本文關鍵詞：補腎疏肝膏方改善卵巢儲備功能下降的臨床觀察　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 補腎疏肝 膏方 卵巢儲備功能下降 臨床療效

【摘要】：目的:本研究旨在通過收集分析2015年12月至2016年12月就診禪城區(qū)中心醫(yī)院中醫(yī)婦科門診,并符合入組標準的患者60例。通過運用中醫(yī)學理論和中西醫(yī)結合的方法,從理論和臨床研究兩方面探討卵巢儲備功能下降的病因病機及其防治問題。認為"腎虛肝郁"是當代社會卵巢儲備功能下降常見的主要病機,故以補腎疏肝為治法,予膏方治療,通過隨機對照研究,觀察膏方治療卵巢儲備功能下降的療效及安全性,為膏方防治卵巢儲備功能下降提供臨床醫(yī)學證據,以期為卵巢儲備功能下降患者早發(fā)現、早診斷、早治療、有效改善卵巢功能,提高生活質量提供一套有效安全的治療方案。方法:采用隨機對照的方法,將60例卵巢儲備功能下降(diminished ovarian reserve DOR)患者隨機分為膏方組、湯劑組以及空白組。膏方組予補腎疏肝膏、湯劑組予補腎疏肝湯口服,治療3個月經周期,空白組不予藥物干預。觀察并比較3組患者治療前后的中醫(yī)證候評分、基礎卵泡刺激素(bFSH)、基礎雌二醇(bE2)、抗苗勒管激素(AMH)、竇卵泡數、肝腎功能。結果:中醫(yī)證候量表評分:①組內比較結果顯示:膏方組及湯劑組治療后經前乳房脹痛、腰膝酸軟、月經量、月經周期、月經色質、頭暈耳鳴、夜尿頻多、情志抑郁或煩躁、經行下腹脹痛及癥狀總分均較治療前有明顯下降。差異均有統(tǒng)計學意義(P0.05);空白組治療前后中醫(yī)證候評分差異無統(tǒng)計學意義(P0.05)。②組間比較結果顯示:膏方組及湯劑組治療后中醫(yī)證候量表評分均低于空白組,兩兩比較顯示:膏方組與空白組、湯劑組與空白組組間差異有統(tǒng)計學意義(P0.05),膏方組與湯劑組組間差異無統(tǒng)計學意義(P0.05)。bFSH、bE2、AMH 水平①組內比較結果顯示:膏方組及湯劑組治療后bFSH均呈下降趨勢,AMH水平上升,差異均有統(tǒng)計學意義(P0.05),膏方組及湯劑組治療前后bE2差異無統(tǒng)計學意義(P0.05);空白組治療前后bFSH、bE2、AMH水平差異均無統(tǒng)計學意義(P0.05)。②組間比較結果顯示:膏方組及湯劑組較空白組bFSH明顯更低,而AMH水平上升,膏方組與空白組、湯劑組與空白組組間差異有統(tǒng)計學意義(P0.05),膏方組與湯劑組組間差異無統(tǒng)計學意義(P0.05)。三組進行兩兩比較,治療后bE2差異均無統(tǒng)計學意義(P0.05)�；A竇卵泡數分析①組內比較結果顯示:膏方組及湯劑組治療后患者基礎竇卵泡數均明顯增加,差異均有統(tǒng)計學意義(P0.05);空白組治療前后患者基礎竇卵泡數差異無統(tǒng)計學意義(P0.05)。②組間比較結果顯示:膏方組及湯劑組較空白組基礎竇卵泡數增多,膏方組與空白組、湯劑組與空白組組間差異有統(tǒng)計學意義(P0.05),膏方組與湯劑組組間差異無統(tǒng)計學意義(P0.05)。結論:在卵巢儲備功能下降的治療上,補腎疏肝膏與補腎疏肝湯,均能有效改善患者臨床癥狀、降低血清bFSH水平、提高AMH水平,增加竇卵泡數目,但因缺乏停藥后隨訪,其治療持續(xù)效應有待進一步探索。膏方和湯劑在卵巢儲備功能下降治療上總體療效相當,且治療期間未發(fā)現明顯不良反應,說明補腎疏肝膏與補腎疏肝湯臨床安全性好,與湯劑相比,膏方口感好,攜帶方便,患者依從性提高,值得進一步推廣應用。但膏方制作成本較湯劑增加,因此膏方與湯劑在療效相當的前提下各有優(yōu)勢。
[Abstract]:Objective: This study aimed to collect analysis from December 2015 to December 2016 from the center of Chancheng District Hospital of TCM gynecology clinic, and 60 patients met the inclusion criteria. By combining the theory of traditional Chinese medicine and Western medicine and the use of traditional Chinese medicine, etiology and pathogenesis and control of ovarian function decreased from two aspects of theory and clinical research. "Shenxu Ganyu" is a contemporary social decline in ovarian reserve main pathogenesis common, so as to extract the effect of Bushen Shugan therapy, treatment by randomized control study to evaluate the efficacy and safety of herbal paste treatment of ovarian reserve function decline, provide evidence for clinical medicine cream in treating ovarian function decline, in order to a decline in ovarian reserve function in patients with early detection, early diagnosis, early treatment, improve ovarian function, provide a safe and effective treatment to improve the quality of life. Methods: random Machine control method, 60 patients with diminished ovarian reserve (diminished ovarian reserve DOR) were randomly divided into paste group, decoction group and control group. The paste group was treated with Bushen Shugan decoction group was treated with ointment, Bushen Shugan decoction, treatment of 3 menstrual cycles, the blank group were given drug intervention and observation of traditional Chinese medicine. The syndrome before and after treatment were compared between the 3 groups score, basal follicle stimulating hormone (bFSH), basic estradiol (bE2), anti Mullerian hormone (AMH), liver and kidney function of antral follicle number. Results: the TCM Syndrome Scale scores: group comparison shows: Cream group and Decoction group after the treatment of premenstrual breast