复方左归胶囊联合穴位贴敷治疗肾虚肝郁型卵巢储备功能下降患者的临床观察

Clinical Observation on Compound Zuogui Capsules Combined with Acupoint Application in the Treatment of Patients with Kidney Deficiency and Liver Stagnation Type of Diminished Ovarian Reserve

【目的】探讨复方左归胶囊联合穴位贴敷治疗肾虚肝郁型卵巢储备功能下降(DOR)患者的临床疗效。【方法】将60例肾虚肝郁型DOR患者随机分为治疗组和对照组,每组各30例。对照组给予戊酸雌二醇和地屈孕酮的人工周期疗法治疗,治疗组在对照组的基础上给予复方左归胶囊联合穴位贴敷治疗,疗程为3个月经周期。观察2组患者治疗前后各项血清性激素水平、双侧卵巢窦卵泡数(AFC)及中医证候评分的变化情况,并评价2组患者的临床疗效。【结果】(1)治疗3个月经周期后,治疗组的治愈率和总有效率分别为20.0%(6/30)和93.3%(28/30),对照组分别为6.7%(2/30)和76.7%(23/30);组间比较,治疗组的治愈率和总有效率均优于对照组,但差异均无统计学意义(P>0.05)。(2)治疗后,2组患者血清促卵泡生成素(FSH)、黄体生成素(LH)水平均较治疗前明显降低(P<0.01),抗缪勒氏管激素(AMH)水平均较治疗前明显升高(P<0.01),而2组患者血清雌二醇(E2)虽较治疗前升高,但差异均无统计学意义(P>0.05);组间比较,治疗组对血清FSH、LH水平的降低作用均明显优于对照组,差异均有统计学意义(P<0.05或P<0.01)。(3)治疗后,2组患者的左侧、右侧和双侧AFC均较治疗前明显升高(P<0.01),且治疗组的升高作用均明显优于对照组,组间治疗后及差值比较,差异均有统计学意义(P<0.01)。(4)治疗后,2组患者的月经积分、肾虚肝郁积分及中医证候总积分均较治疗前明显降低(P<0.01),且治疗组的降低作用均明显优于对照组,组间治疗后及差值比较,差异均有统计学意义(P<0.01)。【结论】在人工周期疗法基础上使用复方左归胶囊联合穴位贴敷治疗肾虚肝郁型DOR的疗效优于单纯人工周期疗法,可有效提高患者的AFC,改善患者的性激素水平、月经情况和相关临床症状。

Objective To investigate the clinical efficacy of compound Zuogui Capsules combined with acupoint application in the treatment of patients with kidney deficiency and liver stagnation type of diminished ovarian reserve(DOR).Methods Sixty patients with kidney deficiency and liver stagnation type of DOR were randomly divided into the treatment group and the control group,30 cases in each group.The control group was given artificial periodic therapy of estradiol valerate and dydrogesterone,while the treatment group was given compound Zuogui Capsules combined with acupoint application on the basis of treatment for the control group.The treatment in both groups lasted for 3 menstrual cycles.The changes in serum sex hormone levels,antral follicle count(AFC)and traditional Chinese medicine(TCM)syndrome scores were observed in the two groups before and after treatment,and the clinical efficacy of the two groups was evaluated after treatment.Results(1)After 3 menstrual cycles of treatment,the cure rate and total effective rate of the treatment group were 20.0%(6/30)and 93.3%(28/30)respectively,and those of the control group were 6.7%(2/30)and 76.7%(23/30)respectively.The intergroup comparison showed that the cure rate and total effective rate of the treatment group were mildly higher than those of the control group,and the differences were not statistically significant(P>0.05).(2)After treatment,serum follicle-stimulating hormone(FSH)and luteinizing hormone(LH)levels in both groups were significantly decreased compared with those before treatment(P<0.01),and anti-Müllerian hormone(AMH)level was significantly increased compared with that before treatment(P<0.01).The serum estradiol(E2)level in both groups was increased compared with before treatment,but the difference was not statistically significant(P>0.05).The intergroup comparison showed that the effect on lowering serum FSH and LH levels in the treatment group was significantly superior to that in the control group,and the differences were statistically significant(P<0.05 or P<0.01).(3)After treatment,the left ovarian AFC,right ovarian AFC and bilateral ovarian AFC of the two groups were significantly increased compared with those before treatment(P<0.01).The effect on increasing AFC in the treatment group was significantly superior to that in the control group,and statistically significant difference was shown in the post-treatment AFC between the two groups and in the pre-and post-treatment difference of AFC between the two groups(P<0.01).(4)After treatment,the menstruation scores,kidney deficiency and liver stagnation syndrome scores and the overall TCM syndrome scores of the two groups were all significantly decreased compared with those before treatment(P<0.01).The effect on decreasing the scores in the treatment group was significantly superior to that in the control group,and statistically significant difference was shown in the post-treatment scores between the two groups and in the pre-and post-treatment difference of scores between the two groups(P<0.01).Conclusion The efficacy of compound Zuogui Capsules plus acupoint application together with artificial periodic therapy is superior to artificial periodic therapy alone in treating kidney deficiency and liver stagnation type of DOR.The combined therapy is effective on increasing AFC,and on improving sex hormone level,menstrual condition and related clinical symptoms of the patients with kidney deficiency and liver stagnation type of DOR.