發(fā)布時(shí)間：2018-03-18 08:14

  本文選題：卵巢儲(chǔ)備功能下降　切入點(diǎn)：肝郁腎虛證　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：[目的]:本課題旨在通過臨床隨機(jī)對(duì)照研究,對(duì)符合卵巢儲(chǔ)備功能下降(肝郁腎虛證)的患者分別采用"滋腎養(yǎng)肝"中藥序貫療法和西醫(yī)激素治療,比較患者治療前后中醫(yī)證候積分和激素水平的變化,初步探討"滋腎養(yǎng)肝"法系列方劑治療卵巢儲(chǔ)備功能下降(肝郁腎虛證)的臨床療效,為進(jìn)一步研究中醫(yī)藥改善卵巢功能及郭志強(qiáng)教授學(xué)術(shù)思想提供前期基礎(chǔ)。[方法]:本研究收集2015年12月～2016年12月就診于北京中醫(yī)藥大學(xué)東直門醫(yī)院本部和國際部婦科門診并符合納入標(biāo)準(zhǔn)的60例患者,通過隨機(jī)數(shù)字表法分為治療組("滋腎養(yǎng)肝"法系列方劑)和對(duì)照組(補(bǔ)佳樂+黃體酮膠囊)。分別治療3個(gè)月經(jīng)周期后,比較2組在治療前后中醫(yī)證候積分及月經(jīng)第2～4天基礎(chǔ)性激素水平改變:基礎(chǔ)卵泡刺激素(FSH)、黃體生成素(LH)、雌激素(E2)、FSH/LH值,并觀察計(jì)劃妊娠者于治療期間及停藥后1個(gè)月內(nèi)是否自然妊娠以及治療過程中是否出現(xiàn)不良反應(yīng)。[結(jié)果]:1.治療組和對(duì)照組治療前基線一致性比較:年齡段分布未見明顯差異(P0.05);中醫(yī)證候積分方面,月經(jīng)量和主癥總積分差異明顯(P0.05),不具有可比性。其余主癥單項(xiàng)積分、次癥總積分及次癥單項(xiàng)積分均未見明顯差異(P0.05),具有可比性。FSH、LH、FSH/LH、E2水平差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2.治療組和對(duì)照組治療前后組內(nèi)對(duì)比提示經(jīng)期未有明顯變化(P0.05),而月經(jīng)周期、經(jīng)量、經(jīng)色和經(jīng)質(zhì)、心煩易怒、腰骶酸痛癥狀經(jīng)過治療均有明顯改善(P0.05);治療后組間比較,治療組僅在增加同房次數(shù)上有明顯優(yōu)勢(shì)(P0.05),其余各項(xiàng)癥狀均無明顯差異(P0.05)。3.治療組治療后FSH、FSH/LH均下降,與治療前相比差異有統(tǒng)計(jì)學(xué)意義(P0.05),LH、E2均未見明顯差異(P0.05);對(duì)照組治療后FSH值下降,與治療前相比差異有統(tǒng)計(jì)學(xué)意義(P0.05),LH、FSH/LH均未見明顯差異(P0.05)。組間比較中,治療組FSH/LH比值較對(duì)照組有顯著改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余各項(xiàng)均為見明顯差異(P0.05)。4.治療組治療期間有5例患者因個(gè)人原因未能完成治療而退出臨床研究,對(duì)照組治療期間有4例患者因出現(xiàn)不良反應(yīng)而退出臨床研究。5.治療過程中,治療組未出現(xiàn)不良反應(yīng);對(duì)照組患者有4例出現(xiàn)明顯惡心、乳房脹痛加重的情況,3例出現(xiàn)僅乳房脹痛加重的情況。[結(jié)論]:1."滋腎養(yǎng)肝"法系列方劑可以明顯改善卵巢儲(chǔ)備功能下降(肝郁腎虛證)患者月經(jīng)周期、經(jīng)量、心煩易怒、腰酸、乳房脹痛等癥狀。2."滋腎養(yǎng)肝"法系列方劑可以有效降低FSH水平和FSH/LH比值;與補(bǔ)佳樂+黃體酮膠囊治療相比,更能有效改善FSH/LH比值。3."滋腎養(yǎng)肝"法系列方劑與西醫(yī)"補(bǔ)佳樂+黃體酮膠囊"在改善DOR(肝郁腎虛證)患者的中醫(yī)證候和激素水平方面療效相當(dāng),且前者無明顯副作用。4.卵巢儲(chǔ)備功能下降(肝郁腎虛證)患者主訴以"月經(jīng)量少"和"未避孕未孕1年以上"為主,但月經(jīng)周期的改變并不明顯。5.卵巢儲(chǔ)備功能下降(肝郁腎虛證)患者的中醫(yī)證候改善和激素水平改善并不存在同一性,猜測(cè)臨床癥狀好轉(zhuǎn)較激素水平的改善略有延遲性。
[Abstract]:[Objective]: this topic through randomized controlled clinical study, with diminished ovarian reserve (liver and kidney deficiency syndrome) patients were treated with "zishenyanggan" of traditional Chinese medicine and Western Medicine Sequential Therapy of hormone therapy, changes of TCM syndrome integral and hormone levels were compared before and after treatment, explore the "zishenyanggan" series decoction for the treatment of diminished ovarian reserve (liver and kidney deficiency syndrome) clinical curative effect, for the further study of traditional Chinese medicine on improving the academic thought of Professor Guo Zhiqiang ovarian function and provide a basis. Methods: This study collected from December 2015 to December 2016 in Dongzhimen Hospital of Beijing University of Chinese Medicine, the Department of the International Department of gynecology clinic and 60 cases and in accordance with the inclusion criteria were randomized by randomly divided into the treatment group ("zishenyanggan" series of prescriptions) and control group (progynova + progesterone capsules) respectively. After treatment for 3 menstrual cycles, The 2 groups were compared before and after treatment of TCM syndrome integral and menstruation second ~ 4 days of basic hormone level change: basal follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), FSH/LH value, and observe the plan of pregnancy during the treatment period and 1 months after