本文選題：絕經(jīng)綜合征 + 血脂異常��； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過觀察加味清心滋腎湯聯(lián)合立普妥對絕經(jīng)綜合征(心腎不交型)合并血脂異常患者臨床癥狀、性激素及血脂的影響,探究加味清心滋腎湯改善心腎不交型絕經(jīng)綜合征的臨床療效,及其在調(diào)節(jié)性激素紊亂、改善血脂代謝方面的干預(yù)作用及可能作用機(jī)制,為中醫(yī)藥防治絕經(jīng)相關(guān)脂質(zhì)代謝異常及心血管疾病提供依據(jù)。方法:2016年1月～2017年3月期間在江蘇省中醫(yī)院婦科、心內(nèi)科門診及住院部接受治療的符合納入及排除標(biāo)準(zhǔn)的心腎不交型絕經(jīng)綜合征合并脂質(zhì)代謝異常患者,隨機(jī)納入治療組(予加味清心滋腎湯+立普妥))及對照組(予立普妥)。治療前評估患者一般情況、臨床癥狀,完善性激素三項(雌二醇(E2)、黃體生成素(LH)、卵泡刺激素(FSH))及血脂四項(血清總膽固醇(TC)、甘油三醋(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C))的實驗室檢測。治療12周后再次評估患者一般情況、臨床癥狀,完善性激素三項及血脂四項的實驗室檢測。最終,對照組有2例研究對象因失訪而脫落,2例研究對象因性激素三項結(jié)果缺失而剔除,最終本臨床研究共納入44例研究對象,治療組24例,對照組20例。結(jié)果:(1)改善臨床癥狀方面:12周后,治療組絕經(jīng)綜合征患者臨床癥狀程度定量及定性指標(biāo)均較前改善(P0.05),Kupperman評分降低(P0.05);對照組除了出汗次數(shù)及程度較前減輕(P0.05),其余臨床癥狀程度定量及定性指標(biāo)均無明顯改善(P0.05),且Kupperman評分升高(P0.05)。12周末,組間臨床癥狀程度定量及定性指標(biāo)均具有統(tǒng)計學(xué)差異(P0.05),治療組臨床癥狀程度定量及定性指標(biāo)明顯輕于對照組。(2)調(diào)節(jié)性激素紊亂方面:12周后,治療組FSH、LH水平下降(P0.05),E2水平基本保持穩(wěn)定(P0.05);對照組FSH、LH水平無明顯變化(P0.05),E2水平下降(P0.05)。12周末,組間FSH水平比較具有統(tǒng)計學(xué)差異(P0.01),而E2、LH水平無明顯統(tǒng)計學(xué)差異(P0.05)。(3)改善脂質(zhì)代謝方面:12周后,在兩組膳食評價積分均無明顯改變的情況下(P0.05),兩組TC、LDL-C水平均顯著下降(P0.01),此外,治療組TG水平下降、HDL-C水平升高(P0.05),而對照組TG、HDL-C水平未見改變(P0.05)。12周末,兩組間TC、TG、HDL-C、LDL-C水平均有統(tǒng)計學(xué)差異(P0.05),治療組TC、TG、LDL-C水平更低,HDL-C水平更高。(4)實驗室療效方面:兩組在改善絕經(jīng)綜合征伴有血脂異�；颊哐椒矫娴目傆行时容^有統(tǒng)計學(xué)差異(P0.05),治療組調(diào)脂總體療效更好。(5)臨床癥候療效方面:兩組在改善絕經(jīng)綜合征伴有血脂異常患者臨床癥狀方面的總有效率比較有顯著統(tǒng)計學(xué)差異(P0.01),治療組可明顯緩解絕經(jīng)綜合征臨床癥候,而對照組對絕經(jīng)綜合征臨床癥候無明顯療效。(6)性激素與血脂水平的相關(guān)性探討:初診時患者FSH水平越高,TC、LDL-C水平也越高(P0.05);經(jīng)加味滋腎清心湯治療后的患者,其FSH下降越多,TC、LDL下降也越明顯(P0.05),而與TG、HDL-C水平無明顯相關(guān)性(P0.05)。結(jié)論:加味清心滋腎湯可明顯改善絕經(jīng)綜合征伴有血脂異�；颊叩呐R床癥狀,下調(diào)FSH、LH水平,保持E2水平,不但可以增強(qiáng)調(diào)脂藥物降低TC、LDL-C水平,還可降低TG水平、升高HDL-C水平。初診時絕經(jīng)綜合征伴有血脂異�；颊逨SH水平與TC、LDL-C水平呈正相關(guān),予加味清心滋腎湯治療后,患者FSH下降程度與TC、LDL-C的下降程度呈正相關(guān)。初步猜想加味滋腎清心湯可能通過調(diào)節(jié)生殖性腺軸功能,延緩兩側(cè)性腺器官衰老,改善內(nèi)分泌水平,從而達(dá)到調(diào)節(jié)脂質(zhì)代謝的作用。
[Abstract]:Objective: To explore the clinical effect of Jiawei Qingxin Zi Shen Decoction in improving the heart and kidney non cross menopausal syndrome by observing the effect of Jiawei Qingxin Toni decoction combined with Lipitor on the clinical symptoms, sex hormone and blood lipid in the patients with dyslipidemia in the patients with menopause syndrome (heart kidney disjoint type) and dyslipidemia, and the intervention of the intervention of regulating sex hormone disorder and improving the metabolism of blood lipids. The mechanism of action and possible action is provided to provide basis for the prevention and treatment of menopause related lipid metabolism and cardiovascular diseases. Methods: during the period of January 2016 to March 2017, the treatment in Jiangsu Province Traditional Chinese Medicine Hospital, Department of Cardiology, outpatient and inpatient department was treated with the inclusion and exclusion criteria of cardiac and renal insufficiency menopause syndrome with lipid metabolism abnormality. The patients were randomly included in the treatment group (treated with modified Qingxin Toni Decoction + Lipitor) and the control group (Lipitor). Before treatment, the general condition, clinical symptoms, three items of perfect sex hormone (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH) and four blood lipids (serum total cholesterol (TC), glycerol three vinegar (TG), and high-density lipoprotein (HDL-C)) were evaluated. Laboratory tests of low density lipoprotein (LDL-C). After 12 weeks of treatment, the general situation, clinical symptoms, three items of perfect sex hormone and four items of blood lipid were tested. In the control group, 2 subjects fell off because of the loss of visits and 2 of the subjects were excluded because of the three loss of sex hormones, and the final clinical study included 4. 