补肾调冲汤治疗肾阳虚型围绝经期功能失调性子宫出血的疗效分析

目的:探讨补肾调冲汤治疗肾阳虚型围绝经期功能失调性子宫出血(DUB)的疗效以及对血清促卵泡生成素(FSH),黄体生成素(LH)和雌激素(E2)的影响。方法:选择在围绝经期DUB患者,随机分为对照组和治疗组;对照组46例于诊断性刮宫术后3 d,开始采取米非司酮治疗,12.5 mg/次,每晚睡前口服,1次/d。治疗组47例在对照组治疗的基础上给予补肾调冲汤治疗,1剂/d,常规水煎煮2次,分早晚口服。两组疗程均为3个月。比较两组患者出血停止时间、复发率、中医(TCM)症状积分及临床疗效;检测两组血清FSH,LH,E_2水平。结果:治疗组出血停止时间明显短于对照组(P0.01);随访治疗后3个月,治疗组复发率为2.13%,明显少于对照组的15.22%(P0.01);治疗后治疗组精神萎靡、四肢不温、腰膝酸软、夜尿频多评分明显下降,并低于对照组(P0.01);治疗组临床总有效率为95.74%,高于对照组的80.43%(P0.05);治疗组治疗后血清FSH,LH水平均明显低于对照组,而E_2明显高于对照组,比较差异有统计学意义(P0.01)。结论:在西药治疗的基础上,补肾调冲汤治疗肾阳虚型围绝经期DUB可降低出血停止时间、复发率及TCM症状积分,提高临床疗效,抑制血清FSH和LH水平及上调E_2水平可能在以上效果中起到重要作用。

Effect of Bushen Tiaochong Decoction in Treating Peri-menopausal Dysfunctional Uterine Bleeding with Syndrome of Kidney-yang Deficiency

Objective: To investigate the efficacy of Bushen Tiaochong decoction in treating peri-menopausal dysfunctional uterine bleeding (DUB) with syndrome of kidney-Yang deficiency and its influences on levels of serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estrogen (E₂). Method: Peri-menopausal DUB cases treated in our hospital were selected and randomly divided into control group and treatment group. Forty-six patients in control group were given mifepristone from the 3^rd day after diagnostic curettage every night before sleep by oral (12.5 mg/time, qd). In addition to the therapy of control group, 47 patients in treatment group were treated with Bushen Tiaochong decoction (1 dose/day, bid). The courses of treatment were 3 months for both groups. Bleeding stop time, recurrence rates, traditional Chinese medicine (TCM) symptom integrals and clinical efficacies were compared between both groups. Serum levels of FSH, LH and E₂ were detected in the two groups. Result: Bleeding stop time in treatment group were lower than control group after treatment (P<0.01). In the follow-up visit 3 months later, the recurrence rate of treatment group was 2.13%, which was evidently lower than 15.22%of control group (P<0.01). After treatment, the scores of depression, lack of warmth in the limbs, soreness and weakness of waist and knees, more urinate at night in treatment group were more significantly decreased, which were evidently lower than control group (P<0.01). Clinical total effective rate of treatment group was 95.74%, was higher than 80.43%of control group (P<0.05). After treatment, serum levels of FSH and LH in treatment group were significantly lower than control group, but with a higher E₂ (P<0.01). Conclusion: In addition to the western medicine routine treatment, Bushen Tiaochong decoction in treating peri-menopausal DUB with syndrome of kidney-Yang deficiency could obviously reduce the bleeding stop time, recurrence rate, TCM symptoms score, improve clinical efficacy, and inhibition of serum levels of FSH and LH and up-regulation of E₂ may play an important role in the above effects.