基于临床流行病学调查探讨排卵障碍性异常子宫出血的证治特点

Exploration on the Features of Syndrome Differentiation and Treatment for Abnormal Uterine Bleeding Caused by Ovulatory Dysfunction with the Method of Clinical Epidemiological Survey

【目的】通过临床流行病学调查探讨排卵障碍性异常子宫出血(AUB-O)的证治特点。【方法】采用流行病学调查方法,收集2018年1月1日至2020年12月31日期间在广东省中医院妇科门诊就诊并明确诊断为AUB-O的病例183例,填写调查问卷,分析AUB-O患者的中医病性要素及中医证型分布情况、临床处方用药情况,并随访调查近期疗效(阴道流血停止时间)及远期疗效(月经周期恢复时间)。【结果】(1)从病性要素来看,AUB-O虚证(50.8%)出现频数高于实证(32.8%)、虚实夹杂证(16.4%);从中医证型分布来看,AUB-O患者前5位中医证型分别为肾虚证(19.1%)、脾虚证(9.3%)、肾虚血瘀证(8.2%)、肝郁气滞证(7.7%)、肝郁血热证(7.7%)。(2)处方用药方面,肾虚证常用固阴煎加减、两地汤合二至丸加减、举元煎加减;脾虚证常用归脾汤、补中益气汤加减;肾虚血瘀证常用自拟方,方中常用海螵蛸、续断、白术、党参、甘草、墨旱莲、白芍、桑寄生、菟丝子、益母草等;肝郁气滞证常用逍遥丸加减;肝郁血热证常用丹栀逍遥丸、清经散及龙胆泻肝汤加减。(3)疗效方面,中西医结合治疗组患者的近期疗效(阴道流血停止时间)及远期疗效(月经周期恢复时间)与纯中医治疗组患者比较,差异均无统计学意义(P>0.05)。【结论】本研究运用流行病学调查分析的方法,论证了AUB-O两大证治特点:虚则健脾补肾,实则疏肝解郁;标本兼顾,活用“塞流、澄源、复旧”。

Objective To explore the features of syndrome differentiation and treatment for abnormal uterine bleeding caused by ovulatory dysfunction(AUB-O) by using the method of clinical epidemiological survey.Methods The method of clinical epidemiological survey was used for collecting the questionnaire of 183 cases of confirmed AUB-O outpatients visited the gynecological outpatient clinic of Guangdong Provincial Hospital of Traditional Chinese Medicine from 1st January 2018 to 31st December 2020. The disease-nature syndrome elements and the distribution of traditional Chinese medicine(TCM)syndrome types,and the prescriptions and medication for AUB-O patients were analyzed. Meanwhile,the short-term efficacy assessed by time for vaginal bleeding stopping and long-term efficacy assessed by time for the recovery of menstrual cycle were evaluated.Results(1)In terms of disease-nature syndrome elements, the occurrence frequency of deficiency syndrome(50.8%)was higher than that of the excess syndrome(32.8%)and deficiency interweaved with excess syndrome(16.4%)in AUB-O. In terms of the distribution of TCM syndrome types,the top 5 TCM syndrome types in AUB-O patients were kidney deficiency syndrome(19.1%),spleen deficiency syndrome(9.3%),kidney deficiency and blood stasis syndrome(8.2%),liver depression and qi stagnation syndrome(7.7%),liver depression and blood heat syndrome(7.7%).(2)For the treatment of kidney deficiency syndrome,modified Guyin Decoction,modified Liangdi Decoction plus Erzhi Pills, and modified Juyuan Decoction were usually prescribed. Spleen deficiency syndrome was often treated with modified Guipi Decoction and modified Buzhong Yiqi Decoction. For the treatment of kidney deficiency and blood stasis syndrome, self-prescribed formula was usually used, which was mainly composed of Endoconcha Sepiae, Radix Dipsaci, Rhizoma Atractylodis Macrocephalae, Radix Codonopsis,Radix Glycyrrhizae, Herba Ecliptae, Radix Paeoniae Alba, Herba Taxilli, Semen Cuscutae and Leonurus japonicus. Liver depression and qi stagnation syndrome was usually treated with modified Xiaoyao Pills. For the treatment of liver depression and blood heat syndrome, modified Danzhi Xiaoyao Pills, Qingjing Powder and Longdan Xiegan Decoction were frequently used.(3)In terms of therapeutic effect, there was no statistically significant difference in the short-term efficacy and long-term efficacy of the patients between the integrated traditional Chinese and western medicine treatment group and the Chinese medicine treatment group(P>0.05).Conclusion The results of epidemiological investigation and analysis indicate the two features of syndrome differentiation and treatment for AUB-O:for deficiency syndrome,therapies of invigorating spleen and tonifying kidney should be adopted,and for excess syndrome,therapies of soothing liver and relieving depression are often used;during the treatment,it is necessary to treat symptom and root cause simultaneously and the methods of“stopping bleeding,identifying cause,recovering health” should be utilized flexibly.