补肾疏肝法治疗月经过少病肾虚肝郁证的临床研究

目的观察补肾疏肝法治疗卵巢储备功能下降所致月经过少病肾虚肝郁证患者的临床疗效。方法选取2018年6月—2019年9月就诊于北京中医医院妇科门诊的70例卵巢储备功能下降所致月经过少病肾虚肝郁证患者,随机分为试验组和对照组各35例,最终试验组和对照组各33例和31例完成研究。试验组给予益肾疏肝汤(补肾疏肝法中药饮片)口服,对照组给予戊酸雌二醇片/雌二醇环丙孕酮片口服,均从月经第5天开始服药,连续服用21 d,连续服药3个月经周期。观察2组治疗前后月经量PBAC积分、中医症状积分、血清性激素水平[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E 2)]、基础窦卵泡计数变化,比较2组临床疗效及治疗安全性。结果2组患者治疗后月经量PBAC积分及血清E 2水平均明显升高(P均<0.05),月经量少、腰膝酸软、胸胁胀痛、烦躁易怒、烘热汗出、胸闷叹息、精神抑郁积分、中医症状总积分及血清FSH水平和FSH/LH均明显降低(P均<0.05);其中试验组治疗后腰膝酸软、胸胁胀痛、烦躁易怒、头晕耳鸣、胸闷叹息积分及中医症状总积分均明显低于对照组(P均<0.05),月经量少、烘热汗出、精神抑郁积分及血清性激素水平与对照组比较差异均无统计学意义(P均>0.05)。试验组治疗后窦卵泡个数明显多于治疗前及对照组(P均<0.05),对照组窦卵泡个数与治疗前比较差异无统计学意义(P>0.05)。试验组和对照组总有效率分别为84.8%(28/33)和62.3%(24/31),组间比较差异有统计学意义(P<0.05)。2组患者治疗期间均未见明显不良反应。结论补肾疏肝法治疗卵巢储备功能下降所致月经过少病肾虚肝郁证,不仅能改善患者临床症状,增加月经量,还能改善卵巢储备功能,调节性激素水平,且在改善临床症状及增加窦卵泡数量方面效果优于西药治疗。

Clinical study on the treatment of oligomenorrhea with syndrome of kidney deficiency and liver depression with the methods of tonifying kidney and dispersing liver

Objective It is to observe the clinical efficacy of the method of invigorating the kidney and dispersing the liver in treating patients with oligomenorrhea with syndrome of kidney deficiency and liver depression caused by decreased ovarian reserve.Methods 70 patients with oligomenorrhea with syndrome of kidney deficiency and liver depression caused by decreased ovarian reserve function treated in the gynecological clinic of Beijing Hospital of Traditional Chinese Medicine from June 2018 to September 2019 were selected and randomly divided into test group and control group,with 35 cases in each group.Finally,33 cases in the test group and 31 cases in the control group completed the study.The test group was given Yishen Shugan Decoction(decoction pieces for invigorating the kidney and dispersing liver)orally,and the control group was given estradiol valerate tablets/estradiol cyproterone tablets orally,both of which were treated from the 5th day of menstruation for 21 consecutive days,continuously for 3 menstrual cycles.The changes of menstrual volume PBAC score,TCM symptom score,serum sex hormone levels[follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E 2)],basic antral follicle counts were observed before and after treatment in the two groups,and the clinical efficacy and treatment safety were compared between the two groups.Results After treatment,the menstrual volume PBAC score and serum E 2 level of the patients were significantly increased(P<0.05),the scores of scanty menstruation,soreness and weakness of waist and knees,chest pain,irritability,hot sweating,chest tightness and sighs,mental depression,total scores of TCM symptoms,serum FSH levels and FSH/LH were significantly reduced in the two groups(all P<0.05),the scores of soreness and weakness of waist and knees,chest pain,irritability,dizziness and tinnitus,chest tightness and sighs and the total scores in the test group were significantly lower than those of the control group(all P<0.05),there was no significant difference in the scores of scanty menstruation,hot sweating,mental depression and serum sex hormone levels between the two groups(all P>0.05).After treatment,the number of antral follicles in the test group was significantly higher than that before treatment and the control group(P<0.05).There was no significant difference in the number of antral follicles between before and after treatment in the control group(P>0.05).The total effective rates of the test group and the control group were 84.8%(28/33)and 62.3%(24/31),respectively,and the difference between the groups was statistically significant(P<0.05).There was no obvious adverse reaction in the two groups during treatment.Conclusion The therapy of invigorating the kidney and dispersing the liver can not only improve the patient's clinical symptoms,increase menstrual flow,but also improve ovarian reserve,regulate sex hormone levels in the treatment of oligomenorrhea with syndrome of kidney deficiency and liver stagnation syndrome caused by decreased ovarian reserve,and it is better than western medicine in improving clinical symptoms and increasing the number of antral follicles.