Analysis of curative effect of Zishen Huoxue Decoction in treating kidney deficiency and blood stasis type of diminished ovarian reserve
-
摘要:
目的 观察分析滋肾活血方治疗肾虚血瘀型卵巢储备功能减退的临床疗效，及对卵巢功能和血流的影响，为临床治疗提供依据。 方法 选取2022年7月—2023年11月宁波市中医院收治的750例卵巢储备功能减退(肾虚血瘀型)患者作为研究对象，采用随机数字表法将患者分为A组(滋肾活血方治疗)，B组(戊酸雌二醇片联合地屈孕酮片治疗)，C组(滋肾活血方+戊酸雌二醇片联合地屈孕酮片治疗)，每组250例。比较3组患者治疗效果、治疗前后血清促卵泡刺激素(FSH)、黄体生成素(LH)、抗米勒管激素(AMH)，窦卵泡数量(AFC)、卵巢体积(OV)以及卵巢基质血流指数的变化。 结果 A组、B组、C组总有效率分别为82.0%(205/250)、64.4%(161/250)、90.8%(227/250)，C组总有效率均高于B组、A组，A组总有效率高于B组(P＜0.05)。治疗后C组FSH、LH较A组及B组显著下降，A组FSH、LH较B组显著下降(P＜0.05)；C组AMH较A组及B组显著上升，A组AMH较B组显著上升(P＜0.05)。治疗后C组AFC、OV较A组及B组显著上升，A组AFC、OV较B组显著上升(P＜0.05)。治疗后C组PSV、VI、FI较A组及B组显著上升，A组VI较B组显著上升(P＜0.05)。 结论 滋肾活血方治疗肾虚血瘀型卵巢储备功能减退患者能有效调节卵巢功能，改善患者卵巢血流灌注，临床疗效显著，值得临床应用。 Abstract:Objective To observe and analyze the clinical efficacy of Zishen Huoxue Decoction in treating kidney deficiency and blood stasis type of diminished ovarian reserve, and its effect on ovarian function and ovarian blood flow, providing a basis for clinical treatment. Methods A total of 750 patients with diminished ovarian reserve (kidney deficiency and blood stasis type) admitted to Ningbo Municipal Hospital of Traditional Chinese Medicine(TCM) from July 2022 to November 2023 were selected as the study subjects, and the included patients were divided into group A (treated with Zishen Huoxue Decoction), group B (treated with estradiol valerate tablets combined with dydrogesterone tablets), and group C (treated with Zishen Huoxue Decoction + estradiol valerate tablets combined with dydrogesterone tablets) using the random number table method, with 250 patients in each group. Treatment effects, changes in follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), antral follicle count (AFC), ovarian volume (OV), and ovarian stromal flow index before and after treatment were compared among the three groups of patients. Results The total effective rates of group A, group B, and group C were 82.0% (205/250), 64.4% (161/250), and 90.8% (227/250), respectively, and the total effective rates of group C were all higher than those of group B and A, and the total effective rate of group A was higher than that of group B (P < 0.05). After treatment, FSH and LH decreased more significantly in group C than in groups A and B, and FSH and LH decreased more significantly in group A than in group B (P < 0.05). AMH rose more significantly in group C than in groups A and B, and AMH rose more significantly in group A than in group B (P < 0.05). AFC and OV rose more significantly in group C than in groups A and B after treatment, and AFC and OV rose more significantly in group A than in group B (P < 0.05). PSV, VI, and FI rose were more significantly in group C than in groups A and B after treatment, and VI levels rose was more significantly in group A than in group B (P < 0.05). Conclusion Zishen Huoxue Decoction can effectively regulate ovarian function and improve ovarian blood supply in patients with kidney deficiency and blood stasis type of diminished ovarian reserve, with remarkable clinical efficacy, and is worth applying in clinical practice. -
