补肾调心治法治疗排卵障碍性不孕_甘瑾.pdf

第 39 卷第 3 期2023 年 3 月长春中医药大学学报Journal of Changchun University of Chinese MedicineVol.39 No.3Mar.2023301DOI:10.13463/ki.cczyy.2023.03.016补肾调心治法治疗排卵障碍性不孕甘 瑾，王进进，高 娟，夏亚芳，华彩凤，季佳文*（江苏省江阴市中医院妇产科，江苏 江阴 214400）摘要：目的目的 探讨补肾调心治法用于排卵障碍性不孕的价值。方法方法 选择 108 例排卵障碍性不孕患者，以随机数表法分为观察组与对照组，各 54 例。对照组予补肾调周中药内服，观察组在对照组用药基础上加用调心中药治法，比较治疗后2 组排卵率与妊娠情况、综合疗效，比较 2 组治疗前后最大排卵日雌二醇（E2）及黄体中期孕酮（P）、E2、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、生活质量量表（SF-36）总评分，治疗后随访 1 年，比较 2 组抱婴率。结果结果 治疗后，观察组排卵率、妊娠率、抱婴率均显著高于对照组（P 0.05）。2 组治疗后最大排卵日 E2、黄体中期P 均显著高于本组治疗前，观察组治疗后黄体中期 E2显著高于本组治疗前（P 0.05）；观察组治疗后最大排卵日 E2、黄体中期 P、黄体中期 E2与对照组治疗后比较均显著提高（P 0.05）。治疗后 2 组 HAMD、HAMA 总评分均显著低于本组治疗前，SF-36 总评分均显著高于本组治疗前（P 0.05）；治疗后观察组 HAMD、HAMA 总评分显著低于对照组，SF-36 总评分显著高于对照组（P 0.05）。观察组临床疗效总有效率（90.74%，49/54）显著高于对照组（68.52%，37/54）（P 0.05）。结论结论 在补肾调周法基础上联合调心治法治疗排卵障碍性不孕症，可有效提高临床疗效，能明显改善患者卵泡质量与心理状态，提高患者生活质量，值得临床推广。关键词：中医；补肾调周；调心治法；排卵障碍性不孕；调心安神钩藤汤中图分类号：R271.14 文献标志码：A 文章编号：2095-6258(2023)03-0301-05Value of the kidney tonifying and mental activity regulating therapy in the treatment Value of the kidney tonifying and mental activity regulating therapy in the treatment of anovulatory infertilityof anovulatory infertilityGAN Jin,WANG Jinjin,GAO Juan,XIA Yafang,HUA Caifeng,JI Jiawen*(Department of Gynecology and Obstetrics,Jiangyin Hospital of Traditional Chinese Medicine,Jiangyin 214400,China)Abstract:Objective Abstract:Objective To explore the value of the kidney tonifying and mental activity regulating therapy in the treatment of anovulatory infertility.MethodsMethods A total of 108 patients were randomly divided into an observation group(n=54)and a control group(n=54).The control group was treated with traditional Chinese medicine for invigorating the kidney and regulating menstruations,while the observation group was treated with traditional Chinese medicine for regulating mental activities on that basis.After treatment,the ovulation rate,pregnancy and TCM syndrome curative effect of the two groups were compared.The total scores of estradiol(E2)on the maximum ovulation day,mid luteal progesterone(P),E2,Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and Quality of Life Scale(SF-36)were compared between the two groups before and after treatment.The patients were followed up for one year after treatment,and the baby-holding rates of the two groups were counted and compared.ResultsResults The ovulation rate,pregnancy rate and baby holding rate in the observation group were significantly higher than those in the control