本文選題：多囊卵巢綜合征 + 胰島素抵抗�。� 參考：《北京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：探討半夏瀉心湯加減治療多囊卵巢綜合征(PCOS)胰島素抵抗(IR)的臨床療效、時(shí)效關(guān)系及安全性。方法：選擇2014年6月至2015年12月就診于中國中醫(yī)科學(xué)院廣安門醫(yī)院婦科門診,符合納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的脾虛胃熱型PCOS IR患者84例,以半夏瀉心湯為基礎(chǔ)方隨證加減,治療6個(gè)月,分別檢測治療前、治療3個(gè)月、治療6個(gè)月空腹、餐后1h、2h血糖和胰島素(FPG、Plh-PG、P2h-PG、FINS、Plh-INS、P2h-INS)及空腹雌二醇(E2)、卵泡刺激素(FSH)、黃體生成素(LH)、睪酮(T)、催乳素(PRL)、總膽固醇(CHO)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、丙氨酸氨基轉(zhuǎn)移酶(ALT)、肌酐(Cr)、尿素氮(BUN),測量身高、體重、腰圍、臀圍,計(jì)算胰島素和血糖曲線下面積、體重指數(shù)(BMI,體重kg/身高2m2)、腰臀比(WHR,腰圍cm/臀圍cm),統(tǒng)計(jì)治療前、治療3個(gè)月、治療6個(gè)月月經(jīng)周期評分、中醫(yī)癥狀評分及治療3月、6月妊娠率。結(jié)果：1.與治療前相比,治療3個(gè)月及6個(gè)月P2h-INS及胰島素曲線下面積均明顯下降(P0.05),其中,治療6個(gè)月P2h-INS的下降幅度尤為顯著(PO.01)；治療6個(gè)月Plh-PG、 P2h-PG和葡萄糖曲線下面積較治療前均降低(P0.05)。與治療3個(gè)月相比,治療6個(gè)月P2h-PG明顯降低(P0.05)。2.與治療前相比,治療3個(gè)月及治療6個(gè)月LH水平均明顯降低(P0.05)；治療3個(gè)月FSH、T水平均無明顯差異(P0.05),但治療6個(gè)月均明顯降低(P0.05),其中T降低幅度更為顯著(P0.01)。3.治療第一個(gè)3個(gè)月的妊娠率為13.21%,治療第二個(gè)3個(gè)月的妊娠率為41.30%,兩者比較有明顯差異(P0.05)。4.與治療前相比,治療3個(gè)月、6個(gè)月月經(jīng)周期評分均明顯降低(P0.01),但兩者間相比無明顯差異(P0.05)。5.與治療前相比,治療3個(gè)月、治療6個(gè)月中醫(yī)癥狀評分均明顯降低(P0.05),其中治療6個(gè)月降低幅度更為顯著(P0.01)。6.與治療前相比,治療3個(gè)月、治療6個(gè)月ALT、Cr、BUN均無明顯變化(P0.05)。結(jié)論：1.半夏瀉心湯加減能改善PCOS IR患者胰島素敏感性及生殖內(nèi)分泌狀態(tài),并存在時(shí)效關(guān)系。2.半夏瀉心湯加減能改善PCOS IR患者臨床癥狀,促進(jìn)自主月經(jīng)的恢復(fù),提高妊娠率,并存在時(shí)效關(guān)系,其改善作用可能與糾正IR及生殖內(nèi)分狀態(tài)有關(guān)。3.半夏瀉心湯加減治療PCOS IR具有一定的安全性。
[Abstract]:Objective: to investigate the clinical efficacy, time-effect and safety of Banxia Xiexin decoction (Banxia Xexin decoction) in the treatment of insulin resistance (IRR) in patients with polycystic ovary syndrome (PCOS). Methods: from June 2014 to December 2015, 84 PCOS IR patients with spleen deficiency and stomach heat type were selected from the department of gynecology of Guang'an Men Hospital, Chinese Academy of traditional Chinese Medicine, who met the criteria of inclusion and exclusion. The basic prescription of Banxia Xiexin decoction was added and subtracted according to the syndrome. After 6 months of treatment, before treatment, 3 months of treatment, 6 months of treatment, 2 h postprandial blood glucose and insulin FPG Plh-PGh-PGN P2h-PGN FINSU Plh-INS (Plh-INS) and fasting estradiol (E2N), follicle stimulating hormone (FSHN), luteinizing hormone (LHH), testosterone (T), prolactin (PRLL), total cholesterol (Cho), triglyceride (TGN), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), alanine ammoxide (ADA), triglyceride (TGN), low density lipoprotein cholesterol (LDL-C) Metamyltransferase (alt), creatinine (Cr), bun (bun), measurement of height, Body weight, waist circumference, hip circumference, area under insulin and blood glucose curve, body mass index (BMI), weight, kg/ height, waist to hip ratio, waist circumference and hip circumference, waist circumference, hip circumference, waist circumference and hip circumference were calculated. TCM symptom score and pregnancy rate of 3 months and 6 months after treatment. The result is 1: 1. Compared with before treatment, the area under the curve of P2h-INS and insulin decreased significantly at 3 and 6 months after treatment, among which, the decrease of P2h-INS in 6 months was more significant than that before treatment, and the area under the planh-PGR, P2h-PG and glucose curves at 6 months was lower than that before treatment (P 0.05). Compared with the treatment for 3 months, P2h-PG decreased significantly at 6 months (P 0.05. 2). After 3 months and 6 months of treatment, the levels of LH were significantly lower than those before treatment, while there was no significant difference in the level of FSHT between 3 months and 6 months after treatment, but at 6 months of treatment, the level of LH decreased significantly, and the decrease of T was more significant than that of P0.01U. 3. The pregnancy rate was 13.21 in the first 3 months and 41.30 in the second 3 months. There was a significant difference between the two groups. Compared with before treatment, the scores of menstrual cycle in 3 months and 6 months were significantly lower than those before treatment, but there was no significant difference between the two groups. Compared with before treatment, the scores of TCM symptoms in 3 months and 6 months of treatment were significantly lower than that of before treatment, and the decrease range of symptoms of traditional Chinese medicine in 6 months of treatment was more significant than that of before treatment. Compared with before treatment, there was no significant change in alt Cr bun in 3 months and 6 months after treatment (P 0.05). Conclusion 1. Banxia Xiexin decoction can improve the insulin sensitivity and reproductive endocrine state of PCOS IR patients, and there is a time-effect relationship. 2. Banxia Xiexin decoction can improve the clinical symptoms of PCOS IR patients, promote the recovery of spontaneous menstruation, increase the pregnancy rate, and there is a time-effect relationship, its improvement may be related to the correction of IR and reproductive status. Banxia Xiexin decoction has certain safety in the treatment of PCOS IR.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R271.9

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