表 1 3组卵巢储备功能减退(肾虚血瘀型)患者一般资料比较
Table 1. Comparison of general data of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups
组别 例数 年龄范围(岁) 年龄(x±s，岁) 初潮年龄范围(岁) 初潮年龄(x±s，岁) 生育次数(x±s) A组 250 23~40 35.67±3.14 9~19 13.24±1.32 1.35±0.66 B组 250 26~40 35.94±3.05 8~18 13.15±1.36 1.38±0.64 C组 250 27~40 35.98±3.22 10~18 13.26±1.20 1.36±0.68 F值 0.725 0.492 0.159 P值 0.485 0.611 0.853 
下载: 导出CSV
表 2 3组卵巢储备功能减退(肾虚血瘀型)患者临床疗效比较
Table 2. Comparison of clinical efficacy of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups
组别 例数 治愈(例) 显效(例) 有效(例) 无效(例) 有效率(%) A组 250 48 103 54 45 82.0(205/250)a B组 250 29 51 81 89 64.4(161/250) C组 250 89 75 63 23 90.8(227/250)ab χ2值 54.481 P值 ＜0.001 注：与B组比较，aP＜0.017；与A组比较，bP＜0.017。
下载: 导出CSV
表 3 3组卵巢储备功能减退(肾虚血瘀型)患者FSH、LH、AMH比较(x±s)
Table 3. Comparison of FSH, LH and AMH of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups(x±s)
组别 例数 FSH(IU/L) LH(IU/L) AMH(ng/mL) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 A组 250 16.61±2.20 9.90±2.19a 7.74±2.09 6.43±2.03a 0.72±0.22 1.62±0.55a B组 250 16.67±2.15 10.70±2.16 7.79±2.04 6.88±1.94 0.70±0.23 1.31±0.53 C组 250 16.78±2.30 9.16±2.26ab 7.66±2.02 5.65±1.81ab 0.74±0.21 2.14±0.59ab F值 0.394 30.139 0.287 25.953 1.917 137.494 P值 0.675 ＜0.001 0.751 ＜0.001 0.148 ＜0.001 注：与B组比较，aP＜0.05；与A组比较，bP＜0.05。
下载: 导出CSV
表 4 3组卵巢储备功能减退(肾虚血瘀型)患者AFC、OV比较(x±s)
Table 4. Comparison of AFC, OV of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups(x±s)
组别 例数 AFC(个) OV(cm3) 治疗前 治疗后 治疗前 治疗后 A组 250 3.54±1.49 5.84±2.05a 4.05±1.40 5.21±1.07a B组 250 3.52±1.60 5.34±2.07 3.94±1.30 4.73±1.02 C组 250 3.49±1.57 6.42±2.05ab 4.03±1.32 5.41±1.10a F值 0.081 18.187 0.429 28.792 P值 0.922 ＜0.001 0.652 ＜0.001 注：与B组比较，aP＜0.05；与A组比较，bP＜0.05。
下载: 导出CSV
表 5 3组卵巢储备功能减退(肾虚血瘀型)患者卵巢基质动脉血流指数比较(x±s)
Table 5. Comparison of ovarian stromal artery flow index of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups(x±s)
组别 例数 PSV(cm/s) VI FI 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 A组 250 9.70±3.64 10.85±3.66 3.56±1.31 4.11±1.34b 25.34±3.74 26.55±3.75 B组 250 9.86±3.50 10.76±3.67 3.69±1.32 3.82±1.32 25.44±3.76 26.10±3.92 C组 250 9.63±3.40 11.17±3.90ab 3.64±1.28 4.65±1.37ab 25.51±3.74 26.95±3.82ab F值 0.273 3.954 0.651 24.531 0.128 3.089 P值 0.761 0.020 0.522 ＜0.001 0.880 0.046 注：与A组比较，aP＜0.05；与B组比较，bP＜0.05。
下载: 导出CSV
-
[1] YIN J, CHANG H M, LI R, et al. Recent progress in the treatment of women with diminished ovarian reserve[J]. GOCM, 2021, 1(4): 186-189. doi: 10.1016/j.gocm.2021.10.004 [2] 梁秀茹, 孟艳. 卵巢储备功能减退的内质网应激机制及其研究进展[J]. 中华生殖与避孕杂志, 2020, 40(6): 521-525. doi: 10.3760/cma.j.cn101441-20190601-00233LIANG X R, MENG Y. Research progress of endoplasmic reticulum stress on diminished ovarian reserve[J]. Chinese Journal of Reproduction and Contraception, 2020, 40(6): 521-525. doi: 10.3760/cma.j.cn101441-20190601-00233 [3] JIAO Z, BUKULMEZ O. Potential roles of experimental reproductive technologies in infertile women with diminished ovarian reserve[J]. J Assist Reprod Genet, 2021, 38(10): 2507-2517. doi: 10.1007/s10815-021-02246-6 [4] 刘阿慧, 张学红. 