黄连温胆汤合少腹逐瘀汤加减治疗痰瘀互结证多囊卵巢综合征致排卵障碍的临床疗效  

Efficacy of Modified Huanglian Wendantang and Shaofu Zhuyutang Against Ovulation Disorder in Combined Phlegm and Stasis-Induced Polycystic Ovary Syndrome

作　　者：周雨禾 刘婷[3] 马宏博 ZHOU Yu-he;LIU Ting;MA Hong-bo(Shandong University of Traditional Chinese Medicine,Jinan 250355,China;Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Second Affiliated Hospital of Shandong University of TCM,Jinan 250001,China)

机构地区：[1]山东中医药大学,济南250355 [2]山东第一医科大学附属省立医院,济南250021 [3]山东中医药大学第二附属医院,济南250001

出　　处：《中国实验方剂学杂志》2021年第16期96-101,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家中医药管理局第四批全国中医临床优秀人才研修项目(国中医药人教发[2017]24号);山东省名中医药专家传承工作室建设项目(鲁卫函[2019]92号);山东省中医药科技计划面上项目(2020M042)。

摘　　要：目的:观察黄连温胆汤合少腹逐瘀汤加减治疗痰瘀互结证多囊卵巢综合征(PCOS)致排卵障碍的临床疗效及对慢性炎症状态的影响。方法:将100例患者按随机数字表法分为对照组和观察组各50例。所有患者给予生活方式干预,并口服枸橼酸氯米芬(CC)胶囊促排卵。对照组口服桂枝茯苓丸,6 g/次,2次/d;观察组黄连温胆汤合少腹逐瘀汤加减内服,1剂/d。两组疗程均为6个月经周期;监测排卵情况,测量治疗前后子宫内膜厚度,A型子宫内膜比例、子宫动脉血流的搏动指数(PI)和阻力指数(RI);检测治疗前后空腹血糖(FBG),空腹胰岛素(FINS),黄体生成素(LH),卵泡刺激素(FSH),血清睾酮(T),雌二醇(E2)和硫酸脱氢表雄酮(DHEAS)水平,计算胰岛素抵抗指数(HOMA-IR);评价治疗前后卵巢体积和痰瘀互结证积分;检测治疗前后肿瘤坏死因子-α(TNF-α),超敏C-反应蛋白(hs-CRP),脂联素(APN)和白细胞介素-6(IL-6)水平。结果:观察组临床疗效总有效率为(44/47)93.62%,高于对照组的(36/46)78.26%(χ^(2)=4.802,P<0.05);观察组排卵率为(199/264)75.38%,高于对照组的(173/272)63.60%(χ^(2)=8.714,P<0.01),观察组临床妊娠率(11/47)23.40%,高于对照组的(5/46)10.87%,但差异无统计学意义(χ^(2)=2.564,P>0.05);观察组PI和RI均低于对照组(P<0.01),子宫内膜厚度,A型内膜比例高于对照组(P<0.01);观察组LH,T和DHEAS水平均低于对照组(P<0.01),E2和FSH水平均高于对照组(P<0.01);观察组双侧卵巢体积和痰瘀互结证积分均低于对照组(P<0.01);观察组FINS,FPG和HOMA-IR均低于对照组(P<0.01);观察组TNF-α,hs-CRP和IL-6水平均低于对照组(P<0.01),APN水平高于对照组(P<0.01)。结论:在CC治疗的基础上,黄连温胆汤合少腹逐瘀汤加减内服可改善PCOS痰瘀互结证患者的排卵障碍,并能调节胰岛素抵抗(IR)和慢性炎症状态,为临床妊娠创造了条件,值得进一步的研究。Objective:To observe the clinical efficacy of modified Huanglian Wendantang and Shaofu Zhuyutang in the treatment of ovulation disorder in patients with polycystic ovary syndrome(PCOS)due to the combined phlegm and stasis-induced and its influence on chronic inflammation. Method: According to the random number table,100 patients were divided into a control group(50 cases)and an observation group(50 cases). Apart from lifestyle intervention and oral administration of clomiphene citrate(CC)capsules to induce ovulation,patients in the control group further received Guizhi Fulingwan,6 g/time,2 times/day,while those in the observation group were treated with the modified Huanglian Wendantang and Shaofu Zhuyutang,1 dose/day,for six menstrual cycles. The ovulation,endometrial thickness,proportion of type A endometrium,as well as the pulsatility index(PI)and resistance index(RI)of uterine artery were monitored before and after treatment. The fasting blood glucose(FBG),fasting insulin(FINS),luteinizing hormone(LH),follicle stimulating hormone(FSH),serum testosterone(T),estradiol(E2),dehydroepiandrosterone sulfate(DHEAS),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP),adiponectin(APN),and interleukin-6(IL-6)levels before and after treatment were detected,followed by the calculation of homeostasis model assessmentinsulin resistance(HOMA-IR)value and the evaluation of ovarian volume and combined phlegm and stasisinduced syndrome score. Result: The overall response rate of the observation group was(44/47)93.62%,which was higher than(36/46)78.26% of the control group(χ^(2)=4.802,P<0.05). The ovulation rate in the observation group was(199/264)75.38%,higher than(173/272)63.60% in the control group(χ^(2)=8.714,P<0.01). The clinical pregnancy rate of the observation group was(11/47)23.40%,higher than(5/46)10.87% of the control group,but the difference was not statistically significant(χ^(2)=2.564,P>0.05). Compared with the control group,the observation group exhibited reduced PI,RI,LH,T,DHEAS,FINS,

关 键 词：多囊卵巢综合征 慢性炎症 痰瘀互结证 黄连温胆汤 少腹逐瘀汤 胰岛素抵抗 

分 类 号：R289[医药卫生—方剂学] R271[医药卫生—中药学]