drug withdrawal is natural pregnancy and adverse reactions. Results] whether there in the course of treatment: 1. treatment group and control group before baseline consistency: the age distribution showed no significant difference (P0.05); TCM syndrome score, menstrual volume and main symptoms total score difference (P0.05), not comparable. The rest of the main in a single score, total score of secondary symptoms and secondary symptoms of individual scores had no significant difference (P0.05), comparable to.FSH, LH, FSH/LH, E2 levels were not significantly different (P0.05), comparable to.2. treatment group and control group before and after treatment group compared with that period did not change significantly (P0.05), and The menstrual cycle, by volume, the color and the quality, irritability, lumbosacral pain symptoms were significantly improved after treatment (P0.05); comparison between groups after treatment, treatment group increased only in the same room number have an obvious advantage (P0.05), there was no significant difference of symptoms (P0.05) and.3. treatment group after treatment FSH and FSH/LH were decreased, compared with before treatment, the difference was statistically significant (P0.05), LH, E2 had no significant difference (P0.05); the control group after treatment FSH decreased, compared with before treatment, the difference was statistically significant (P0.05), LH, FSH/LH had no significant differences between two groups (P0.05). In the treatment group, the ratio of FSH/LH compared with the control group improved significantly, the difference was statistically significant (P0.05), the rest were all significantly difference (P0.05).4. treatment group during the treatment of 5 patients for personal reasons failed to complete treatment from the clinical study, the control group during the treatment in 4 cases because of not Exit and clinical study of.5. adverse reaction during the treatment, the treatment group did not appear adverse reaction; the control group had 4 cases of obvious nausea, breast pain worse, only 3 cases of breast pain worse. Conclusion: 1. "zishenyanggan" series of prescriptions can significantly improve the ovarian reserve function decline (liver and kidney deficiency syndrome) in patients with menstrual cycle, by volume, irritability, backache, breast pain and other symptoms of.2. "zishenyanggan" series of prescriptions can effectively reduce the FSH level and FSH/LH ratio; compared with progynova plus progesterone capsule treatment, can effectively improve the ratio of FSH/LH.3. "zishenyanggan" series of prescription and Western Medicine "progynova plus progesterone capsule in the improvement of DOR (liver and kidney deficiency syndrome) is the traditional Chinese medicine syndrome and hormone levels in patients with curative effect and no obvious side effects, the.4. diminished ovarian reserve (liver and kidney deficiency syndrome) patients complained to menstruation Less "and" no contraception not pregnant for more than 1 years ", but the menstrual cycle did not change significantly.5. diminished ovarian reserve (liver and kidney deficiency syndrome) patients with TCM symptoms and hormone level improvement does not exist in the same sex, guess the improvement of clinical symptoms improved slightly compared with hormone level delay.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R271.9

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