地黄丸合芎归二陈汤加减治疗肾虚血瘀型多囊卵巢综合征高雄激素血症

刘玉兰; 宋春侠; 暴宏伶; 徐鸿雁; 龙森; 权兴苗; 高慧

doi:10.13422/j.cnki.syfjx.20181830

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地黄丸合芎归二陈汤加减治疗肾虚血瘀型多囊卵巢综合征高雄激素血症

临床 | 更新时间：2024-01-04

- 地黄丸合芎归二陈汤加减治疗肾虚血瘀型多囊卵巢综合征高雄激素血症
- Dihuang Wan Combined with Xionggui Erchen Tang on Hyperandrogenism and Polycystic Ovary Syndrome with Syndrome of Kidney Deficiency and Blood Stasis
- 中国实验方剂学杂志 2018年24卷第18期页码：180-185
- 作者机构：
- 作者简介：
- 基金信息：
  
  河北省政府资助临床医学优秀人才培养项目（2014571024）;承德市科学技术研究与发展计划项目（201422038）
- DOI：10.13422/j.cnki.syfjx.20181830
  中图分类号： R271.9
- 纸质出版日期：2018
- 稿件说明：
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刘玉兰, 宋春侠, 暴宏伶, 等. 地黄丸合芎归二陈汤加减治疗肾虚血瘀型多囊卵巢综合征高雄激素血症[J]. 中国实验方剂学杂志, 2018,24(18):180-185.

LIU Yu-lan, SONG Chun-xia, BAO Hong-ling, et al. Dihuang Wan Combined with Xionggui Erchen Tang on Hyperandrogenism and Polycystic Ovary Syndrome with Syndrome of Kidney Deficiency and Blood Stasis[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(18): 180-185.
刘玉兰, 宋春侠, 暴宏伶, 等. 地黄丸合芎归二陈汤加减治疗肾虚血瘀型多囊卵巢综合征高雄激素血症[J]. 中国实验方剂学杂志, 2018,24(18):180-185. DOI： 10.13422/j.cnki.syfjx.20181830.

LIU Yu-lan, SONG Chun-xia, BAO Hong-ling, et al. Dihuang Wan Combined with Xionggui Erchen Tang on Hyperandrogenism and Polycystic Ovary Syndrome with Syndrome of Kidney Deficiency and Blood Stasis[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(18): 180-185. DOI： 10.13422/j.cnki.syfjx.20181830.

摘要

目的：观察地黄丸合芎归二陈汤加减对多囊卵巢综合征高雄激素血症（PCOS-HA）性激素水平和细胞因子的影响。方法：将120例患者以就诊先后，随机按数字表法分为对照组和观察组各60例。对照组口服炔雌醇环丙孕酮片，从月经第5天开始服用，1次/d，连续服用21 d，停药，待月经来潮。观察组采用地黄丸合芎归二陈汤加减治疗。两组疗程均为治疗3个月经周期。检测治疗前后血清睾酮（T），双氢睾酮（DHT），硫酸脱氢表雄酮（DHEAS），促黄体生成素（LH），卵泡刺激素（FSH），性激素结合球蛋白（SHBG），催乳素（PRL）水平，并计算游离睾酮指数（FAI）；进行治疗前后痤疮严重情况（Rosenfield），多毛和肾虚血瘀证评分；进行妇科B超检查记录卵巢大小、每侧卵巢的窦卵泡个数、恢复排卵情况等；记录月经周期、月经量、基础体温（BBT），计算BBT双相率和月经恢复正常率；检测治疗前后瘦素（LP），胰岛素样生长因子-1（IGF-1）和脂联素（APN）水平；评价治疗前后胰岛素抵抗指数（HOMA-IR），体质量指数（BMI）和腰臀比（WHR）。结果：经有序资料的χ2检验，观察组的临床疗效优于对照组（χ2＝7.213，P<0.05）；治疗后观察组患者T，DHT，DHEAS，FAI，LH，PRL水平均低于对照组，LH/FSH比值低于对照组，SHBG，FSH水平均高于对照组（P<0.01）；观察组患者Rosenfield，多毛、肾虚血瘀证评分均低于对照组，卵巢体积小于对照组（P<0.01）；观察组月经恢复率为86.67%，高于对照组的68.33%（χ2=5.784，P<0.05）；观察组患者排卵恢复率为78.33%，高于对照组的56.67%（χ2=6.419，P<0.05）；观察组BBT双相率为80%，高于对照组的60%（χ2=5.714，P<0.05）；观察组IGF-1和LP水平均低于对照组，APN水平高于对照组（P<0.01）；治疗后观察组患者HOMA-IR，BMI和WHR均低于对照组（P<0.01）。结论：地黄丸合芎归二陈汤加减治疗肾虚血瘀型PCOS-HA，可改善高雄激素血症的临床症状和血清生化指标，调节内分泌指标，促进了PCOS月经恢复和自发排卵恢复，临床疗效优于西医治疗。