group after treatment(P0.05).The maximum ovulation day E2 and mid luteal phase P of the two groups after treatment were significantly higher than those before treatment,and the mid luteal phase E2 of the observation group after 基金项目：江苏省中医药科技发展计划项目（YB2020045）作者简介：甘 瑾（1983），女，硕士，副主任中医师，主要从事生殖不孕研究*通信作者：季佳文，女，主治中医师，电子信箱-第 39 卷第 3 期2023 年 3 月长春中医药大学学报Journal of Changchun University of Chinese MedicineVol.39 No.3Mar.2023302 不孕症临床表现为 12 个月定期无防护房事后始终不能建立临床妊娠，近些年已成为一个全球性的临床和民生问题，患病率呈升高趋势1-2。不孕症通常是排卵障碍和盆腔问题引发。卵泡发育成熟障碍及排卵障碍均会导致排卵障碍性不孕3。下丘脑垂体、卵巢等功能性障碍是影响排卵障碍的普遍病因。辅助生殖技术能化解因精子计数低和输卵管疾病而引起的妊娠障碍4-5。西药一般利用对内或外源的促性激素提升，调节下丘脑-垂体-卵巢轴（H-P-O）功能，促卵泡成熟发育6。排卵药具有多种不良反应，可能会造成卵子总量与质量水平低下，升高致畸风险性、流产率等7。研究8表明，中药通过对生殖系统中相应激素水平的控制来改进卵巢功能和子宫容受性，具备特异性或多靶点作用机制。国医大师夏桂成的补肾调周法源于对人工周期疗法梳理，由“阴阳互根互用”“肾宜闭藏精气”“子午流注施治”等理论作指导，遵循当代医学中卵巢周期性变化影响子宫功能的再认知与临床多年以来的研究所确立的周期用药机制9。夏桂成教授认为，“补肾”亦应注重“调心”10。本研究评估中医补肾调周联合调心治法用于排卵障碍性不孕患者的价值，观察补肾调周法联合调心安神钩藤汤治疗排卵障碍性不孕患者的疗效，报道如下。1 资料与方法1.1 一般资料一般资料 选择 2019 年 1 月 2020 年 11 月江苏省江阴市中医院收治的排卵障碍性不孕患者 108 例，按随机数表法分为对照组与观察组，各 54 例。对照组，年龄 25 34 岁，平均（29.453.49）岁；BMI 16 23 kgm-2，平均（19.583.09）kgm-2；病程 3 6 年，平均（4.651.23）年；原发性不孕30 例，继发性不孕 24 例。观察组，年龄 25 38岁，平均（29.143.66）岁；BMI 16 23 kgm-2，平均（19.593.06）kgm-2；病程 2 7 年，平均（5.111.20）年；原发性不孕 34 例，继发性不孕20 例。2 组年龄、BMI、病程等一般资料比较，差异无统计学意义（P 0.05），具备可比性。本研究开始前已获江苏省江阴市中医院医学伦理委员会审批（伦理批号 2019-16 号）。1.2 诊断标准诊断标准 辨证诊断标准参照中医妇科学11结合中药新药临床研究指导原则（试行）12中肾虚型拟定：1）久婚不孕；2）经行后期，量少，色淡红，无血块，带下过少；3）腰膝部酸软无力；4）头晕耳鸣、心慌心悸；5）手足心及心胸烦热，口渴咽干，夜寐差；6）性欲低下，精神疲惫，肢凉畏寒，小便频繁；7）舌红或淡红，薄苔；脉弦细或细数。1）2）3）4）项为必须具有的症状，另加其余 1 项即可诊断。兼证：肝郁，1）月经先后无定期，量少，色红，有小血块；2）小腹发胀；3）月经性乳胀；4）情志异常；5）舌质红，苔薄黄腻，脉细弦。血瘀，1）月经先期，时少时多，色紫红，夹有血块；2）经前、经行小腹疼痛；3）舌质紫黯，或有瘀点，脉弦涩。痰湿，1）月经后期，色淡红，带下黏稠状；2）胸胁胀闷，噫气泛恶；3）形体肥胖；4）舌苔白而腻，滑脉。以上兼证中具有 3 项即可诊断。1.3 纳入标准纳入标准 1）符合上述中医、西医临床诊断标准；2）年龄treatment was significantly higher than that before treatment(P0.05).The maximum ovulation day E2,mid luteal P and mid luteal E2 in the observation group were significantly higher than those in the control group after treatment(P0.05).After treatment,the total scores of HAMD and HAMA in the two groups were significantly lower than those before treatment,while the total score of SF-36 was significantly higher than that before treatment(P0.05).After treatment,the total scores of HAMD and HAMA in the observation group were significantly lower than those in the control group,while the total score of SF-36 was significantly higher than that in the control group(P0.05).The total effective rate of TCM syndrome in the observation group(90.74%,49/54)was significantly higher t