【摘要】：目的：觀察補(bǔ)腎調(diào)周法治療不同表型(肥胖和非肥胖)多囊卵巢綜合征(PCOS)患者高雄激素血癥的臨床療效,探討其作用機(jī)理,為臨床治療提供理論依據(jù)和治療方法。 方法：選取符合納入標(biāo)準(zhǔn)的腎虛型PCOS高雄激素血癥患者作為研究對(duì)象,根據(jù)體重指數(shù)(BMI)分為肥胖組和非肥胖組各30例。均給予補(bǔ)腎調(diào)周中藥治療3個(gè)月。觀察治療前后患者月經(jīng)情況、腎虛證候、多毛及痤瘡、B超卵巢多囊及基礎(chǔ)體溫(BBT)的改善情況,測(cè)量并計(jì)算治療前后的BMI。分別于治療前后測(cè)定血清睪酮(T)、黃體生成素(LH)、卵泡刺激素(FSH)、雌二醇(E2)、硫酸脫氫表雄酮(DHEAS)、性激素結(jié)合球蛋白(SHBG)、空腹胰島素(FINS)水平。同時(shí)比較兩組治療前的內(nèi)分泌激素情況。所得數(shù)據(jù)經(jīng)統(tǒng)計(jì)學(xué)方法處理后判定療效。 結(jié)果：①補(bǔ)腎調(diào)周法治療肥胖型和非肥胖型PCOS高雄激素血癥患者總有效率分別為70.00%,73.33%。兩組有效率無(wú)明顯差異(P0.05)。②自身對(duì)照：治療后兩組患者的月經(jīng)周期、多毛、痤瘡、腎虛證候、竇卵泡數(shù)均得到明顯改善(P0.01)。改善肥胖組及非肥胖組BBT的有效率為56.67%、60.00%。還能降低肥胖組患者的BMI(P0.01)。治療后兩組的血T、LH、LH/FSH、DHEAS值均較治療前有所下降,血E2、SHBG值上升,肥胖組FINS值降低。 ③組間對(duì)照：兩組患者治療前的T值無(wú)明顯差異(P0.05),非肥胖組PCOS患者LH、LH/FSH均高于肥胖組,而肥胖組患者的FINS高于非肥胖組。兩組治療后的T、LH、 LH/FSH、DHEAS、E2、SHBG水平均無(wú)明顯差異(P0.05),兩組治療后月經(jīng)周期、多毛、痤瘡、腎虛證候、竇卵泡數(shù)、BBT情況無(wú)明顯差異(P0.05),治療效果相近。 結(jié)論：兩組患者內(nèi)分泌特征有差別：非肥胖組患者LH、LH/FSH水平均高于肥胖組,而肥胖組患者的FINS水平高于非肥胖組。補(bǔ)腎調(diào)周法對(duì)不同表型PCOS高雄激素血癥患者臨床療效肯定,兩組療效相近,可通過(guò)調(diào)節(jié)下丘腦-垂體-卵巢軸的功能來(lái)改善患者臨床癥狀及體征：糾正月經(jīng)失調(diào),改善痤瘡、多毛及腎虛證候,降低體重,改善卵巢多囊狀態(tài)及BBT；可調(diào)節(jié)內(nèi)分泌代謝紊亂：降低T、LH、LH/FSH、DHEAS,升高SHBG、E2,降低肥胖型患者FINS。
[Abstract]:Objective: to observe the clinical effect of tonifying kidney and regulating week on hyperandrogenemia in patients with polycystic ovary syndrome (PCOS) with different phenotypes (obesity and non-obesity), and to explore its mechanism, and to provide theoretical basis and treatment methods for clinical treatment. Methods: patients with PCOS hyperandrogenemia according to the inclusion criteria were selected and divided into obese group (30 cases) and non obese group (30 cases) according to body mass index (BMI). All of them were treated with tonifying kidney and regulating week Chinese medicine for 3 months. To observe the improvement of menstruation, kidney deficiency syndrome, hirsutism and acne, (BBT) of ovarian polycystic and basal body temperature before and after treatment, and to measure and calculate BMI. before and after treatment. Serum testosterone (T), luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2) and dehydroepiandrosterone (DHEAS), sex hormone binding globulin (SHBG), fasting insulin (FINS) were measured before and after treatment. At the same time, the endocrine hormones before treatment were compared between the two groups. The data were processed by statistical method to determine the curative effect. Results: 1 the total effective rate of tonifying kidney and regulating week therapy for obese and non-obese PCOS patients with hyperandrogenemia was 70.000 and 73.33, respectively. There was no significant difference in the effective rate between the two groups (P0.05). 2 Self-control: after treatment, the menstrual cycle, hirsutism, acne, kidney deficiency syndrome and the number of antral follicles were significantly improved in the two groups (P0.01). The effective rate of improving BBT in obese and non obese groups was 56.67 and 60.00. It also reduced the BMI of obese patients (P0.01). After treatment, the blood TLHH / FSHH / FSHHEAS values of both groups were lower than those before treatment, and the serum E2SHBG values increased, and the FINS values of obesity group decreased. There was no significant difference in T value between the two groups before treatment (P0.05). The LH,LH/FSH of PCOS patients in non-obese group was higher than that of obese group, while the FINS of obese group was higher than that of non-obese group. There was no significant difference in the levels of LH/FSH,DHEAS,E2,SHBG and LH/FSH,DHEAS,E2,SHBG between the two groups after treatment (P0.05). There was no significant difference in menstrual cycle, hirsutism, acne, kidney deficiency syndrome, number of antral follicles and BBT after treatment between the two groups (P0.05). The therapeutic effect was similar. Conclusion: there are differences in endocrine characteristics between the two groups: the level of LH,LH/FSH in non-obese group is higher than that in obese group, while the FINS level in obese group is higher than that in non-obese group. The clinical effect of tonifying kidney and regulating week method on patients with different phenotypes of PCOS hyperandrogenemia was confirmed. The two groups had similar curative effects. They could improve the clinical symptoms and signs by regulating the function of hypothalamus-pituitary-ovary axis: correcting menstrual disorders and improving acne. Multiple hair and Kidney deficiency Syndrome, reduce body weight, improve Ovarian Polycystic State and BBT; Adjustable Endocrine Metabolism Disorder: reduce Thyristor LH / FSHDHEASA, increase SHBG,E2, and reduce FINS. in obese patients
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R711.75

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