卵巢储备功能降低女性的生育策略研究新进展[J]. 中国计划生育和妇产科, 2022, 14 (6): 10-13. doi: 10.3969/j.issn.1674-4020.2022.06.03LIU A H, ZHANG X H. New advances in fertility strategies for women with reduced ovarian reserve[J]. Chinese Journal of Family Planning & Gynecotokology, 2022, 14 (6): 10-13. doi: 10.3969/j.issn.1674-4020.2022.06.03 [5] BOMPOULA M S, VALSAMAKIS G, NEOFYTOU S, et al. Demographic, clinical and hormonal characteristics of patients with premature ovarian insufficiency and those of early menopause: data from two tertiary premature ovarian insufficiency centers in Greece[J]. Gynecol Endocrinol, 2020, 36(8): 693-697. doi: 10.1080/09513590.2020.1739266 [6] 杨思晨, 王玲, 章勤, 等. 中医药治疗卵巢功能减退性疾病研究文献可视化分析[J]. 中国中医药信息杂志, 2023, 30(4): 34-40. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYY202304006.htmYANG S C, WANG L, ZHANG Q, et al. Literature visual analysis of TCM research on ovarian hypofunction diseases[J]. Chinese Journal of Information on Traditional Chinese Medicine, 2023, 30(4): 34-40. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYY202304006.htm [7] 谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018: 359.XIE X, KONG B H, DUAN T. Gynecology and obstetrics[M]. 9th edition. Beijing: People's Medical Publishing House, 2018: 359. [8] 卵巢储备功能减退临床诊治专家共识专家组, 中华预防医学会生育力保护分会生殖内分泌生育保护学组. 卵巢储备功能减退临床诊治专家共识[J]. 生殖医学杂志, 2022, 31(4): 425-434. doi: 10.3969/j.issn.1004-3845.2022.04.001Consensus expert group on clinical diagnosis and treatment of ovarian reserve dysfunction, Reproductive endocrinology and Fertility Protection Group, Fertility Protection Branch, Chinese Preventive Medical Association. Consensus on clinical diagnosis and management of diminished ovarian reserve[J]. Journal of Reproductive Medicine, 2022, 31(4): 425-434. doi: 10.3969/j.issn.1004-3845.2022.04.001 [9] 李灿东, 吴承玉. 中医诊断学[M]. 10版. 北京: 中国中医药出版社, 2012: 91-93.LI C D, WU C Y, (Ed.). TCM diagnostics[M]. 10th edition. Beijing: China Traditional Chinese Medicine Press, 2012: 91-93. [10] 谈勇. 中医妇科学[M]. 10版. 北京: 中国中医药出版社, 2016: 139-141.Tan Y. Gynecology of traditional Chinese medicine[M]. 10th edition. Beijing: China Traditional Chinese Medicine Press, 2016: 139-141. [11] 郑筱萸. 中药新药临床研究指导原则试行[M]. 北京: 中国医药科技出版社, 2002: 239-243.ZHENG X Y. Trial implementation of guiding principles for clinical research of new Chinese medicine[M]. Beijing: China Medical Science Press, 2002: 239-243. [12] SCANTAMBURLO V M, VON LINSINGEN R, CENTA L J R, et al. Association between decreased ovarian reserve and poor oocyte quality[J]. Obstetrics & Gynecology Science, 2021, 64(6): 532-539. [13] BARROS F, CARVALHO F, BARROS A, et al. Premature ovarian insufficiency: clinical orientations for genetic testing and genetic counseling[J]. Porto Biomed, 5(3): e62. DOI: 10.1097/j.pbj.0000000000000062. [14] 田沛哲, 李蕾, 范英英, 等. 卵巢储备功能减退的研究进展[J]. 中华实用诊断与治疗杂志, 2021, 35(7): 753-756. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202107026.htmTIAN P Z, LI L, FAN Y Y, et al. Diminished ovarian reserve function[J]. Journal of Chinese Practical Diagnosis and Therapy, 2021, 35(7): 753-756. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202107026.htm [15] 张文瑜, 吴欢. 陈氏调经汤联合芬吗通治疗肝肾阴虚型卵巢早衰的临床疗效观察[J]. 中华全科医学, 2022, 20(11): 1934-1937. doi: 10.16766/j.cnki.issn.1674-4152.002739ZHANG W Y, WU H. Clinical observation of Chen' s menstrual conditioning soup combined with femostone on premature ovarian failure of liver and kidney Yin deficiency syndrome[J]. Chinese Journal of General Practice, 2022, 20(11): 1934-1937. doi: 10.16766/j.cnki.issn.1674-4152.002739 [16] 李善霞, 何东云, 张艳红, 等. 补肾养血方治疗肾阴虚型卵巢储备功能下降的临床观察[J]. 中华中医药学刊, 2019, 37(2): 361-364. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201902025.htmLI S X, HE D Y, ZHANG Y H, et al. Clinical observation on diminished ovarian reserve of kidney-yin deficiency syndrome treated with kidney-tonifying and blood-nourishing method[J]. Chinese Archives of Traditional Chinese Medicine, 2019, 37(2): 361-364. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201902025.htm [17] 彭勋潜. 基于"天癸竭"探讨补肾法治疗绝经后骨质疏松症[J]. 湖北中医杂志, 2019, 41(6): 53-55. https://www.cnki.com.cn/Article/CJFDTOTAL-HBZZ201906021.htmPENG X Q. Study on tonifying kidney therapy for postmenopausal osteoporosis based on "Tiandecui exhaustion"[J]. Hubei Journal of Traditional Chinese Medicine, 2019, 41(6): 53-55. https://www.cnki.com.cn/Article/CJFDTOTAL-HBZZ201906021.htm [18] 刘振斌, 王刚, 李梦虎. 下肢深静脉血栓形成的中西医治疗进展[J]. 中国中西医结合外科杂志, 2021, 27(1): 149-153. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZX202101037.htmLIU Z B, WANG G, LI M H. Progress of traditional Chinese and Western medicine in the treatment of deep vein thrombosis of lower extremities[J]. Chinese Journal of Surgery of Integrated Traditional and Western Medicine, 2021, 27(1): 149-153. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZX202101037.htm [19] 刘柳青, 刘雁峰, 王悦竹, 等. 卵巢储备功能下降中医证型特点及用药规律文献挖掘研究[J]. 中国中医药信息杂志, 2021, 28(6): 33-38. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYY202106007.htmLIU L Q, LIU Y F, WANG Y Z, et al. Characteristics of TCM syndromes and medication rules in treatment of diminished ovarian reserve based on data mining[J]. Chinese Journal of Information on Traditional Chinese Medicine, 2021, 28(6): 33-38. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYY202106007.htm [20] 刘芸, 王慧, 张莹, 等. 补肾活血法治疗卵巢储备功能减退机制研究进展[J]. 江西中医药, 2021, 52(1): 72-75. https://www.cnki.com.cn/Article/CJFDTOTAL-JXZY202101035.htmLIU Y, WANG H, ZHANG Y, et al. Research progress on mechanism of tonifying kidney and promoting blood circulation in treatment of decreased ovarian reserve function[J]. Jiangxi Journal of Traditional Chinese Medicine, 2021, 52(1): 72-75. https://www.cnki.com.cn/Article/CJFDTOTAL-JXZY202101035.htm [21] 代琪, 叶臻, 叶俏波, 等. 续断来源考证, 化学成分及药理作用综述[J]. 中国药物评价, 2020, 37(6): 432. doi: 10.3969/j.issn.2095-3593.2020.06.007DAI Q, YE Z, YE Q B, et al. Textual research of source, chemical constituents and pharmacological action of radixdipsaci: a review[J]. Chinese Journal of Drug Evaluation, 2020, 37(6): 432. doi: 10.3969/j.issn.2095-3593.2020.06.007 [22] 江峰, 李肇暖. AMH﹑FSH和LH联合检测用于评估卵巢储备功能的研究[J]. 