發(fā)布時間：2018-06-27 02:30

  本文選題：經(jīng)前期綜合征 + 從肝論治　； 參考：《廣州中醫(yī)藥大學》2016年博士論文

【摘要】：目的:經(jīng)前期綜合征(Premenstrual syndrome)發(fā)病率日趨升高,重度經(jīng)前期綜合征(PMDD)更是嚴重影響婦女的身心健康及日常生活工作。大量的臨床研究表明,從肝論治PMS有較好的臨床療效,但其具體作用機制未明。本研究通過臨床單盲隨機研究,對比治療前后患者神經(jīng)遞質(zhì)(如單胺氧化酶、多巴胺、腦神經(jīng)營養(yǎng)因子等)、內(nèi)分泌激素等的變化,探討從肝論治經(jīng)前期綜合征的臨床療效及可能的作用機制,為闡明從肝論治經(jīng)前期綜合征的作用療效機制提供科學證據(jù),促進中藥的應(yīng)用和推廣。方法:本課題采取單盲隨機對照臨床試驗方法,選擇2014年12月-2016年3月門診就診的經(jīng)前期綜合征患者,辨證屬肝郁氣滯型患者共66例,隨機分為中藥組、西藥組,經(jīng)前10天開始服藥,共治療3個月經(jīng)周期,通過填寫《癥狀嚴重程度每日報告》(DRSP)、《PMDD證候嚴重程度測評表》;《漢密爾頓抑郁量表》等量表觀察患者治療前后的臨床療效。并于治療前后的不同月經(jīng)周期采血,內(nèi)容包括神經(jīng)遞質(zhì)、性激素及腎上腺激素等,探討從肝論治治療PMDD的可能作用機制。采用SPASS17.0對所得數(shù)據(jù)建立數(shù)據(jù)庫并進行統(tǒng)計分析。兩組自身治療前后量表評分及采血指標的比較采用配對樣本的t檢驗和秩和檢驗;組間比較采用t檢驗或秩和檢驗。結(jié)果:(1)治療前,中藥組、西藥組在年齡、婚育情況、教育程度、職業(yè)、相關(guān)病史之間的比較差異無統(tǒng)計學意義,P0.05,具有可比性。治療前,兩組的《問題嚴重性每日記錄表》(DRSP)、《PMDD證候嚴重程度測評表》、《漢密頓抑郁量表》(HAMD)評分之間以及神經(jīng)遞質(zhì)、性激素、腎上腺激素等共13個指標間的比較差異無統(tǒng)計學意義,P0.05,具有可比性。(2)兩組經(jīng)前《癥狀嚴重程度每日報告》(DRSP)評分均在治療前、治療中、隨訪期逐漸下降,不同時期的經(jīng)前DRSP評分比較差異有統(tǒng)計學意義,P0.01。治療3個月經(jīng)周期后,中藥組有效29例,無效9例,總有效率76.5%;西藥組有效17例,無效3例,總有效率85%。兩組療效比較,差異無統(tǒng)計學意義,P0.05;兩組療效相同。(3)兩組《PMDD癥狀嚴重程度評價表》評分均在治療前、治療中、隨訪期逐漸下降,組內(nèi)比較差異有統(tǒng)計學意義,P0.01。治療3個月經(jīng)周期后,中藥組顯效19例,有效14例,無效7例,總有效率83%;西藥組顯效9例,有效9例,無效2例,總有效率90%;兩組療效比較,差異無統(tǒng)計學意義,P0.05;兩組療效相同。但中藥組治療后評分的下降趨勢稍優(yōu)于西藥組。(4)兩組《漢密頓抑郁量表》(HAMD)評分均在治療前、治療中、隨訪期逐漸下降,組內(nèi)比較差異有統(tǒng)計學意義,P0.01。治療3個月經(jīng)周期后,中藥組治愈12例,顯效9例,有效6例,無效2例,總有效率94.1%;西藥組治愈6例,顯效3例,有效2例,無效1例,總有效率93.7%;兩組療效比較,差異無統(tǒng)計學意義,P0.05;兩組療效相同。(5)組內(nèi)同一月經(jīng)期周期治療前后比較發(fā)現(xiàn),2組治療后單胺氧化酶(MA0)在黃體期升高,在月經(jīng)期下降,差異無統(tǒng)計學意義,P0.01;MA0在排卵期下降,差異有統(tǒng)計學意義,P0.01。組內(nèi)不同月經(jīng)周期間比較,2組治療前,MAO月經(jīng)期黃體期排卵期,差異有統(tǒng)計學意義,P0.01。組內(nèi)不同月經(jīng)周期間的兩兩比較發(fā)現(xiàn),中藥組能調(diào)節(jié)MAO在不同月經(jīng)周期的差異,而西藥組僅能調(diào)節(jié)MAO在黃體期與月經(jīng)期、月經(jīng)期與排卵期的差異。組間比較發(fā)現(xiàn),兩組在同一月經(jīng)周期對MAO的調(diào)節(jié)作用相當,差異無統(tǒng)計學意義,P0.05。(6)組內(nèi)同一月經(jīng)期周期治療前后比較發(fā)現(xiàn),2組治療后多巴胺(DA)在黃體期、排卵期升高,差異無統(tǒng)計學意義,P0.05;在月經(jīng)期下降,差異有統(tǒng)計學意義,P0.01。組內(nèi)不同月經(jīng)周期間比較,2組治療前,DA黃體期排卵期月經(jīng)期,差異有統(tǒng)計學意義,P0.01。組內(nèi)不同月經(jīng)周期間的兩兩比較發(fā)現(xiàn),中藥組能調(diào)節(jié)月經(jīng)期與排卵期間DA的差異,西藥組能調(diào)節(jié)黃體期與月經(jīng)期間、月經(jīng)期與排卵期間DA的差異。組間比較發(fā)現(xiàn),兩組在同一月經(jīng)周期對DA的調(diào)節(jié)作用相當,P0.05。