补中益气汤合二仙汤加减治疗围绝经期妇女压力性尿失禁的临床疗效

Clinical Observation of Modified Buzhong Yiqitang Combined with Erxian Decoction in Treatment of Stress Urinary Incontinence in Perimenopausal Women

目的观察补中益气汤合二仙汤加减治疗围绝经期妇女压力性尿失禁(SUI)脾肾气虚证的临床疗效。方法将106例患者随机按数字表法分为对照组52例和观察组54例。两组患者均给予生活方式干预和盆底肌训练(PFMT)。对照组口服缩泉丸,6 g/次,2次/d;观察组口服补中益气汤合二仙汤加减,1剂/d;两组疗程均为8周。进行治疗前后国际尿失禁咨询问卷简表(ICIQ-SF)评分,检测治疗前后最大尿流率(Q_(max)),最大尿道闭合压(MUCP),残余尿量(RUV),腹压漏尿点压力(ALPP)和膀胱顺应性(BC)等参数尿流动力学指标;记录治疗前后24 h漏尿失禁次数、尿失禁漏尿程度评分,1 h漏尿量和脾肾气虚证评分;检测治疗前后雌二醇(E_(2)),卵泡刺激素(FSH),垂体腺苷酸环化酶激活肽(PACAP)和血管活性肠肽(VIP)水平。结果治疗后,观察组ICIQ-SF量表尿失禁频率、严重程度和对生活质量影响3个维度评分及ICIQ-SF总分均低于对照组(P<0.01);观察组Q_(max),MUCP,ALPP和BC均高于对照组(P<0.01),RUV低于对照组(P<0.01);观察组24 h漏尿失禁次数、尿失禁漏尿程度评分,1 h漏尿量和脾肾气虚证评分均低于对照组(P<0.01);观察组E_(2),PACAP和VIP均高于对照组(P<0.01),FSH低于对照组(P<0.01);观察组临床治愈率为(29/50)58.00%,有效率为(47/50)94.00%,分别高于对照组的(18/48)37.50%和(38/48)79.17%(χ^(2)=4.124,χ^(2)=4.683,P<0.05)。结论在生活方式和PFMT干预的基础上,补中益气汤合二仙汤加减治疗绝经期女性SUI脾肾气虚证患者可明显改善尿失禁症状和程度,提高生活质量,并能调节性激素,PACAP和VIP水平,改善尿流动力学参数,临床治愈率和有效率均高于对照组。

Objective To observe the clinical efficacy of the modified Buzhong Yiqitang combined with Erxian decoction in treating stress urinary incontinence(SUI)of perimenopausal women due to spleen and kidney Qi deficiency.Method One hundred and six patients were randomly divided into a control group(52 cases)and an observation group(54 cases).Patients in both groups received lifestyle intervention and pelvic floor muscle training(PFMT).On this basis,patients in the observation group were further treated with the modified Buzhong Yiqitang combined with Erxian decoction,1 bag/day,while those in the control group were provided with Suoquan pills,6 g/time,2 times/day,for eight weeks.Following the international consultation on incontinence questionnaire-short form(ICIQ-SF)scoring before and after treatment,the urodynamic parameters such as_(max)imum urinary flow rate(Q_(max)),_(max)imum urethral closure pressure(MUCP),residual urine volume(RUV),abdominal pressure leakage point pressure(ALPP),and bladder capacity(BC)were measured.The number of incontinence episodes per 24 h,the degree of urinary incontinence,the amount of 1 h urine leakage,and the spleen and kidney Qi deficiency syndrome score were recorded before and after treatment.The levels of estradiol(E_(2)),follicle stimulating hormone(FSH),pituitary adenylate cyclase activating peptide(PACAP),and vasoactive intestinal peptide(VIP)were measured before and after treatment.Result The ICIQ-SF sub-scores of the urinary incontinence frequency,severity,and impact on quality of life as well as the total score in the observation group were all lower than those in the control group(P<0.01).Q_(max),MUCP,ALPP and BC in the observation group were elevated in contrast to those in control group(P<0.01),while the RUV declined(P<0.01).Compared with the control group,the observation group exhibited a decreased number of incontinence episodes per 24 h,milder degree of urinary incontinence,reduced amount of 1 h urine leakage,and lower spleen and kidney Qi deficiency syndrome score(P<0.01).The E_(2),PACAP,and VIP in the observation group were up-regulated as compared with those in the control group(P<0.01),whereas the FSH was down-regulated(P<0.01).The cure and effective rates of the observation group were(29/50)58.00%and(47/50)94.00%,respectively,significantly better than(18/48)37.50%and(38/48)79.17%of the control group(χ^(2)=4.124,χ^(2)=4.683,P<0.05).Conclusion On the basis of the lifestyle intervention and PFMT,the modified Buzhong Yiqitang combined with Erxian decoction obviously alleviates urinary incontinence,adjusts sex hormones,PACAP and VIP,ameliorates urodynamic parameters,and enhances the quality of life of patients with SUI due to spleen and kidney Qi deficiency.The resulting cure and effective rates are superior to those of the positive control.