本文關(guān)鍵詞：針刺疏肝調(diào)氣法治療多囊卵巢綜合征臨床研究　出處：《北京中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 達因-35 多囊卵巢綜合征(PCOS) 肝郁證候 疏肝調(diào)氣法 針刺療法 證型 癥狀自評量表(SCL-90)

【摘要】：1.基于SCL-90量表的多囊卵巢綜合征臨床調(diào)查目的通過對多囊卵巢綜合征(polycystic ovary syndrome, PCOS)月經(jīng)稀發(fā)或不孕患者進行SCL-90問卷調(diào)查,探討其心理健康問題及證型分布特點,初步探討肝失疏泄、氣機失調(diào)與PCOS的關(guān)系。方法采用問卷調(diào)查形式,被調(diào)查對象為2012年6月至2014年9月間中醫(yī)科學(xué)院針灸醫(yī)院就診、符合2003年歐洲人類生殖和胚胎學(xué)會與美國生殖醫(yī)學(xué)學(xué)會(ESHRE/ASRM)鹿特丹專家會議推薦的PCOS診斷標(biāo)準(zhǔn)、并以月經(jīng)稀發(fā)或不孕為主訴(癥)的PCOS患者。調(diào)查問卷分為患者填寫部分和醫(yī)生填寫部分。研究人員發(fā)放調(diào)查問卷的患者填寫部分,內(nèi)容包括一般因素及癥狀自評量表(SCL-90),令患者現(xiàn)場填寫并收回。SCL-90量表共有90個項目,內(nèi)容包括9個因子,分別為軀體化、強迫癥狀、人際關(guān)系敏感、抑郁、焦慮、敵對、恐怖、偏執(zhí)和精神病性。記錄人員完成調(diào)查問卷的醫(yī)生填寫部分,對患者進行中醫(yī)辨證分型。結(jié)果1)共發(fā)放調(diào)查問卷143份,收回140份,回收率為97.9%。被調(diào)查對象平均年齡(28.09±4.07)歲,月經(jīng)不調(diào)年限平均(7.71±4.90)年；其中已婚者91例,占65.0%；有生育要求者90例,占64.3%。2) PCOS患者的總分,以及軀體化、強迫癥狀、抑郁、焦慮、敵對、恐怖、偏執(zhí)及精神病性等8個因子評分顯著高于國內(nèi)標(biāo)準(zhǔn)常模組(P0.01)。被調(diào)查對象中SCL-90量表總分GSIt≥153分、具有明顯心理問題的患者占總數(shù)的41.43%。3)本研究中,PCOS患者的證型分布以肝經(jīng)郁熱證最多,占36.4%,其后依次為：痰濕阻滯證(占25.0%),腎虛證者(占22.9%),氣滯血瘀證(占15.7%)。結(jié)論1) PCOS月經(jīng)稀發(fā)或不孕患者存在明顯的心理健康問題。2) PCOS月經(jīng)稀發(fā)或不孕患者中,肝經(jīng)郁熱證所占比例最高。3)肝失疏泄、全身氣機失調(diào),可能是PCOS患者身心同病的主要病機。2.針刺疏肝調(diào)氣法治療PCOSI臨床觀察目的1)通過臨床對照試驗,對比西藥達因-35,探討針刺疏肝調(diào)氣法治療PCOS的療效及其對患者心理健康的影響。2)挖掘針灸治療PCOS的優(yōu)勢,探索身心同調(diào)PCOS的針灸治療思路。方法通過中國中醫(yī)科學(xué)院針灸醫(yī)院門診,收集年齡在18-35歲、以月經(jīng)稀發(fā)或不孕為主訴(癥)、符合2003年歐洲人類生殖和胚胎學(xué)會與美國生殖醫(yī)學(xué)學(xué)會(ESHRE/ASRM)鹿特丹專家會議推薦的PCOS診斷標(biāo)準(zhǔn)、肝郁證候評分≥3分,并符合其它各項納入標(biāo)準(zhǔn)的PCOS患者,共72例,隨機分為西藥組和針刺組,兩組各36例。西藥組服用達因-35,自月經(jīng)第5天開始,連續(xù)服用21天,共服用3個月。針刺組以疏肝調(diào)氣為主要治則制訂處方,選用膻中、期門(雙)、肝俞(雙)、中脘、天樞(雙)、關(guān)元、子宮(雙)、三陰交(雙)、足三里(雙)、太沖(雙)穴。針刺得氣后,在中脘與關(guān)元穴、同側(cè)天樞與子宮穴連接電針,連續(xù)波,頻率20Hz,強度以患者耐受為度,留針30分鐘。每周治療3次,連續(xù)治療3個月,月經(jīng)期間停止治療。治療結(jié)束后,觀察和測評兩組患者的以下指標(biāo)：1)中醫(yī)癥狀積分：根據(jù)月經(jīng)不調(diào)中醫(yī)癥狀評分分級量化標(biāo)準(zhǔn),由專人進行評分并記錄。2)一般測量學(xué)指標(biāo)：專人測量身高、體重、腰圍、臀圍,計算體質(zhì)量指數(shù)(BMI)、腰臀比(WHR)。3)血清性激素水平：于月經(jīng)周期第2-4天采集空腹靜脈血,測定促卵泡激素(FSH)、黃體生成素(LH)、睪酮(T)、雌二醇(E2)、孕酮(P)、催乳素(PRL)水平,并計算LH/FSH。4)痤瘡評分：用Rosenfield評分方法。5)多毛評分：用F-G評分方法。6)心理健康評分：采用癥狀白評量表(SCL-90),由患者填寫問卷。治療結(jié)束3個月后隨訪,記錄兩組患者月經(jīng)恢復(fù)及排卵情況。結(jié)果1)西藥組完成試驗共33例,脫落3例；針刺組完成試驗35例,脫落1例�；颊咂骄挲g(28.16±3.76)歲；平均月經(jīng)不調(diào)年限(7.26±3.83)年；平均病程(2.88±1.76)年,兩組治療前的基線資料無統(tǒng)計學(xué)差異(P0.05)。2)治療后兩組的癥狀積分較同組治療前顯著下降(均為P=0.000),治療后針刺組癥狀積分顯著低于西藥組(P=0.004)。3)治療后,針刺組體重(P=0.016)、BMI (P=0.004)、腰圍(P=0.035)、臀圍(P=0.000)均顯著低于西藥組。4)治療后,兩組血清LH、T及LH/FSH值均較同組治療前顯著下降(均為P=0.000),兩組間無統(tǒng)計學(xué)差異(PO.05)。5)治療后兩組痤瘡評分均較同組治療前顯著下降(均為P=0.000)；兩組多毛評分在治療前后均未見統(tǒng)計學(xué)差異(P0.05)。6)治療后針刺組SCL-90總分較治療前顯著下降(P=0.006),并顯著低于西藥組治療后(P=0.021)。治療后,針刺組的軀體化、人際關(guān)系、抑郁、焦慮、敵對因子評分較治療前顯著下降(P0.05),針刺組軀體化、人際關(guān)系、抑郁、焦慮、敵對、恐怖因子的評分顯著低于西藥組(P0.05)。7)西藥組總有效率為81.8%,針刺組總有效率88.6%,兩組間無統(tǒng)計學(xué)差異(P=0.308),兩組的月經(jīng)恢復(fù)率及排卵率均無統(tǒng)計學(xué)差異(P0.05)。結(jié)論1)在總有效率、月經(jīng)恢復(fù)率、排卵率方面,針刺疏肝調(diào)氣治療與西藥達因-35的療效相近。2)針刺疏肝調(diào)氣治療與達因-35,均可調(diào)節(jié)PCOS患者血清性激素水平,有效緩解高雄激素血癥。3)在改善PCOS患者的中醫(yī)癥狀、調(diào)節(jié)體重、BMI等代謝指標(biāo)方面,針刺疏肝調(diào)氣治療的作用優(yōu)于達因-35。4)針刺疏肝調(diào)氣法治療PCOS具有身心同調(diào)作用,其降低SCL-90評分、改善心理健康的作用優(yōu)于達因-35。
