桃核承气汤加减治疗子宫腺肌症的临床疗效观察_邱海鸥.pdf

662022 Vol.9 No.11Electronic Journal of Practical Gynecological Endocrinology临床研究桃核承气汤加减治疗子宫腺肌症的临床疗效观察邱海鸥（毕节市第一人民医院 中医科，贵州 毕节 551700）【摘要】目的 分析子宫腺肌症治疗中应用核桃承气汤加减的效果。方法 选取本院收治的88例子宫腺肌症患者，根据随机数字表法分为研究组和对照组，每组44例。研究组采用桃核承气汤加减治疗，对照组采用宫瘤消胶囊治疗。比较两组治疗前后的月经及子宫情况、血清学激素水平、中医证候积分及不良反应发生率。结果 治疗前，两组的各项月经及子宫情况指标比较，差异无统计学意义（P0.05）；治疗3个月后，两组的月经量、月经周期、子宫内膜厚度均优于治疗前，且研究组各项指标水平均优于对照组，差异有统计学意义（P0.05）。治疗前，两组的各项血清学激素水平及中医证候积分比较，差异无统计学意义（P0.05）；治疗3个月后，两组的雌二醇（E2）、促黄体生成素（LH）、促卵泡生成激素（FSH）及中医证候积分均低于治疗前，且研究组上述各项指标水平均低于对照组，差异有统计学意义（P0.05）。研究组的不良反应发生率为13.64%，略高于对照组的6.82%，但两组间比较，差异无统计学意义（P0.05）。结论 采用桃核承气汤加减治疗子宫腺肌症，既能改善患者的月经状态，又能调节其血清激素水平，值得临床推广使用。【关键词】桃核承气汤；子宫腺肌症；月经周期；血清激素Observation of clinical effect of modified Taohe Chengqi Decoction in the treatment of adenomyosisQiu Haiou(Department of Traditional Chinese Medicine,The First Peoples Hospital of Bijie City,Bijie 551700,China)【Abstract】Objective To analyze the effect of modified Taohe Chengqi Decoction in the treatment of adenomyosis.Methods A total of 88 patients with adenomyosis admitted to our hospital were selected and divided into a study group and a control group according to the random number table method,with 44 cases in each group.The study group was treated with modified Taohe Chengqi Decoction,and the control group was treated with Gongliuxiao Capsules.The menstrual and uterine conditions,serum hormone levels,TCM syndrome scores and incidence of adverse reactions were compared between the two groups before and after treatment.Results Before treatment,there were no significant differences in the indicators of menstruation and uterine condition between the two groups(P0.05);after 3 months of treatment,the menstrual volume,menstrual cycle and endometrial thickness of the two groups were better than those before treatment,and the levels of all indicators in the study group were better than those in the control group,and the differences were statistically significant(P0.05).Before treatment,there were no significant differences in serum hormone levels and TCM syndrome scores between the two groups(P0.05);after 3 months of treatment,the levels of estradiol(E2),luteinizing hormone(LH),follicle stimulating hormone(FSH)and TCM syndrome score in the two groups were lower than those before treatment,and the levels of the above indexes in the study group were lower than those in the control group,and the differences were statistically significant(P0.05).The incidence of adverse reactions in the study group was 13.64%,which was slightly higher than 6.82%in the control group,but there was no significant difference between the two groups(P0.05).Conclusion Modified Taohe Chengqi Decoction in the treatment of adenomyosis can not only improve the menstrual status of patients,but also regulate the serum hormone level,which is worthy of clinical application.