清心滋肾汤治疗阴虚火旺型绝经综合征的临床疗效及调节KNDy的神经内分泌机制  

Qingxin Zishen Decoction Treats Menopausal Syndrome Due to Yin Deficiency with Effulgent Fire by Regulating KNDy Neurons

作　　者：周雨欣 张镕晴 卢苏 许美娟 陈赟 ZHOU Yuxin;ZHANG Rongqing;LU Su;XU Meijuan;CHEN Yun(The First Clinical Medical College of Nanjing University of Chinese Medicine,Nanjing 210023,China;Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学第一临床医学院,南京210023 [2]南京中医药大学附属医院,江苏省中医院,南京210029

出　　处：《中国实验方剂学杂志》2024年第6期119-125,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：第七批全国老中医药专家学术经验继承工作项目(国中医药人教函[2022]76号);第三周期江苏省妇幼健康青年人才项目(FRC202150);江苏省中医药科技发展计划重点项目(ZD202206);国家自然科学基金项目(81574009);江苏省卫计委科研课题(Q201602)。

摘　　要：目的:探究清心滋肾汤对绝经综合征阴虚火旺型患者治疗前后的综合疗效、症状评分、神经内分泌指标的影响及其调节KNDy神经元的作用机制。方法:选取60例于南京中医药大学附属江苏省中医院更年期专病门诊就诊且符合绝经综合征阴虚火旺诊断的患者,随机分为观察组(清心滋肾汤组)和对照组(芬吗通组)各30例,观察期为12周,比较两组治疗前后综合疗效、潮热汗出次数及程度、改良Kupperman评分、下丘脑神经元活性肽Kisspeptin、神经激肽B(NKB)、强啡肽(Dyn)、卵泡刺激素(FSH)和雌二醇(E2)在血清学水平的变化。结果:①临床综合疗效比较。治疗后,与对照组比较,两组患者综合疗效相当,差异无统计学意义。②潮热、汗出次数及程度比较。与本组治疗前比较,治疗后两组患者潮热、汗出次数及程度均明显降低(P<0.05);治疗后组间比较,对照组患者潮热、汗出次数及程度均优于观察组(P<0.05)。③改良Kupperman评分、更年期症状比较。与本组治疗前比较,两组患者改良Kupperman评分均明显下降(P<0.05),与对照组治疗后比较,治疗第4周观察组患者头晕、头痛评分优于对照组(P<0.05)。④血清性激素水平比较。与本组治疗前比较,治疗后两组患者E2明显提高(P<0.05),FSH水平明显下降(P<0.05);治疗后组间比较,对照组改善更明显(P<0.05)。⑤神经内分泌指标比较。与本组治疗前比较,治疗后两组患者Kisspeptin和NKB均明显下降(P<0.05),观察组患者Dyn水平明显上升(P<0.05);与对照组治疗后比较,观察组患者Dyn水平明显升高(P<0.05)。结论:清心滋肾汤可以改善更年期女性潮热汗出症状,缓解绝经综合征临床证候群,其主要机制是作用于下丘脑KNDy神经元通路,下调Kisspeptin、NKB水平,上调Dyn水平,进一步缓解绝经综合征症状及改善患者血清性激素水平。该研究为中医药治疗绝经综合征潮热症状提供新思路。Objective:To explore the comprehensive effects of Qingxin Zishen decoction on the symptom score and neuroendocrine indexes and the mechanism of the decoction in regulating KNDy neurons in the patients with menopausal syndrome.Method:A total of 60 patients with menopausal syndrome due to yin deficiency with effulgent fire who attended the menopausal outpatient of Jiangsu Province Hospital of Chinese Medicine were randomized into an experimental(Qingxin Zishen decoction)group(30 cases)and a control(femoston)group(30 cases).The treatment lasted for 12 weeks in both groups.The two groups were compared in terms of the comprehensive efficacy,frequency and degree of hot flashes and sweating,modified Kupperman score,and the serum levels of hypothalamic peptide kisspeptin,neurokinin B(NKB),dynorphin(Dyn),follicle-stimulating hormone(FSH),and estradiol(E2).Result:①Comprehensive efficacy:The comprehensive efficacy of the two groups was comparable.②Frequency and degrees of hot flashes and sweating:After treatment,the frequency and degrees of hot flashes and sweating in the two groups were reduced(P<0.05)and the control group outperformed the experimental group(P<0.05).③Modified Kupperman score and menopausal symptoms:After treatment,the modified Kupperman score decreased in both groups(P<0.05).After 4 weeks of treatment,the experimental group was superior to the control group in terms of the scores of dizziness and headache(P<0.05).④Serum levels of sex hormones:After treatment,the serum E2 level elevated and the FSH level lowered in both groups(P<0.05),and the changes were more obvious in the control group(P<0.05).⑤Neuroendocrine indexes:After treatment,the serum levels of kisspeptin and NKB in the two groups decreased(P<0.05),and the serum Dyn level in the experimental group increased(P<0.05).Moreover,the experimental group had higher Dyn level than the control group after treatment(P<0.05).Conclusion:Qingxin Zishen decoction can alleviate hot flashes,sweating,and other symptoms in the women with menopausal syndro

关 键 词：绝经综合征 清心滋肾汤 KNDy神经元 作用机制 

分 类 号：R242[医药卫生—中医临床基础] R2-031[医药卫生—中医学] R259R271.116