【摘要】：目的:觀察自擬健脾補(bǔ)腎方聯(lián)合克羅米芬治療脾腎陽虛型多囊卵巢綜合征(polycystic ovarian syndrome,PCOS)所致不孕癥的臨床療效,初步探討其可能的作用機(jī)理。方法:將所收集的2013年6月至2014年12月到青島市海慈醫(yī)療集團(tuán)中醫(yī)婦科門診因不孕癥來就診,并確診多囊卵巢綜合征辨證屬脾腎陽虛型患者隨機(jī)分為觀察組40例、對(duì)照組30例,觀察組應(yīng)用健脾補(bǔ)腎方,同時(shí)月經(jīng)周期第5天起服克羅米芬(CC),每次50mg,每日1次,連續(xù)服5天,于月經(jīng)周期8-10天時(shí)做B超監(jiān)測(cè)卵泡直徑在18-22mm時(shí),肌注絨毛膜促性腺激素(HCG)5000~10000 U。對(duì)照組應(yīng)用上述治療除外健脾補(bǔ)腎方,連續(xù)觀察臨床療效3個(gè)月經(jīng)周期。觀察兩組患者治療前后中醫(yī)癥狀改善、周期排卵率、妊娠率、及黃體生成素(luteinizing hormone LH)/卵泡刺激素(follicle-stimulating hormone,FSH)值、睪酮(testosterone,T)值和空腹胰島素變化情況。結(jié)果1.治療3個(gè)月經(jīng)周期后,觀察組和對(duì)照組患者綜合療效的總有效率分別87.50%、60.0%,兩組綜合療效比較,差異有極顯著性(P0.01),觀察組綜合療效優(yōu)于對(duì)照組。兩組中醫(yī)證候積分和中醫(yī)主癥積分隨著治療周期的延續(xù),積分下降越明顯(P0.05或P0.01),且觀察組中醫(yī)證候積分和中醫(yī)主癥積分改善情況優(yōu)于對(duì)照組(P0.05或P0.01)。2.觀察組患者周期排卵率為75.44%,對(duì)照組患者周期排卵率為48.19%,兩組相比差異有極顯著性(P0.01)。觀察組妊娠率為52.50%,對(duì)照組妊娠率為23.33%,兩組相比差異顯著(P0.05)。3.兩組治療后LH/FSH值較治療前下降,有極顯著性差異(P0.01),且組間比較,差異顯著(P0.05),治療組T值較治療前下降,差異顯著(P0.05)。兩組治療后空腹胰島素較治療前下降,差異顯著(P0.05)。結(jié)論:自擬健脾補(bǔ)腎方聯(lián)合克羅米芬治療脾腎陽虛型多囊卵巢綜合征所致不孕癥取得了較為滿意的臨床療效。中西醫(yī)結(jié)合療法能明顯的改善脾腎陽虛型PCOS不孕癥患者的中醫(yī)臨床癥狀,提高周期排卵率、妊娠率、降低患者血清LH/FSH值、T值、空腹胰島素值。研究提示,中西醫(yī)結(jié)合治療此病是一種行之有效的方法,可能通過低LH、FSH比值、T值及空腹胰島素水平,改善內(nèi)分泌環(huán)境而發(fā)揮臨床治療作用。
[Abstract]:Objective: to observe the clinical effect of Jianpi Bushen prescription combined with clomiphene in the treatment of infertility caused by polycystic ovary syndrome (polycystic ovarian syndrome) with deficiency of spleen and kidney yang, and to explore its possible mechanism. Methods: from June 2013 to December 2014, 40 patients with polycystic ovary syndrome (PCOS) were randomly divided into observation group (n = 40) and control group (n = 30). The observation group was treated with Jianpi Bushen recipe and clomiphene (CC), 50mg once a day for 5 days from the 5th day of menstrual cycle. B ultrasound was used to monitor follicle diameter in 18-22mm at 8-10 days of menstrual cycle, and chorionic gonadotropin (HCG) 5000,10000U) was injected intramuscularly. The control group was treated with the above treatment except the prescription of invigorating spleen and tonifying the kidney, and observed the clinical curative effect for 3 consecutive menstrual cycles. The changes of TCM symptoms, periodic ovulation rate, pregnancy rate, luteinizing hormone (luteinizing hormone LH) / follicle stimulating hormone (follicle-stimulating), testosterone (T) and fasting insulin were observed before and after treatment. Result 1. After three menstrual cycles, the total effective rates of the observation group and the control group were 87.50 and 60.0, respectively. There was a significant difference between the two groups (P0.01). The comprehensive curative effect of the observation group was better than that of the control group. With the continuation of treatment cycle, the scores of TCM syndromes and main symptoms of the two groups decreased significantly (P0.05 or P0.01), and the improvement of TCM syndromes and TCM main symptoms in the observation group was better than that in the control group (P0.05 or P0.01) .2. The rate of periodic ovulation was 75.44 in the observation group and 48.19 in the control group. There was a significant difference between the two groups (P0.01). The pregnancy rate in the observation group was 52.50, and the pregnancy rate in the control group was 23.330.The difference between the two groups was significant (P0.05). After treatment, the LH/FSH value of the two groups was significantly lower than that before treatment (P0.01), and the difference between the groups was significant (P0.05), the T value of the treatment group was lower than that before treatment, the difference was significant (P0.05). Fasting insulin decreased significantly after treatment in both groups (P0.05). Conclusion: the prescription of invigorating spleen and tonifying kidney combined with clomiphene in the treatment of infertility caused by polycystic ovary syndrome with deficiency of spleen and kidney yang has obtained satisfactory clinical curative effect. The combination of traditional Chinese and western medicine can obviously improve the clinical symptoms of PCOS infertility patients with deficiency of spleen and kidney yang, increase the rate of periodic ovulation, pregnancy rate, reduce the serum LH/FSH value of T value, fasting insulin value. It is suggested that the combination of traditional Chinese and western medicine is an effective method for the treatment of this disease. It may play a clinical role by improving the endocrine environment and improving the endocrine environment by low LHH-FSH / T value and fasting insulin level.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R711.6

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