本文選題：多囊卵巢綜合 + 高雄激素血癥��； 參考：《湖南中醫(yī)藥大學》2015年碩士論文

【摘要】：目的： 通過臨床研究,觀察中藥周期療法聯(lián)合胰島素增敏劑對治療腎精不足型多囊卵巢綜合征(PCOS)高雄激素血癥患者的臨床療效,探索中醫(yī)藥的作用機理,為臨床治療此病提供理論依據(jù)和治療方法。 方法： 收集符合納入標準的PCOS高雄激素血癥患者108例,隨機分為2組,每組各54例,中西醫(yī)結合治療組采用中藥人工周期治療,西醫(yī)對照組采用達英-35治療,對存在胰島素抵抗(HR)或高胰島素血癥(HI)的患者兩組同時予胰島素增敏劑治療。兩組均治療3個月,觀察治療前后患者中醫(yī)證候、多毛、座瘡、體重指數(shù)的改善情況,靜脈抽血觀察血清黃體生成素(LH)、卵泡刺激素(FSH)、泌乳素(PRL)、睪酮(T)、雌二醇(E2)、孕酮(P)、性激素結合蛋白(SHBG)、硫酸脫氫表雄酮(DHEAS)、雄烯二酮(A2)、LH/FSH的變化,觀察B超卵巢體積的變化,觀察兩種治療方案對PCOS高雄激素血癥患者恢復排卵的臨床療效,所得的數(shù)據(jù)經統(tǒng)計學方法處理后進行判定。 結果： 1.療程治療結束后,治療后治療組：痊愈12例,顯效22例,有效11例,無效9例,總有效率為83.3%。對照組：痊愈7例,顯效19例,有效10例,無效18例,總有效率66.7%,差異有顯著性(P0.05)。 2.自身對照：治療后兩組患者中醫(yī)證候均得到明顯改善(P0.01)。治療后兩組患者多毛、座瘡體征,體重指數(shù)均得到改善(PO.05)。治療后兩組血清T、LH、LH/FSH、A2值較治療前均明顯下降(P0.01),治療組治療后血E2、SHBG值上升,DHEAS下降(P0.05)均具有統(tǒng)計學意義。治療后兩組患者卵巢體積縮小,卵巢多囊樣改變均得到改善(PO.05)具有統(tǒng)計學意義。 3.組間對照：兩組治療后的LH、LH/FSH水平、中醫(yī)證候改善情況有明顯差異(P0.01),兩組治療后T、E2、SHBG、DHEAS水平,多毛、座瘡體征評分均有差異(P0.05)。結論： 中醫(yī)人工周期療法是治療PCOS高雄激素血癥的有效方法之一,能有效地改善PCOS高雄激素血癥患者血清內分泌水平,降低血T、LH、LH/FSH、DHEAS、A2的水平,有效提高E2的水平,改善患者多毛、座瘡等臨床高雄表現(xiàn),同時可縮小卵巢的體積,改善卵巢多囊樣改變。中醫(yī)人工周期療法可以改善腎精不足型患者的內分泌環(huán)境,重建月經周期,恢復排卵,值得臨床推廣。
[Abstract]:Objective: To observe the clinical effect of periodic therapy combined with insulin sensitizer in the treatment of hyperandrogenemia in patients with PCOS with deficiency of renal spermatozoa, and to explore the mechanism of traditional Chinese medicine in the treatment of hyperandrogenemia. To provide theoretical basis and treatment for clinical treatment of this disease. Methods: One hundred and eight patients with PCOS hyperandrogenemia were collected and randomly divided into two groups, 54 cases in each group. The treatment group was treated with traditional Chinese medicine artificial cycle therapy, while the western medicine control group was treated with Dain-35. Two groups of patients with insulin resistance or hyperinsulinemia were treated with insulin sensitizer at the same time. Both groups were treated for 3 months to observe the improvement of TCM syndromes, hirsutism, sores and body mass index before and after treatment. The changes of serum luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), testosterone (T), estradiol (E _ 2), progesterone (P), sex hormone binding protein (SHBG), dehydroepiandrosterone sulfate (DHEASA), androtenedione (A _ 2N) -LH- / FSH were observed. To observe the clinical effect of two treatment schemes on the recovery of ovulation in patients with PCOS hyperandrogenemia. Results: 1. After the treatment, 12 cases were cured, 22 cases were effective, 11 cases were effective, 9 cases were ineffective. The total effective rate was 83.3%. In the control group, 7 cases were cured, 19 cases were markedly effective, 10 cases were effective and 18 cases were ineffective. The total effective rate was 66.7% (P 0.05). 2. Self-control: after treatment, the TCM syndromes of the two groups were significantly improved. After treatment, the symptoms of hirsutism, sores and body mass index were improved in both groups. After treatment, the levels of serum THH / FSH / FSHA _ 2 in both groups were significantly lower than those before treatment (P 0.01), and the serum E _ 2H _ 2 SHBG increased and DHEAS decreased (P 0.05) in the treatment group. After treatment, the ovarian volume was reduced and the ovarian polycystic changes were improved in both groups (P < 0.05). 3. Control group: after treatment, the level of LHH / FSH and the improvement of TCM syndromes were significantly different between the two groups. After treatment, there were significant differences between the two groups in the level of SHBGN DHEAS, hirsutism, and signs of sores in the two groups (P 0.05). Conclusion: Chinese medicine artificial cycle therapy is one of the effective methods to treat PCOS hyperandrogenemia. It can effectively improve the serum endocrine level of patients with PCOS hyperandrogenemia, reduce the level of serum TLH / FSHH / DHEASA A 2, effectively raise the level of E2 and improve the hirsutism of patients. The clinical manifestation of Kaohsiung, such as sores, can reduce the volume of ovary and improve the polycystic change of ovary at the same time. Traditional Chinese medicine artificial cycle therapy can improve the endocrine environment of patients with deficiency of kidney essence, rebuild menstrual cycle and restore ovulation, which is worthy of clinical promotion.
【學位授予單位】：湖南中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R711.75

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