红花逍遥颗粒联合他莫昔芬治疗多囊卵巢综合征患者的效果观察

目的探讨红花逍遥颗粒联合枸橼酸他莫昔芬片治疗多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的临床效果。方法选取2017年6月至2019年1月承德市妇幼保健院收治的PCOS患者92例作为研究对象,按照入组顺序交替分为对照组(46例)和治疗组(46例)。对照组患者于月经周期第5天起口服枸橼酸他莫昔芬片,2片/次,1次/d。治疗组患者在口服枸橼酸他莫昔芬片基础上口服红花逍遥颗粒,3袋/次,3次/d。连服21 d后停用5 d为1个疗程,两组患者均连续治疗3个疗程。比较两组患者临床疗效、排卵情况及治疗前后血糖、胰岛素抵抗指标、性激素水平、氧化应激的变化情况。结果治疗组患者总有效率为95.65%(44/46)、排卵率为97.83%(45/46),对照组分别为80.43%(37/46)、84.78%(39/46),两组比较差异均有统计学意义(χ^2值分别为5.06、4.93,P值分别为0.025、0.029)。治疗组患者治疗前、后空腹胰岛素分别为(20.31±3.06)、(12.49±2.34)mU/L,胰岛素抵抗指数分别为4.84±1.30、2.92±0.83;对照组治疗前、后空腹胰岛素分别为(20.14±2.55)、(16.15±2.17)mU/L、胰岛素抵抗指数分别为4.86±1.08、3.86±0.93,两组治疗前、后比较差异均有统计学意义(t值分别为26.15、17.10、19.68、12.17;P均<0.001);且治疗后组间两项指标比较差异均有统计学意义(t值分别为0.77、5.11,P均<0.001)。治疗组患者治疗前、后血清黄体生成素分别为(19.98±2.22)、(12.61±2.55)U/L,卵泡刺激素分别为(5.97±0.69)、(4.52±0.79)U/L,睾酮分别为(5.38±0.88)、(3.62±0.60)nmol/L;对照组血清黄体生成素分别为(20.44±2.23)、(16.18±2.65)U/L,卵泡刺激素分别为(6.09±0.59)、(5.31±0.86)U/L,睾酮分别为(5.44±0.77)、(4.48±0.62)nmol/L;两组各指标治疗前、后比较差异均有统计学意义(t值分别为23.32、15.29、13.70、8.67、19.80、12.30;P均<0.001);且治疗后组间性激素指标比较差异均有统计学意义(t值分别为6.58、4.61、6.70,P均<0.001)。治疗组患者治疗前、后血清丙二醛分别为(9.20±1.15)、(5.63±0.94)μmol/L,氧化物歧化酶分别为(62.99±5.37)、(89.63±8.81)U/L;对照组血清丙二醛分别为(9.45±1.08)、(7.48±0.85)μmol/L,氧化物歧化酶分别为(61.88±5.78)、(75.60±6.87)U/L,两组治疗前、后比较差异均有统计学意义(t值分别为40.00、19.84、28.14、15.24;P均<0.001);且组间治疗后氧化应激指标比较差异均有统计学意义(t值分别为9.88、8.52,P均<0.001)。结论红花逍遥颗粒联合枸橼酸他莫昔芬片治疗PCOS可有效改善患者临床表现,促进排卵、降低性激素水平、改善胰岛素抵抗和氧化应激,有较好的临床推广应用价值。

Observation on Honghua Xiaoyao Granules combined with tamoxifen in treatment of polycystic ovary syndrome

Objective To investigate the clinical effect of Honghua Xiaoyao granule combined with tamoxifen citrate tablets in the treatment of polycystic ovary syndrome(PCOS).Methods From June 2017 to January 2019,92 patients with PCOS admitted to Chengde maternal and child health care hospital were selected as the study objects,and divided into control group(46 cases)and treatment group(46 cases)according to the order of admission.The patients in the control group took tamoxifen citrate tablets,2 tablets/time,1 time/day from the 5th day of menstrual cycle.The patients in the treatment group were treated with safflower Xiaoyao granules on the basis of tamoxifen citrate tablets,3 bags/time,3 times/day.After 21 days of continuous administration,5 days of discontinuation was a course of treatment,and the two groups of patients were treated for 3 consecutive courses.The clinical effect,ovulation,blood glucose,insulin resistance index,sex hormone level and oxidative stress of the two groups were compared before and after treatment.Results The total effective rate of the treatment group was 95.65%(44/46),the ovulation rate was 97.83%(45/46),the control group was 80.43%(37/46),84.78%(39/46),the difference between the two groups was statistically significant(χ^2 value was 5.06,4.93,P value was 0.025,0.029)..Before and after treatment,the fasting insulin were(20.31±3.06)mU/L and(12.49±2.34)mU/L,and the homeostatic model assessment of insulin resistance were 4.84±1.30 and 2.92±0.83 in the treatment group,which were(20.14±2.55)mU/L,(16.15±2.17)mU/L,4.86±1.08 and 3.86±0.93 in control group.There all were differences in two groups about the insulin resistance index before and after treatment,and there all were differences between two groups about the insulin resistance index after treatment(tvalue was 26.15,16.10,19.68 and 12.17;all P<0.001).and there were statistically significant differences between the two indexes after treatment(t=0.77,5.11,all P<0.001).Before and after treatment,the luteinizing hormone were(19.98±2.22)and(12.61±2.55)U/L,and the follicle stimulating hormone were(5.97±0.69)U/L and(4.52±0.79)U/L,and testosterone was(5.38±0.88)and(3.62±0.60)nmol/L,which was(20.44±2.23)U/L,(16.18±2.65)U/L,(6.09±0.59)U/L,(5.31±0.86)U/L,(5.44±0.77)nmol/L and(4.48±0.62)nmol/L in control group.The difference between the two groups before and after treatment was statistically significant(t value was 23.32,15.29,13.70,8.67,19.80 and 12.30,respectively;all P<0.001);and the difference between the groups after treatment was statistically significant(t value was 6.58,4.61 and 6.70,respectively,all P<0.001).Before and after treatment,the malondialdehyde were(9.20±1.15)μmol/L and(5.63±0.94)μmol/L,and the superoxide dismutase were(62.99±5.37)U/L and(89.63±8.81)U/L,which were(9.45±1.08)μmol/L,(7.48±0.85)μmol/L,(61.88±5.78)U/L and(75.60±6.87)U/L in control group.There all were differences in two groups about the oxidative stress index before and after treatment,and there all were differences between two groups about the oxidative stress index after treatment(t value was 40.00,19.84,28.14,15.24,9.88 and 8.52,respectively,all P<0.001).Conclusion Honghua Xiaoyao Granules combined with Tamoxifen Citrate Tablets can effectively improved the clinical symptoms of patients with PCOS,promoting ovulation,reducing sex hormone level,improving insulin resistance and oxidative stress,which has a certain clinical application value.