补肾健脾化瘀法联合优思明治疗肾虚血瘀型多囊卵巢综合征对患者中医证候、卵巢功能的影响

Effects of Bushen jianpi huayu method combined with drospirenone and ethinylestradiol tablets for treating patients with polycystic ovary syndrome of kidney deficiency and blood stasis type on their TCM syndromes and ovarian function

目的:探讨补肾健脾化瘀法联合优思明治疗对肾虚血瘀型多囊卵巢综合征(PCOS)疗效及对患者中医证候、卵巢功能的影响。方法:选择2019年1月-2021年1月本院收治的肾虚血瘀型PCOS病例104例,随机分为对照组和观察组各52例,均给予屈螺酮炔雌醇片(优思明)治疗,观察组加予补肾健脾化瘀法治疗,均治疗3个月经周期,对比两组治疗前后中医证候积分,评估两组中医证候疗效,比较两组治疗前后B超检查卵泡个数、子宫内膜厚度、卵巢体积、促黄体激素(LH)、睾酮(T)和LH/促卵泡激素(FSH)值、抗苗勒氏管激素(AMH)、抑制素B(IHNB)、瘦素(LP)和脂联素(ADPN)水平,观察两组月经恢复情况和排卵恢复情况,评估不良反应。结果:治疗后,两组中医证候积分均比治疗前下降且观察组低于对照组;观察组中医证候总有效率(92.3%)高于对照组(76.9%)(均P<0.05);与治疗前比较,两组卵泡个数和卵巢体积均减少,子宫内膜厚度增厚,血清LH、T水平、LH/FSH值和AMH均降低,LP水平降低,ADPN水平提高,且观察组变化幅度大于对照组(均P<0.05);观察组月经恢复率及排卵恢复率(86.5%、78.9%)高于对照组(67.3%、59.6%)(均P<0.05);两组均未见明显不良反应。结论:补肾健脾化瘀法联合优思明治疗肾虚血瘀型PCOS,能明显减少患者中医证候积分,提高中医证候疗效,有效改善卵巢储备功能,调节性激素水平,下调血清LP水平,促进ADPN水平,促进月经及排卵恢复,临床应用安全性高。

Objective:To explore the effects of Bushen jianpi huayu method combined with drospirenone and ethinylestradiol tablets for treating patients with polycystic ovary syndrome(PCOS)of kidney deficiency and blood stasis type on their TCM syndromes and ovarian function.Methods:104 patients with PCOS of kidney deficiency and blood stasis type were selected and were randomly divided into control group and observation group(52 cases in each group)from January 2019 to January 2021.The patients in the control group were treated with drospirenone and ethinylestradiol tablets for 3 menstrual cycles,and the patients in the observation group were given Bushen jianpi huayu method on the basis of the medication of the control group additionally for 3 menstrual cycles.The scores of TCM syndromes of the patients before and after treatment were compared between the two groups,and the efficacy for TCM syndromes of the patients in the two groups was evaluated.The results by B ultrasound examination,such as the number of follicles,the endometrial thickness and the ovarian volume,and levels of sex hormones,such as luteinizing hormone(LH),testosterone(T),LH/follicle stimulating hormone(FSH),reproductive hormones anti-Müllerian hormone(AMH),inhibin B(IHNB),leptin(LP),and adiponectin(ADPN)of the patients before and after treatment were compared between the two groups.The menstrual recovery and ovulation recovery of the patients in the two groups were observed,and the adverse reactions of the patients in the two groups were evaluated.Results:After treatment,the TCM syndrome scores of the patients in the two groups had decreased significantly,and which of the patients in the observation group were significantly lower than those of the patients in the control group.The total effective rate of TCM syndrome(92.3%)of the patients in the observation group was significantly higher than that(76.9%)of the patients in the control group(all P<0.05).The number of follicles,the ovarian volume,the endometrial thickness,the levels of serum LH,T,AMH,and LP,and LH/FSH value of the patients in the two groups had decreased significantly,the ADPN level of the patients in the two groups had increased significantly,and the range of changes of which of the patients in the observation group were significantly more than those of the patients in the control group(all P<0.05).The recovery rates of menstruation and ovulation(86.5%and 78.9%)of the patients in the observation group were significantly higher than those(67.3%and 59.6%)of the patients in the control group(all P<0.05).There was no any patient with obvious adverse reactions in the two groups.Conclusion:Bushen jianpi huayu method combined with drospirenone and ethinylestradiol tablets for treating the patients with PCOS of kidney deficiency and blood stasis type can significantly reduce their TCM syndromes scores,enhance their efficacy of TCM syndromes,effectively improve the ovarian reserve function,regulate the levels of sex hormones,down-regulate the level of their serum LP level,promote their ADPN level,and promote their menstrual recovery and ovulation recovery,with high safety in clinical application.