Abstract

Objective: To observe the effect of addition and subtraction syndrome differentiation treatment of Dihuang Wan combined with Xionggui Erchen Tang on sex hormone levels and cytokines in patients with polycystic ovary syndrome hyperandrogenemia (PCOS-HA). Method: According to the order of medical treatment

one hundred and twenty patients were randomly divided into control group (60 cases) and observation group (60 cases) by random number table. Patients in control group got ethinylestradiol and cyproterone acetate tablets by oral administration from the fifth day of menstruation for 21 days

1 time/day

then stopped the drug use to wait for menstrual onset. Patients in observation group got addition and subtraction syndrome differentiation treatment of Dihuang Wan combined with Xionggui Erchen Tang. The treatment course was 3 menstrual cycles in both groups. Before and after treatment

levels of serum testosterone (T)

dihydrotestosterone (DHT)

dehydroepiandrosterone sulfate (DHEAS)

luteinizing hormone (LH)

follicle stimulating hormone (FSH)

sex hormone binding globulin (SHBG)

and prolactin (PRL) were detected

and free testosterone indexes (FAI) were calculated. Scores of rosenfield

hairy and syndrome of kidney deficiency and blood stasis were graded. The size of ovary

number of antral follicles

recovery rate of ovulation were recorded in gynecologic B-ultrasound examination. Menstrual cycle

menstrual volume and basal body temperature (BBT) were recorded. And double phase rate of BBT and rate of recovery were calculated. Before and after treatment

levels of leptin (LP)

insulin-like growth factor-1 (IGF-1) and adiponectin (APN) were detected. And homeostasis model assessment-insulin resistance index (HOMA-IR)

body mass index (BMI) and waist-to-hipratio (WHR) were detected. Result: In the analysis of χ2test

the clinical efficacy in observation group was superior to that in control group (χ2=7.213

P<0.05). After treatment

the levels of T

DHT

DHEAS

FAI

PRL

LH/FSH

IGF-1

HOMA-IR

BMI and WHR in observation group were lower than those in control group

and levels of SHBG

FSH and APN were higher than those in control group (P<0.01). Scores of Rosenfield

hairy

score of syndrome of kidney deficiency and blood stasis and volume of ovary in observation group were lower than those in control group (P<0.01). Recovery rate of menstruation was 86.67% in observation group

higher than 68.33% in control group (χ2=5.784

P<0.05). Recovery rate of ovulation was 78.33% in observation group

higher than 56.67% in control group (χ2=6.419

P<0.05). Double phase rate of BBT was 80% in observation group

higher than 60% in control group (χ2=5.714

P<0.05). Conclusion: Addition and subtraction syndrome differentiation treatment of Dihuang Wan combined with Xionggui Erchen Tang can ameliorate clinical symptoms of hyperandrogenemia and serum biochemical index

regulate endocrine

and promote recovery of menstrual and spontaneous ovulation

superior to western medicine treatment in clinical efficacy.

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