(7)組內(nèi)同一月經(jīng)期周期治療前后比較發(fā)現(xiàn),2組治療后腦源性神經(jīng)營養(yǎng)因子(BDNF)在黃體期升高,在月經(jīng)期下降,差異無統(tǒng)計學意義,P0.05;BDNF在排卵期升高,差異有統(tǒng)計學意義,P0.01。組內(nèi)不同月經(jīng)周期間的兩兩比較發(fā)現(xiàn),中藥組能調(diào)節(jié)黃體期與月經(jīng)期間、黃體期與排卵期間的BDNF差異,而西藥組不能調(diào)節(jié)不同月經(jīng)周期間BDNF的差異。組間比較發(fā)現(xiàn),兩組在同一月經(jīng)周期對BDNF的調(diào)節(jié)作用相當,P0.05。(8)組內(nèi)不同月經(jīng)周期間比較,提示兩組泌乳素、孕酮在不同月經(jīng)期間差異有統(tǒng)計學意義,P0.05。組內(nèi)同一月經(jīng)周期的比較,兩組治療前后的性激素比較差異無統(tǒng)計學意義,P0.05。(9)腎上腺激素比較,組內(nèi)不同月經(jīng)周期的比較,兩組治療前不同月經(jīng)周期間的COR、ACTH差異無統(tǒng)計學意義,P0.05。組內(nèi)同一月經(jīng)周期治療前后的比較,治療后COR、ACTH在不同月經(jīng)周期均下降,中藥組黃體期、月經(jīng)期治療前后COR差異有統(tǒng)計學意義,P0.01;西藥組各月經(jīng)周期治療前后COR差異無統(tǒng)計意義,P0.05。組間比較,2組治療后的COR、ACTH比較差異無統(tǒng)計學意義,P0.05。結(jié)論:(1)中藥組、西藥組均能減輕經(jīng)前期綜合征患者的臨床癥狀,療效相同。從肝論治是一種治療經(jīng)前期綜合征的有效方法。(2)經(jīng)前期綜合征患者MA0、DA、BDNF在不同月經(jīng)周期的差異可能是該病發(fā)病的物質(zhì)基礎(chǔ)。中藥組和西藥組均能降低排卵期的MAO,降低月經(jīng)期的DA和升高排卵期的BDNF�？梢�,從肝論治法能調(diào)節(jié)經(jīng)前期綜合征患者排卵期MA0、BDNF和月經(jīng)期的DA。雖然,組間比較發(fā)現(xiàn)中藥組和西藥組在同一月經(jīng)周期對上述神經(jīng)遞質(zhì)的影響作用相當。但是,組內(nèi)不同月經(jīng)周期間的兩兩比較發(fā)現(xiàn),中藥組在調(diào)節(jié)MAO和BDNF上優(yōu)于西藥組,而西藥組在調(diào)節(jié)DA上優(yōu)于中藥組。(3)經(jīng)前期綜合征患者孕酮、泌乳素在不同月經(jīng)周期間的變化可能是PMDD發(fā)病機制之一。2組均未能改變經(jīng)前期綜合征患者月經(jīng)周期的性激素。(4)經(jīng)前期綜合征患者COR在不同月經(jīng)周期間無明顯差異。中藥組可降低經(jīng)前期綜合征患者黃體期、月經(jīng)期COR,西藥組不能調(diào)節(jié)經(jīng)前期綜合征患者的COR。中藥在調(diào)節(jié)患者COR在不同月經(jīng)期間的變化優(yōu)于西藥組。經(jīng)前期綜合征患者ACTH在不同月經(jīng)周期間無明顯差異。2組均未能調(diào)節(jié)經(jīng)前期綜合征患者的ACTH。
[Abstract]:Objective: the incidence of premenstrual syndrome (Premenstrual syndrome) is increasing, and severe premenstrual syndrome (PMDD) is more serious affecting the physical and mental health of women and daily life work. A large number of clinical studies have shown that the treatment of PMS from the liver has better clinical efficacy, but the mechanism of its body action is not clear. This study has been studied by single blind randomized clinical study. To compare the changes of neurotransmitters (such as monoamine oxidase, dopamine, brain neurotrophic factor, etc.) and endocrine hormones before and after treatment, to explore the clinical efficacy and possible mechanism of the treatment of premenstrual syndrome from liver theory, and to provide scientific evidence to clarify the effect mechanism of the effect of liver theory on premenstrual syndrome, and to promote the application of Chinese medicine. Methods: a single blind, randomized controlled clinical trial was adopted to select the patients with premenstrual syndrome in the outpatient clinic in March -2016 December 2014. The patients were divided into 66 patients with stagnation of liver qi stagnation. They were randomly divided into Chinese medicine group, western medicine group, taking the medicine for the first 10 days and treating 3 menstrual cycles by filling in the symptom severity daily. Report > (DRSP), ; < Hamilton depression scale > scale > observe the clinical effect of patients before and after treatment, and collect blood in different menstrual cycles before and after treatment, including neurotransmitters, sex hormones and adrenaline, and explore the possible mechanism of treatment of PMDD from liver theory. The results of SPASS17.0 are used. Data set up and statistical analysis. The comparison of two groups before and after their own treatment was compared with paired sample t test and rank sum test; t test or rank sum test were used between groups. Results: (1) before treatment, Chinese medicine group and Western medicine group were compared between age, marriage, education, education, occupation, and related history. The difference was not statistically significant, P0.05 was comparable. Before treatment, the two groups of "serious daily record table" (DRSP), the Hamilton Depression Scale (HAMD) score and the comparison of neurotransmitters, sex hormones, adrenalin and so on were not statistically significant, P0.05, with comparability (2) before the treatment of the two groups, the scores of the daily report on symptom severity (DRSP) were all in the treatment, and the follow-up period decreased gradually. The difference of the pre menstrual DRSP scores at different periods was statistically significant. After P0.01. treatment 3 menstrual cycles, 29 cases were effective in the Chinese medicine group, 9 cases were invalid, the total effective rate was 76.5%, and 17 cases in the western medicine group, 3 cases ineffective, the total effective rate was 85%. The difference between the two groups was not statistically significant, the difference was not statistically significant, P0.05; the two groups had the same effect. (3) the scores of the 【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R271.115

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