4 subjects, 24 cases in the treatment group and 20 cases in the control group. Results: (1) to improve the clinical symptoms: after 12 weeks, the quantitative and qualitative indexes of the clinical symptoms of the patients with menopause syndrome were all improved (P0.05) and the Kupperman score was reduced (P0.05); the control group was less than the number of sweating times and the degree of earlier reduction (P0.05), and the other clinical symptoms were quantified. There was no significant improvement (P0.05) and qualitative index (P0.05), and Kupperman score increased (P0.05).12 weekend, the quantitative and qualitative indicators of clinical symptoms were all statistically different (P0.05). The quantitative and qualitative indicators of clinical symptoms in the treatment group were significantly lighter than those in the control group. (2) the regulation of hormone disorder: after 12 weeks, the treatment group was FSH, LH level decreased (P0). .05), the level of E2 remained stable (P0.05), and there was no significant change in the level of LH in the control group (P0.05), E2 level decreased (P0.05) and.12 weekend, and the FSH level of the group was statistically different (P0.01), while E2, there was no significant difference in the level of FSH (P0.01). (3) the improvement of lipid metabolism: after 12 weeks, there was no obvious change in the two groups of dietary evaluation scores. In P0.05, the level of TC and LDL-C in the two groups decreased significantly (P0.01). In addition, the level of TG in the treatment group decreased and the level of HDL-C increased (P0.05), while the level of HDL-C was not changed in the control group (P0.05).12 weekend, and the level of the two groups was lower and the level was higher. (4) the therapeutic effect in the laboratory. Aspects: the total effective rate of the two groups in improving the blood lipid level of the patients with dyslipidemia was statistically different (P0.05), and the overall effect of the treatment group was better. (5) the clinical symptom effect: the total effective rate of the two groups in the improvement of the clinical symptoms in the patients with dyslipidemia with menopause syndrome was statistically significant The difference (P0.01), the treatment group can obviously relieve the clinical symptoms of menopause syndrome, and the control group has no significant effect on the clinical symptoms of menopause syndrome. (6) the correlation of sex hormone and blood lipid level: the higher the level of FSH, the higher the level of TC, and the higher the level of LDL-C (P0.05) in the first diagnosis; the more the decrease of FSH, TC, LD in the patients after the treatment of the decoction of added nourishing kidney and clearing heart. The decrease of L was also obvious (P0.05), but there was no significant correlation with TG and HDL-C level (P0.05). Conclusion: Jiawei Qingxin Zi Shen decoction can obviously improve the clinical symptoms of patients with dyslipidemia in menopause syndrome, down FSH, LH level, and E2 level, not only can increase the level of TC and LDL-C, but also reduce TG level and increase HDL-C level. The level of FSH in patients with dyslipidemia was positively correlated with the level of TC and LDL-C. After the treatment of Jiawei Qingxin Yishen soup, the degree of FSH decline was positively correlated with the decrease of TC and LDL-C. It was preliminarily assumed that the addition of the flavored kidney Qingxin decoction could delay the aging of the gonadal organs on both sides and improve the endocrine by regulating the reproductive gland axis power. The effect of lipid metabolism is regulated by the level.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R711.75

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