pain, Yaoxisuanruan, menstruation, menstrual cycle, menstruation color quality, dizziness and tinnitus, nocturia, emotional depression or irritability, menstrual abdominal pain and symptom score were markedly decreased. The differences were statistically significant (P0.05); control group before and after treatment of TCM syndrome. The difference was not statistically significant (P0.05). The comparison between groups showed: Cream group and decoction group after treatment of TCM Syndrome Scale scores were lower than the blank group, 22 comparison shows: Cream group and blank control group, the difference was statistically significant between group Decoction group and blank control group (P0.05), no statistical significance the difference between group and group Decoction extract (P0.05).BFSH, bE2, AMH levels of group comparison showed that herbal paste group and decoction group after treatment, bFSH decreased, AMH level increased, the differences were statistically significant (P0.05), paste group and decoction group before and after treatment no significant difference for bE2 the significance (P0.05); control group before and after treatment of bFSH, bE2, AMH levels were not significantly different (P0.05). The comparison between groups showed: Cream group and decoction group than the control group bFSH was significantly lower, while AMH levels rise, cream group and blank group, there are statistical differences between the group and the blank group between the Decoction Significance (P0.05), there was no significant difference between group and group Decoction extract (P0.05). The three groups were compared after treatment of bE2 22, there were no significant differences (P0.05). The number of antral follicle analysis within group comparison shows: Cream group and decoction group after treatment in patients with antral follicle the number was significantly increased, the differences were statistically significant (P0.05); control group had no statistical significance before and after treatment in patients with antral follicle number difference (P0.05). The comparison between groups showed: Cream group and decoction group compared with control group, the number of antral follicle increased, cream group and blank control group, there was statistically significant difference between the groups with the blank group, Decoction (P0.05) there was no significant difference between group and group Decoction paste (P0.05). Conclusion: the treatment of decline in ovarian reserve function, Bushen Shugan ointment and Bushen Shugan decoction, can effectively improve the clinical symptoms of patients, reduce the level of serum bFSH, Improve the level of AMH, increase the number of antral follicle, but due to lack of follow-up after discontinuation of the treatment effect, continue to be explored further. Extract and decoction treatment on overall curative effect in considerably decreased ovarian reserve, and no adverse reaction was found during treatment, that Bushen Shugan ointment and Bushen Shugan decoction clinical safety, and decoction compared to cream taste good, easy to carry, improve the compliance of patients, which is worthy of further application. But the paste production cost is increased and therefore Gaofang decoction, Decoction in the premise of a considerable effect of the advantage.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R271.9

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