[Abstract]:The 1. SCL-90 scale of polycystic ovary syndrome through clinical investigation of polycystic ovary syndrome based on (polycystic ovary syndrome, PCOS) oligomenorrhea or infertility SCL-90 questionnaire, investigate the distribution characteristic of the psychological health problems and syndromes, preliminary study of liver qi, Qi and PCOS. Methods the form of a questionnaire survey, respondents from June 2012 to September 2014, Chinese Academy of Sciences, acupuncture hospital, consistent with the 2003 European Society of human reproduction and embryology and the American Society for reproductive medicine (ESHRE/ASRM) PCOS diagnosis standard of Rotterdam expert meeting recommended, and with oligomenorrhea or infertility complaints (disease) in patients with PCOS. The questionnaire is divided for patients and doctors to fill in fill part of parts. The researchers questionnaires were fill part of the contents include the general factors, and symptom checklist (SCL-90), the trouble Live fill and recover the.SCL-90 scale consists of 90 items, including 9 factors, respectively, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia and psychosis. Records of personnel to complete the questionnaire doctor to complete the part, in patients with TCM syndrome type. Results 1) a total of 143 questionnaires were issued, 140 were recovered, the recovery rate of 97.9%. was the average age (28.09 + 4.07) years of age, menstruation period average (7.71 + 4.90) years; among them married in 91 cases, accounting for 65%; 90 cases have fertility requirements, accounting for 64.3%.2) in patients with PCOS the total score, and somatization, obsessive-compulsive symptoms, depression, anxiety, hostility, terror, 8 factors of paranoia and psychosis score significantly higher than that of the standard norm group (P0.01). SCL-90 was surveyed in the total scores of GSIt more than 153 points, with obvious psychological problems of patients accounted for 41.43%.3 of the total) In this study, patients with PCOS syndrome type distribution in liver heat stagnation of the most, accounting for 36.4%, followed by: phlegm dampness (25%), kidney deficiency syndrome who (22.9%), qi stagnation and blood stasis syndrome (15.7%). Conclusion: 1) PCOS oligomenorrhea or infertility patients have.2 mental health the obvious problem of PCOS) oligomenorrhea or infertility patients, liver meridian with the highest proportion of.3) of liver dysfunction, systemic disorder of Qi, may be the main pathogenesis of.2. in patients with PCOS disease and the acupuncture treatment of PCOSI liver qi) through clinical observation to 1 controlled clinical trials, compared with western medicine Diane -35. To investigate the efficacy of acupuncture treatment of PCOS liver qi and its effects on patients' mental health.2) mining of acupuncture in the treatment of PCOS, acupuncture treatment ideas body-mind PCOS. By homology Chinese hospital acupuncture clinic of Chinese Academy of Sciences, collected at age of 18-35 years, with oligomenorrhea or 涓嶅瓡涓轟富璇，

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