摘要
目的:探讨当归芍药散对肾虚肝郁型早发性卵巢功能不全患者内分泌代谢的调节作用。方法:将本院收治的120例肾虚肝郁型早发性卵巢功能不全患者按照计算机随机数字表法分为对照组和观察组,每组60例。两组患者均给予常规治疗,对照组在常规治疗基础上加用逍遥丸治疗,观察组给予当归芍药散治疗。3月后,比较两组患者的临床疗效、中医证候评分、Kupperman评分、疼痛视觉模拟评分(VAS)、子宫内膜厚度、子宫体积变化及不良反应、内分泌代谢指标[促黄体生成素(LH)、促卵泡素(FSH)、雌二醇(E2)、睾酮(T)抗苗勒管激素(AMH)和泌乳素(PRL)]、血液流变学指标[血浆黏度(ηp)、全血黏度(ηb)、纤维蛋白原(Fib)和红细胞聚集指数(AI)]、子宫动脉血流动力学[收缩期峰值流速(V_(max))、舒张末期流速(V_(min))、搏动指数(PI)及阻力指数(RI)]、免疫指标[T细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))和抗原淋巴细胞(HLA-DR)]。结果:观察组临床疗效93.33%(56/60)显著高于对照组76.67%(46/60)(P<0.05);与治疗前比较,治疗后两组患者中医证候评分均明显降低(P<0.05),观察组月经稀发、性欲减退、头晕耳鸣、腰膝酸软、烦躁易怒评分明显低于对照组(P<0.05);与治疗前比较,治疗后两组Kupperman和VAS评分显著升高(P<0.05),观察组低于对照组(P<0.05);与治疗前比较,治疗后两组子宫内膜厚度增加,子宫体积减小(P<0.05);与对照组比较,治疗后观察组子宫内膜厚度明显增高,子宫体积明显降低(P<0.05);与治疗前比较,两组患者内分泌代谢指标明显改善(P<0.05),与对照组比较,观察组LH、FSH、T、AMH和PRL明显降低,E2水平明显升高(P<0.05);与治疗前比较,两组血液流变学指标和子宫动脉血流动力学指标患者明显改善(P<0.05),与对照组比较,观察组ηp、ηb、Fib、AI、Vmax、Vmin和PI水平明显降低,RI水平升高(P<0.05);与治疗前比较,两组免疫细胞水平显著改善(P<0.05);与对照组比较,观察组CD3^(+)、CD8^(+)和HLA-DR水平明显降低,CD4^(+)水平明显升高;观察组不良反应发生率8.33%(5/60)与对照组6.67%(4/60)比较无差异(P>0.05)。结论:当归芍药散对肾虚肝郁型早发性卵巢功能不全患者具有较好的临床疗效,可改善中医证候,减缓卵巢功能退化,其机制与改善内分泌代谢指标、血液流变学和子宫动脉血流动力学,提高免疫功能有关,且具有较好的安全性。
Objective:To investigate the regulating effect of Danggui Shaoyao Powder(当归芍药散)on the endocrine metabolism of premature ovarian insufficiency(POI)patients with Shenxuganyu(肾虚肝郁)syndrome.Methods:A total of 120 POI patients of Shenxuganyu(肾虚肝郁)syndrome were classified into the control group and observation group,according to the computer-generated random number table,with 60 in each group.Besides the conventional treatment,Xiaoyao Pills(逍遥丸)was added to the control group and Danggui Shaoyao Powder(当归芍药散)was applied in the observation group.After three months,the clinical efficacy,traditional Chinese medicine(TCM)syndrome score,Kupperman score,visual analog scale(VAS)score for pain,endometrial thickness,uterine volume changes,adverse reactions,endocrine metabolism indicators[luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E2),testosterone(T),anti-mullerian hormone(AMH),and prolactin(PRL)],hemorheology indicators[plasma viscosity(ηp),whole blood viscosity(ηb),fibrinogen(Fib),and erythrocyte aggregation index(AI)],uterine artery hemodynamics[peak systolic velocity(V_(max)),end-diastolic velocity(V_(min)),pulsatility index(PI),and resistance index(RI)],immune indexes[T cell subsets(CD3^(+),CD4^(+),CD8^(+))and lymphocyte antigen-DR(HLA-DR)]were compared between the two groups.Results:The clinical effective rate in observation group was 93.33%(56/60),which was significantly higher than the 76.67%(46/60)in the control group(P<0.05).The scores of TCM syndrome in both groups after treatment were reduced compared with those before treatment(P<0.05).The scores of oligomenorrhea,hyposexuality,dizziness,tinnitus,soreness of waist and knees,dysphoria and irritability in the observation group were lower than those in the control group(P<0.05).The Kupperman score and VAS score of both groups were increased compared with those before treatment(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).The endometrial thickness in both groups was raised,while the uterine volume was decreased compared with those before treatment(P<0.05).The observation group had thicker endometrium and smaller uterine volume than the control group(P<0.05).The endocrine metabolism indicators of both groups after treatment were significantly improved compared with those before treatment(P<0.05).The LH,FSH,T,AMH,and PRL in observation group were significantly lower than those in control group,while the E2 level was higher than that in the control group(P<0.05).The hemorheology indexes and uterine artery hemodynamics indexes were significantly improved in both groups after treatment compared with those before treatment(P<0.05).The levels ofηp,ηb,Fib,AI,Vmax,Vmin,and PI in the observation group were lower than those in the control group(P<0.05),while the RI level in the observation group was higher than that in the control group(P<0.05).The immune cell levels of the two groups were significantly improved after treatment compared with those before treatment(P<0.05).The levels of CD3^(+),CD8^(+),and HLADR were lower and the CD4^(+)level was higher in the observation group than in the control group.The incidence of adverse reactions in the observation group was 8.33%(5/60),while that in the control group was 6.67%(4/60),with no statistically significant difference(P>0.05).Conclusion:Danggui Shaoyao Powder(当归芍药散)has definite clinical effect on POI patients of Shenxuganyu(肾虚肝郁)syndrome.It is safe and can alleviate TCM syndrome and slow down the degradation of ovarian function,by improving endocrine metabolism indicators,hemorheology indexes,uterine artery hemodynamics,and immune function.
作者
赵锐
陈阳
王菁
章小娟
孙曌
Zhao Rui;Chen Yang;Wang Jing;Zhang Xiaojuan;Sun Zhao(Hainan Women and Children's Medical Center,Haikou 570000;Hainan Medical University,Haikou 570000)
出处
《中药药理与临床》
CAS
CSCD
北大核心
2022年第1期167-172,共6页
Pharmacology and Clinics of Chinese Materia Medica
基金
国家自然科学基金项目(编号:81960885)
关键词
当归芍药散
早发性卵巢功能不全
肾虚肝郁型
内分泌代谢
血液流变学
血流动力学
免疫功能
Danggui Shaoyao Powder(当归芍药散)
Premature ovarian insufficiency
Shenxuganyu(肾虚肝郁)syndrome
Endocrine metabolism
Hemorheology
Hemodynamics
Immune function
作者简介
通信作者:孙曌,博士,教授,从事针刺机制的研究,E-mail:hy0204036@hainmc.edu.cn;赵锐,博士,副主任医师,从事针药治疗女性生殖内分泌疾病研究,E-mail:z285947gr@163.com。
