本文選題：多囊卵巢綜合征　切入點：高雄激素血癥　出處：《南京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過臨床研究,觀察補腎祛痰法聯(lián)合達英-35治療高雄激素血癥型PCOS的臨床療效;觀察聯(lián)合用藥的臨床優(yōu)效性及其能否降低單獨達英-35治療所產(chǎn)生的不良反應及復發(fā)率;初步探索本方案對AMH的影響及AMH在PCOS中的作用機制,為本病診斷、治療、預測的探索打下基礎。方法:本研究分為理論研究和臨床研究兩部分。理論研究:通過文獻研究,從中醫(yī)學及現(xiàn)代醫(yī)學對PCOS的認識、AMH在PCOS中的研究進展三個方面進行綜述。臨床研究:收集就診于南京中醫(yī)藥大學第三附屬醫(yī)院婦科門診符合腎虛痰濕型PCOS伴HA的患者60例,按對照原則分為試驗組(30例)和對照組(30例),試驗組予補腎祛痰方+達英-35、對照組予達英-35,治療3個月,隨訪3個月;觀察兩組患者治療前后月經(jīng)情況、排卵情況、中醫(yī)證候評分、多毛、痤瘡、BMI、卵巢體積、AFC、肝腎功能、血脂及血清激素水平。記錄隨訪期間的排卵、妊娠情況及以上各指標以評價復發(fā)情況。結(jié)果:兩種方案治療PCOS均有療效,試驗組總有效率86.67%,對照組總有效率73.33%,試驗組療效優(yōu)于對照組(P=0.025)。兩組均能有效改善PCOS的中醫(yī)證候評分,試驗組總有效率達90%,對照組50%,試驗組優(yōu)于對照組(P=0.000)。兩組對于本病月經(jīng)紊亂、痤瘡、肥胖、排卵障礙均有不同程度的改善作用,且試驗組優(yōu)于對照組(P0.05);兩組均未改善患者多毛的體征。兩組均能明顯降低LH、T水平、LH/FSH比值及AMH水平,明顯提高SHBG水平,且試驗組療效更佳(P＜0.05);隨訪三個月期間兩組均有復發(fā),但對照組明顯高于試驗組(P=0.001）。PCOS體內(nèi)AMH水平與雄激素水平及AFC呈正相關,r 值分別為 0.906、0.763。結(jié)論:補腎祛痰法聯(lián)合達英-35治療高雄激素血癥型PCOS的作用優(yōu)于單獨達英-35治療,不僅在總療效、改善中醫(yī)證候評分及激素水平等方面效果更佳,且隨訪期間患者的妊娠數(shù)更多,復發(fā)率更低。AMH與雄激素水平及AFC呈正相關,可能為PCOS排卵障礙的機制所在。由于治療時間短,治療多毛和緩解不良反應的優(yōu)勢未顯示。
[Abstract]:Objective: through clinical research, to observe the clinical efficacy of bushenqutan method combined with -35 in the treatment of Kaohsiung hormones PCOS; observe the combination of adverse reaction and recurrence of clinical superiority and can reduce the production of -35 with single treatment rate; preliminary explore the mechanism of the influence of AMH and AMH of the scheme in PCOS. For the diagnosis, treatment, lay the foundation for prediction of exploration. Methods: This study is divided into two parts: theoretical research and clinical research. The theoretical research: through literature research, from the traditional Chinese medicine and modern medicine on PCOS, reviewed the research progress in the three aspects of PCOS AMH in clinical research: collected. The Third Affiliated Hospital of Nanjing University of Chinese Medicine from gynecology outpatient department in accordance with the 60 cases of patients with kidney deficiency and phlegm type PCOS with HA, according to the control principle is divided into test group (30 cases) and control group (30 cases), treatment group were treated with Tonifying the kidney and Eliminating Phlegm Decoction + Diane -35, The control group was treated with -35 for 3 months, 3 months of follow-up observation, menstruation; two groups of patients before and after ovulation, TCM syndrome score, hirsutism, acne, BMI, ovarian volume, AFC, liver and kidney function, blood lipid and serum hormone levels recorded during the follow-up. The ovulation, pregnancy and above the index to evaluate the condition of recurrence. Results: two treatment schemes of PCOS have the curative effect, the total efficiency of the test group 86.67%, control group total effectiveness 73.33%, the treatment group and the control group (P=0.025). The two groups can effectively improve the TCM syndrome score of PCOS, the experimental group total effective rate was 90%, 50% in the control group, the experimental group than the control group (P=0.000). The two groups for the disease, menstrual disorders, acne, obesity, improve ovulation disorder in different degrees, and the experimental group than the control group (P0.05); the two groups were no improvement in patients with hairy symptoms. The two groups can obviously reduce the level of T, LH, LH/F The ratio of SH and AMH levels, significantly increase the SHBG level, and better effect in experimental group (P < 0.05); follow-up period of three months two group had recurrence, but the control group was significantly higher than the experimental group (P=0.001) and.PCOS AMH levels were positively in vivo androgen levels and AFC, R = 0.906,0.763. conclusion: kidney and phlegm combined with -35 in the treatment of hyperlipidemia type PCOS Kaohsiung hormone function is better than that of single Diane -35 treatment, not only in the total effect, improvement of TCM syndrome score and hormone level, better effect, and the number of patients during the follow-up period of pregnancy more, the recurrence rate was lower.AMH and androgen levels and AFC, PCOS may be located mechanism for ovulation disorders because of short treatment time, treatment of hirsutism and alleviate adverse reactions showed that there was no advantage.

【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.75

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