中外医疗, 2019, 38(34): 170-172. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ201934058.htmJIANG F, LI Z N. Study on combined detection of AMH, FSH and LH for evaluating ovarian reserve function[J]. China Foreign Medical Treatment, 2019, 38(34): 170-172. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ201934058.htm [23] MOOLHUIJSEN L M E, VISSER J A. Anti-Müllerian hormone and ovarian reserve: update on assessing ovarian function[J]. J Clin Endocrina Metab, 2020, 105(11): 3361-3373. doi: 10.1210/clinem/dgaa513 [24] 钟思苗, 欧婉燕, 黄芳, 等. 经阴道彩色多普勒在评估卵巢储备功能的临床价值[J]. 中国医学创新, 2020, 17(1): 147-150. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYCX202001041.htmZHONG S M, OU W Y, HUANG F, et al. The clinical value of transvaginal color Doppler in evaluating ovarian reserve function[J]. Chinese Medical Innovations, 2020, 17(1): 147-150. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYCX202001041.htm [25] 李湘, 杨丽莉, 张伟娜. 阴道彩色多普勒超声对卵巢储备功能的应用价值分析[J]. 中国现代药物应用, 2021, 15(19): 53-55. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202119019.htmLI X, YANG L L, ZHANG W N. The value of transvaginal color Doppler ultrasound in ovarian reserve function[J]. Chinese Journal of Modern Drug Application, 2021, 15(19): 53-55. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202119019.htm [26] 刘传明, 丁利军, 李佳音, 等. 衰老导致卵巢功能低下研究进展[J]. 遗传, 2019, 41(9): 816-826. https://www.cnki.com.cn/Article/CJFDTOTAL-YCZZ201909004.htmLIU C M, DING L J, LI J Y, et al. Advances in the study of ovarian dysfunction with aging[J]. Hereditas, 2019, 41(9): 816-826. https://www.cnki.com.cn/Article/CJFDTOTAL-YCZZ201909004.htm [27] 程扬眉. 经阴道三维超声在卵巢储备功能减低定量评估及不孕症患者治疗监测中的应用研究[D]. 合肥: 安徽医科大学, 2019.CHENG Y M. The value of transvaginal three-dimensional ultrasound in quantitative evaluation of decreased ovarian reserve function and the treatment detection of infertility patients[D]. Hefei: Anhui Medical University, 2019. [28] 王木兰, 谢颜潞, 黎爱容. 经阴道超声检查在排卵预测中的价值以及对卵巢储备的评估[J]. 中国实用医药, 2021, 16(22): 50-52. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202122014.htmWANG M L, XIE Y L, LI A R. Value of transvaginal ultrasonography in ovulation prediction and assessment of transvaginal ultrasonography in ovarian reserve[J]. China Practical Medicine, 2021, 16(22): 50-52. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202122014.htm [29] SAHIN M, GUVEN S, SAL H, et al. Evaluation of ovarian reserve in unexplained ınfertile cases: a case-controlled study[J]. Middle East Fertil Soc J, 2023, 28. DOI: org/ 10.1186/s43043-023-00154-6. [30] 刘三英, 高晓艳, 王旭. 三维多普勒超声评估卵巢储备降低女性的卵巢功能的价值研究[J]. 临床和实验医学杂志, 2020, 19(20): 2234-2238. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC202020032.htmLIU S Y, GAO X Y, W X. Evaluation of the effect of ovarian blood supply on ovulation in diminished ovarian reserve by three dimensional color doppler ultrasound[J]. Journal of Clinical and Experimental Medicine, 2020, 19(20): 2234-2238. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC202020032.htm -
点击查看大图
表(5)
计量
- 文章访问数: 43
- HTML全文浏览量: 24
- PDF下载量: 3
- 被引次数: 0
