当归芍药散加味联合达英-3...治疗多囊卵巢综合征临床研究_张杰.pdf

新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4收稿日期2022-01-25修回日期2022-11-25作者简介张杰（1986-），女，主治医师，E-mail：zhang_jie_z_。当归芍药散加味联合达英-35治疗多囊卵巢综合征临床研究张杰，李丽娟，刘亚楠新郑市公立人民医院妇产科，河南 新郑 451100摘要目的：观察当归芍药散加味联合达英-35 治疗肾虚血瘀型多囊卵巢综合征（PCOS）的疗效及对血清性激素结合球蛋白（SHBG）、促肾上腺皮质激素（ACTH）水平的影响。方法：选取 92 例肾虚血瘀型 PCOS患者为研究对象，按随机数字表法分为西药组及联合组各 46 例，西药组给予达英-35 治疗，联合组予以当归芍药散加味联合达英-35 治疗，2 组均治疗 3 个疗程。比较 2 组临床疗效及不良反应发生情况，比较 2 组治疗前后中医证候积分、卵巢体积、子宫内膜厚度、子宫内膜磷脂酰肌醇 3 激酶（PI3K）、蛋白激酶 B（Akt）、磷酸化 Akt（p-Akt）蛋白表达及血清 SHBG、ACTH 水平的变化。结果：联合组总有效率为 93.48%，西药组总有效率为 78.26%，2 组比较，差异有统计学意义（P0.05）。治疗后，2 组月经周期、月经量、腰膝酸软或腰脊刺痛、头晕耳鸣、经行腹痛中医证候积分及总分均较治疗前下降（P0.05），联合组上述 5 项中医证候积分及总分均低于西药组（P0.05）。治疗后，2 组两侧卵巢体积均较治疗前下降，子宫内膜厚度均较治疗前上升，差异均有统计学意义（P0.05）；治疗后，联合组两侧卵巢体积均小于西药组，子宫内膜厚度大于西药组，差异均有统计学意义（P0.05）。治疗后，2 组子宫内膜 PI3K、Akt、p-Akt 蛋白相对表达量均较治疗前升高（P0.05），联合组均高于西药组（P0.05）。治疗后，2 组血清 SHBG 水平均较治疗前升高，ACTH 水平均较治疗前下降，差异均有统计学意义（P0.05）；治疗后，联合组 SHBG 水平高于西药组，ACTH 水平低于西药组，差异均有统计学意义（P0.05）。联合组不良反应发生率为 4.35%，西药组为 13.04%，2 组比较，差异无统计学意义（P0.05）。结论：当归芍药散加味联合达英-35 治疗肾虚血瘀型 PCOS 疗效显著，能通过调控 PI3K/AKT 信号通路调节生殖轴，缓解患者临床症状，纠正性激素紊乱。关键词多囊卵巢综合征；肾虚血瘀型；当归芍药散；达英-35；血清性激素结合球蛋白；促肾上腺皮质激素中图分类号R711.75文献标志码A文章编号0256-7415（2023）04-0007-06DOI：10.13457/ki.jncm.2023.04.002Clinical Study on Modified Danggui Shaoyao Powder Combined with Daying-35 forPolycystic Ovary SyndromeZHANG Jie，LI Lijuan，LIU YananAbstract：Objective：To observe the clinical effect of the therapy of modified Danggui Shaoyao Powdercombined with Daying-35(Ethinylestradiol and Cyproterone Tablets)on polycystic ovary syndrome(PCOS)of kidney deficiency and blood stasis type and its effect on levels of serum sex hormone-binding globulin(SHBG)and adrenocorticotropic hormone(ACTH).Methods：A total of 92 PCOS patients of kidneydeficiency and blood stasis type were selected as research objects and divided into the western medicine经方古方 7新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4多囊卵巢综合征（PCOS）发病率约为 4%8%，是常见妇科病，以持续性无排卵、雄激素过多、胰岛素抵抗为主要临床表现1。达英-35 等抗雄激素药物是 PCOS 治疗的首选方案，可减少雄激素合成、分泌，使月经周期恢复正常，但疗效有限，停药后易复发2。PCOS 可归属于中医闭经、月经后期、不孕等范畴3。肾虚则阴阳、气血失常，水湿内停，痰湿内生，气血瘀滞，凝结成癥积，导致排卵不畅，因虚致瘀，因瘀致虚，二者形成恶性循环，故肾虚血瘀是 PCOS 发生的重要诱因4-5。当归芍药散为治疗肾虚血瘀证的主要方剂，方中当归、芍药、川芎养血活血，白术、茯苓培中益气，泽泻渗利湿浊、利水入group and the combination group according to random number table method，with 46 cases in each group.The western medicine group was treated with Daying-35，and the combination group was treated withmodified Danggui Shaoyao Powder combined with Daying-35.Both groups were treated for 3 courses oftreatment.The clinical effects and the occurrence of adverse reactions were compared between the twogroups.The changes of traditional Chinese medicine(TCM)syndrome scores，ovarian volume，endometrialthickness，endometrial protein expressions of phosphatidylinositol 3 kinase(PI3K)，protein kinase B(Akt)，phosphorylated Akt(p-Akt)and serum SHBG and ACTH levels before and after treatment were comparedbetween the two groups.Results：The total effective rate was 93.48%in the combination group and78.26%in the western medicine group，the difference being significant(P0.05).After treatment，theTCM syndrome scores of menstrual cycle，menstrual blood volumn，sore and weak lumbar and knee orlumbar spine trickling，dizziness and tinnitus，and abdominal pain during menstruation and the total scoresin the two groups were all decreased when compared with those before treatment(P0.05)，and theabove TCM syndrome scores and the total score in the combination group were lower than those in thewestern medicine group(P0.05).After treatment，the bilateral ovarian volume was decreased andendometrial thickness was increased in both groups when respectively compared with before treatment，differences being significant(P0.05).After treatment，the bilateral ovarian volume in the combinationgroup was smaller than that in the western medicine group，and the endometrial thickness was bigger thanthat in the western medicine group，differences being significant(P0.05).After treatment，the relativeprotein expression levels of PI3K，Akt and P-Akt in the endometrium of the two groups were increasedwhen compared with those before treatment(P0.05)，and those in the combination group were higherthan those in the western medicine group(P0.05).After treatment，the serum SHBG levels in the twogroups were increased when compared with those before treatment，and the ACTH levels were decreasedwhen compared with those before treatment，differences being significant(P0.05).After treatment，theSHBG level in the combination group was higher than that in the western medicine group，and the ACTHlevel was lower than that in the western medicine group，differences being significant(P0.05).Theincidence of adverse reactions was 4.35%in the combination group and 13.04%in the western medicinegroup，there being no significant difference between the two groups(P0.05).Conclusion：The therapy ofmodified Danggui Shaoyao Powder combined with Daying-35 has a significant therapeutic effect on thetreatment of PCOS of kidney deficiency and blood stasis type，which can alleviate clinical symptoms and