一贯煎加味治疗对肾虚肝郁证围绝经期综合征患者下丘脑-垂体-卵巢轴功能的影响  

Clinical efficacy of modified Yiguan Decoction for perimenopausal syndrome of kidney deficiency liver stagnation syndrome,and its influence on the the hypothalamic-pituitary-ovarian axis

作　　者：金焱[1] 李兰兰[1] 孟媛媛[1] 吴海燕[1] JIN Yan;LI Lanlan;MENG Yuanyuan;WU Haiyan(Department of Gynecology,Tongling Traditional Chinese Medicine Hospital,Tongling,Anhui 244000)

机构地区：[1]安徽省铜陵市中医医院妇科,安徽铜陵244000

出　　处：《河北中医》2023年第7期1132-1135,1139,共5页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察一贯煎加味治疗肾虚肝郁证围绝经期综合征的临床疗效,以及对患者下丘脑-垂体-卵巢轴功能的影响。方法将80例肾虚肝郁证围绝经期综合征患者按照随机数字表法分为2组,对照组40例(剔除及脱落4例,实际完成36例)予西医常规治疗,治疗组40例(剔除及脱落2例,实际完成38例)在对照组基础上联合一贯煎加味治疗。2组均治疗30天为1个疗程,治疗3个疗程后统计疗效,比较2组治疗前后中医症状评分(包括烘热汗出、情志异常、月经紊乱且经色紫暗、腰膝酸软、失眠多梦及大便时干时溏)、单胺类神经递质[包括多巴胺(DA)及去甲肾上腺素(NE)]及性激素指标[包括雌二醇(E_(2))、卵泡刺激素(FSH)及黄体生成激素(LH)]水平变化情况。结果治疗组总有效率94.74%(36/38),对照组总有效率77.78%(28/36),治疗组疗效优于对照组(P<0.05)。与本组治疗前比较,2组治疗后中医症状烘热汗出、情志异常、月经紊乱且经色紫暗、腰膝酸软、失眠多梦、大便时干时溏评分及总分均降低(P<0.05),且治疗组治疗后中医症状烘热汗出、情志异常、月经紊乱且经色紫暗、腰膝酸软、失眠多梦评分及总分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后神经递质DA及NE水平均升高(P<0.05),且治疗组治疗后DA及NE水平均高于对照组(P<0.05)。与本组治疗前比较,2组治疗后E_(2)水平均升高(P<0.05),FSH及LH水平均降低(P<0.05),且治疗组治疗后E_(2)水平高于对照组(P<0.05),FSH及LH水平低于对照组(P<0.05)。结论一贯煎加味治疗肾虚肝郁证围绝经期综合征疗效确切,可以有效改善患者中医症状,其作用机制可能是通过调节单胺类神经递质及性激素水平,矫正下丘脑-垂体-卵巢轴功能有关,从而达到提高治疗效果的目的。Objective To observe the clinical efficacy of modified Yiguan Decoction for perimenopausal syndrome(PMS)of kidney deficiency liver stagnation syndrome,and its influence on the the hypothalamic-pituitary-ovarian(HPO)axis.Methods A total of 80 patients with PMS(kidney deficiency liver stagnation syndrome)were randomly assigned into the treatment group(n=40,2 cases of shedding)and the control group(n=40,4 cases of shedding).All patients were managed by routine Western medicine,and those in the treatment group were additionally treated with modified Yiguan Decoction.The treatment continued for 3 courses(1 course for 30 days),the aim was to compare traditional Chinese medicine(TCM)symptom(hot sweating,abnormal emotions,menstrual disorders and dark purple,soreness and weakness of waist and knees,insomnia and dreaminess,stool traits)score,monoamine neurotransmitter indexes(dopamine[DA],norepinephrine[NE]),sex hormone indexes(estrogen[E_(2)],follicle-stimulating hormone[FSH],luteinizing hormone[LH]).The curative effect was assessed.Results The effective rate in the treatment group was better than that in the control group(94.74%[36/38]vs 77.78%[28/36],P<0.05).After treatment,the scores and total scores of TCM symptoms(hot sweating,abnormal emotions,menstrual disorders and dark purple,soreness and weakness of waist and knees,insomnia and dreaminess,stool traits)in both the groups were significantly lower than those before treatment(P<0.05).The above TCM symptoms scores,apart from stool traits,in the treatment group were significantly lower than those in the control group(P<0.05).The levels of DA and NE in both groups increased after treatment(P<0.05),and which were significantly higher in the treatment group than in the control group(P<0.05).Conclusion For patients with PMS(kidney deficiency liver stagnation syndrome),modified Yiguan Decoction has definite curative effect,and can effectively improve TCM symptoms.The mechanism of action may be to correct the HPO axis function by regulating the levels of monoamine neurotran

关 键 词：围绝经期综合征 肾虚肝郁 一贯煎 神经递质 性激素 下丘脑-垂体-卵巢轴 

分 类 号：R271.2[医药卫生—中医妇科学] R917.5[医药卫生—中医学]