deficiency and phlegm dampness syndrome admitted to our hospital from June 2017 to September 2019 were randomly divided into observation group and control group,60 cases in each group.The control group was treated with ethinylestradiol and cyproterone tablets,while the observation group was treated with Butiankui prescription combined with ethinylestradiol and cyproterone tablets.The treatment lasted for 21 days and stopped for 7 days,with 30 days as a course of treatment.Both groups were treated for 3 consecutive courses.The clinical efficacy,traditional Chinese medicine(TCM) syndrome score,sex hormone,AMH changes,ovulation rate,pregnancy rate and adverse reactions were compared between the two groups before and after treatment.Results After treatment,the total effective rate of the observation group was higher than that of the control group(91.67% vs 78.33%,P<0.05).In terms of TCM symptom score,the scores of late menstruation,mental fatigue,vomiting,phlegm,thick and greasy tongue coating in the observation group were lower than those in the control group[(1.03±0.16) vs (1.74±0.32),(0.69±0.07) vs (1.13±0.10),(0.58±0.06) vs (0.91±0.08),(0.52±0.06) vs (0.79±0.05),P<0.05].Luteinizing hormone(LH),LH/follicle stimulating hormone,estradiol and testosterone in the observation group were lower than those in the control group[(6.17±1.85)U/L vs (9.21±2.20)U/L,(1.14±0.18)pmoL/Lvs (1.67±0.25)pmoL/L,(101.21±16.34)pmoL/L vs (119.53±14.62)pmoL/L,(1.45±0.34)nmoL/L vs (1.89±0.27)nmoL/L,P<0.05].AMH in the observation group was lower than that in the control group[(7.01±1.35)μg/L vs (8.39±1.61)μg/L,P<0.05].During the follow-up period,the ovulation rate and pregnancy rate of the observation group were higher than those of the control group(78.33% vs 60.00%,36.67% vs 20.00%,P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Butiankui prescription combined with ethinylestradiol and cyproterone tablets had a significant effect on PCOS patients with spleen deficiency and phlegm dampness syndrome,which can effectively improve ovarian function,regulate serum AMH expression,improve ovulation rate and pregnancy rate,with good safety,and is worthy of application and promotion.