【Key words】Taohe Chengqi Decoction;Adenomyosis;Menstrual cycle;Serum hormones子宫腺肌症好发于生育旺盛期妇女，症状可见盆腔疼痛、月经过多、进行性痛经等，对患者生命质量产生一定影响1。中医学认为，诱发子宫腺肌病的病理机制较为明确，为瘀血阻滞冲任及胞宫，进而出现月经不调、痛经等临床症状2。桃核承气汤为中医传统方药，能够泻热、活血、祛DOI：10.3969/j.issn.2095-8803.2022.11.019通信作者：邱海鸥，E-mail：672022 年第 9 卷第 11 期实用妇科内分泌电子杂志临床研究瘀。为验证桃核承气汤治疗子宫腺肌症的临床效果，本研究选取本院收治的子宫腺肌症患者88例为对象进行分组对照，现报道如下。1 资料与方法1.1 临床资料选择2020年4月至2021年4月本院收治的子宫腺肌症患者88例为研究对象，根据随机数字表法分为两组。对照组患者年龄2748岁，平均（37.654.01）岁；病程0.425.63年，平均（2.460.48）年；孕次03次，平均（1.410.40）次。研究组患者年龄2847岁，平均（36.945.01）岁；病程0.435.49年，平均（2.510.61）年；孕次03次，平均（1.390.38）次。两组患者的年龄、病程、孕次等一般资料比较，差异无统计学意义（P0.05）。本研究已经过本院医学伦理委员会审批。1.2 方法1.2.1 对照组采用宫瘤消胶囊治疗。给予患者宫瘤消胶囊（山东步长神州制药有限公司，国药准字Z20055635，规格：每粒装0.5 g）口服，3粒/次，3次/d，于饭后服用。1个月经周期为1个疗程，持续服用3个疗程。1.2.2 研究组采用桃核承气汤加减治疗。桃核承气汤组方：桃仁12 g、酒大黄12 g、桂枝6 g、灸甘草12 g、芒硝6 g。加减：瘀血重者，加失笑散；肝气郁结者，合小柴胡汤；肾虚重者，加续断、寄生；气滞重者，加枳壳、厚朴、郁金；虚实夹杂者，合四物汤；寒重者：加吴茱萸。1剂/d，传统水煎取汁200 ml，分早晚两次服用，服用时间为饭后2 h，服用前需要用5070温水水浴中药液。1个月经周期为1个疗程，持续服用3个疗程。1.3 观察指标及判定标准月经及子宫情况：于治疗前及治疗3个月后，记录两组患者的月经量及月经周期，并借助二维超声检查其子宫内膜厚度。血清激素水平及中医证候积分：于治疗前及治疗3个月后，抽取患者晨起空腹静脉血5 ml，行实验室指标检测，项目包括雌二醇（E2）、促黄体生成素（LH）、促卵泡生成激素（FSH）及CA125水平；于治疗前及治疗3个月后，借助中药新药临床研究指导原则评估患者的中医证候水平，包括头晕失眠、性欲减退、色淡质稀、月经量多、大便溏、阴道空坠、腰腹疼痛等7个项目，均按照Likert 06级评分法赋分，分值越高，代表患者症状越严重。不良反应：比较两组治疗期间出现下腹疼痛、子宫痉挛、头晕、恶心呕吐等的例数，并计算百分比。1.4 统计学方法采用PEMS 3.2 统计学软件对数据进行统计分析。计量资料以均数标准差（xs）表示，采用t检验；计数资料以n（%）表示，采用2检验。P0.05表示差异具有统计学意义。2 结果2.1 比较两组月经及子宫情况治疗前，两组的月经量、月经周期、子宫内膜厚度比较，差异无统计学意义（P0.05）；治疗3个月后，两组的上述各项指标均优于治疗前，且研究组的月经量少于对照组，月经周期短于对照组，子宫内膜厚度小于对照组，差异有统计学意义（P0.05）。见表1。表1 两组月经及子宫情况比较（xs）组别例数月经量（ml）月经周期（d）子宫内膜厚度（mm）治疗前治疗后治疗前治疗后治疗前治疗后研究组44328.5992.87195.7949.42ab12.381.926.580.49ab13.073.426.741.23ab对照组44326.2589.48236.4553.02a12.762.318.711.38a12.953.478.081.32at0.1203.7210.8399.6480.1634.927P0.9050.0000.4040.0000.8710.000注：与同组治疗前比较，aP0.05；与对照组治疗后比较，bP0.052.2 两组血清激素水平及中医证候积分比较治疗前，两组的LH、FSH、E2、CA125水平及中医证候积分比较，差异无统计学意义（P0.05）；治疗3个月后，两组的各项血清激素水平指标及中医证候积分均低于治疗前，且研究组的LH、FSH、E2水平及中医证候积分均低于对照组，差异有统计学意义（P0.05）；治疗3个月后，两组的CA125水平比较，差异无统计学意义682022 Vol.9 No.11Electronic Journal of Practical Gynecological Endocrinology临床研究（P0.05）。见表2。表2 两组血清激素水平及中医证候积分比较（xs）组别例数FSH（U/L）LH（ng/ml）E2（pmol/L）治疗前治疗后治疗前治疗后治疗前治疗后研究组447.342.403.851.03ab7.952.074.081.13ab186.426