育肾培元方辨证治疗子宫内膜增生症肾虚血瘀证的临床疗效  

Clinica Efficacy of Syndrome Differentiation Therapy of Yushen Peiyuan Decoction for Endometrial Hyperplasia with Syndrome of Kidney Deficiency and Blood Stasis

作　　者：惠月红[1] 程文俊[2] 赵绍杰[1] 华玲玲 吕伯中[1] HUI Yue-hong;CHENG WEN-jun;ZHA0Shao-jie;HUA Ling-ling;LYU Bo-zhong(Wuxi Maternal And Child Health-Care Hospital,Wuxi 214002,China;Jiangsu Province People's Hospital,Nanjing 210029,China)

机构地区：[1]无锡市妇幼保健院,江苏无锡214002 [2]江苏省人民医院,南京210029

出　　处：《中国实验方剂学杂志》2018年第24期189-194,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：江苏省教育厅重点项目(16ZA0144);无锡市科教强卫医学发展学科建设对象项目(ZDXKJS001)

摘　　要：目的:观察育肾培元方辨证治疗子宫内膜增生症(EH)肾虚血瘀证的疗效及对内分泌激素水平和血液流变学的影响。方法:140例患者随机分为对照组和观察组各70例。对照组诊刮术后2周开始口服醋酸甲羟孕酮片(MPA),10 mg/次,2次/d;观察组在对照组治疗的基础上加服育肾培元方辨证,1剂/d,两组连续治疗3个月经周期,经期停服;并进行3个月周期的随访。在月经周期14~16 d以经阴道超声检查子宫内膜厚度、月经量评分采用月经失血图(PBAC)法、进行肾虚血瘀证评分,分别于治疗前、治疗后和随访结束时各评价1次;检测治疗前后促黄体生成素(LH),卵泡刺激素(FSH),雌激素(E2)和孕酮(P)等内分泌激素指标及血液流变学指标;进行子宫内膜活检评价子宫内膜逆转率;进行3个月经周期随访,记录复发率。结果:观察组临床疗效总有效率为95. 16%,高于对照组的81. 67%(χ2=5. 466,P <0. 05);治疗后观察组患者子宫内膜厚度,PBAC评分、肾虚血瘀证评分均低于对照组(P <0. 01);随访期对照组子宫内膜厚度,PBAC评分和肾虚血瘀证评分均较治疗后升高(P <0. 01),观察组的变化无统计学意义,观察组患者在随访期子宫内膜厚度,PBAC评分和肾虚血瘀证评分均低于对照组(P <0. 01);观察组患者血清P水平高于对照组(P <0. 01),E2水平低于对照组(P <0. 01);观察组血液流变学指标全血黏度(高、低切)、血浆黏度、血小板聚集性、纤维蛋白原的改善优于对照组(P <0. 01);观察组子宫内膜逆转率为93. 55%,高于对照组的76. 67%(χ2=5. 407,P <0. 05);观察组复发率为5. 26%,低于对照组的19. 57%(χ2=5. 058,P <0. 05)。结论:育肾培元方联合MPA治疗EH肾虚血瘀证患者可进一步的减轻临床症状,调节P和E2水平,改善血液流变学,提高子宫内膜逆转率,减少复发率,临床疗效优于单纯MPA治疗。Objective:To discuss the clinical efficacy of syndrome differentiation therapy of Yushen Peiyuan decoction for endometrial hyperplasia (EH)with syndrome of kidney deficiency and blood stasis and investigate its effects on endocrine hormone levels and hemorheology.Method:One hundred and forty patients were randomly divided into control group (70cases)and observation group (70cases)by random number table. Patients in control group got medroxyprogesterone acetate (MPA)for 3menstrual cycles from the second week after curettage,10rag/time,2times/days.Based on the treatment in control group,patients in observation group additionally received syndrome differentiation therapy of Yushen Peiyuan decoction for 3menstrual cycles,1dose/day,medication stopped during the menstruation.In addition,3months'follow-up was recorded.At the 14th-16th in menstrual cycle,endometrium thickness was detected by transvaginal ultrasound;menstrual volume scores were evaluated by pictorial blood loss assessment chart (PBAC)and scores of kidney deficiency and blood stasis syndrome were recorded before and after treatment and at the end of follow-up.Before and after treatment,levels of luteinizing hormone (LH),follicle stimulating hormone (FSH),estrogen (E2),progesterone (P)and hemorheological indexes were detected,and endometrial biopsy was used to evaluate the endometrial reversal rate. During follow-up for 3menstrual cycles,recurrence rate was recorded.Result:The total clinical effective rate was 95.16%in observation group,higher than 81.67%in control group (X^2=5.466,P <0.05).After treatment,the scores of endometrium thickness,PBAC and syndrome of kidney deficiency and blood stasis in observation group were all lower than those in control group (P <0.01).During follow-up period,scores of endometrium thickness, PBAC and syndrome of kidney deficiency in observation group were significantly increased in control group as compared with the data after treatment (P <0.01),but the changes in observation group showed no statistical significance;and sc

关 键 词：子宫内膜增生症 肾虚血瘀证 育肾培元方 六味地黄丸 性激素 血液流变学 复发 

分 类 号：R289[医药卫生—方剂学] R271[医药卫生—中药学]