【作者】 万幸；

【导师】 李莉；

【作者基本信息】 广州中医药大学 ， 中医妇科学（专业学位）， 2022， 硕士

【摘要】 目的:本课题以痰瘀型多囊卵巢综合征患者为研究对象,将加味苍附导痰汤联合耳穴治疗和单纯加味苍附导痰汤治疗进行对比,观察加味苍附导痰汤结合耳穴治疗痰瘀型多囊卵巢综合征患者的安全性和有效性,为治疗痰瘀型多囊卵巢综合征患者提供治疗参考。方法:本课题通过回顾性观察性临床研究,收集2020年6月至2021年9月于广州中医药大学第一附属医院诊治的符合纳排标准的痰瘀型多囊卵巢综合征病例71例,根据治疗方案不同分为联合组(加味苍附导痰汤联合耳穴治疗)35例和中药组(单纯加味苍附导痰汤治疗)36例,观察组内和组间治疗前、治疗后和随访后的月经周期评分、中医临床证候评分、促黄体生成素/促卵泡生成素(LH/FSH)比值、抗缪勒管激素(AMH)水平、睾酮(T)水平、身体质量指数(BMI)、腰臀比(WHR)、多毛评分、黑棘皮症评分、痤疮评分、有生育要求者妊娠情况和不良反应情况。使用电子表格建立原始数据库,再用SPSS软件分析处理数据库数据。结果:1.治疗前两组患者一般资料(年龄、BMI、WHR、多毛评分、黑棘皮症评分、痤疮评分、LH/FSH比值、AMH水平、T水平)经统计学分析无显著差异(P>0.05)。2.经治疗后,联合组临床综合疗效总有效率(94.29%)高于中药组(75%),对总有效率进行统计学分析存在显著差异性(P<0.01)。3.治疗后两组组间月经周期评分和中医证候评分经统计学分析均无显著差异(P>0.05)。随访3个月后比较两组组间月经周期评分和中医证候评分,月经周期评分经统计学分析存在显著差异性(P<0.01),中医证候评分经统计学分析无显著差异(P>0.05)。4.治疗后,两组患者LH/FSH值、AMH、T水平都下降,组内激素水平经统计学分析,除LH/FSH值外差异均具有统计学意义(P<0.05);对两组组间AMH、T水平进行比较分析,差异均不具有统计学意义(P>0.05)。5.经治疗后、随访后,两组患者BMI、WHR均有所下降,但两组组内BMI、WHR经统计学分析均无显著差异（P>0.05)。6.两组组内多毛评分、黑棘皮症评分、痤疮评分经分析,仅痤疮评分差异具有统计学意义(P<0.05)。治疗后及随访后组间比较经统计学分析无显著差异(P>0.05)。7.观察期间,每组均有妊娠的患者,其中联合组有4人,中药组有2人,联合组有生育要求者妊娠率23.53%(4/17)高于中药组有生育要求者妊娠率11.76%(2/17)。8.71例痰瘀型PCOS病例,在整个治疗过程中和后续随访中,均无明显不适或严重过敏反应。结论:1.在提高临床综合疗效总有效率,改善月经周期评分、中医证候评分、痤疮评分,降低AMH水平、T水平和改善有生育要求者妊娠情况方面,加味苍附导痰汤联合耳穴贴压疗法和单独加味苍附导痰汤疗法均能作为治疗痰瘀型PCOS患者安全有效的方法。2.在提高临床综合疗效总有效率、改善月经周期评分和改善有生育要求者妊娠情况方面,加味苍附导痰汤联合耳穴贴压疗法比单独使用加味苍附导痰汤治疗疗效更佳。3.加味苍附导痰汤联合耳穴贴压疗法改善月经周期评分的影响可能比单独使用加味苍附导痰汤持续更久,提示耳穴贴压疗法具有远期优势。更多还原

【Abstract】 ObjectiveThis subject takes the patients with phlegm-stasis polycystic ovary syndrome as the research object,compares the modified Cangfu Daotan decoction combined with Auricle Point group and the simple modified Cangfu Daotan decoction group,and observes the clinical efficacy and safety of modified Cangfu Daotan decoction combined with Auricle Point on the patients with phlegm-stasis polycystic ovary syndrome,so as to provide treatment reference for the patients with phlegm-stasis polycystic ovary syndrome.MethodsThrough a retrospective observational clinical study,71 cases of phlegm-stasis polycystic ovary syndrome diagnosed and treated in the First Affiliated Hospital of Guangzhou University of traditional Chinese medicine from June 2020 to September 2021 were collected.According to different treatment schemes,they were divided into 35 cases in the combined group(treated with modified Cangfu Daotan decoction combined with Auricle Point group)and 36 cases in the traditional Chinese medicine group(treated with modified Cangfu Daotan decoction alone).Menstrual cycle score,TCM clinical syndrome score,Luteinizing hormone/follicle stimulating hormone(LH/FSH)ratio,anti-Mullerian hormone(AMH)level,testosterone(T)level,body mass index(BMI),Waist-to-hip ratio(WHR),hirsutism score,acanthosis nigricans score,acne score,pregnancy of those with fertility requirements and adverse reactions,before,after treatment and after follow-up were collected.The original data is processed by SPSS software.Results1.Before treatment,the general data(age,BMI,WHR,hirsutism score,acanthosis nigricans score,acne score,LH/FSH ratio,AMH level and T level)of the two groups were not statistically significant by test(P>0.05).2.After treatment,the total effective rate of clinical comprehensive curative effect in the combined group(94.29%)was higher than that in the traditional Chinese medicine group(75%),there was significant difference in curative effect(P<0.01).3.After treatment,the menstrual cycle score and TCM syndrome score of the two groups had no statistical significance(P>0.05).After 3 months of follow-up,the menstrual cycle score and TCM syndrome score of the two groups were compared.There was significant difference in menstrual cycle score(P<0.01),but there was no significant difference in TCM syndrome score(P>0.05).4.After treatment,the levels of LH/FSH,AMH and T in the two groups decreased.The hormone levels in the two groups were statistically significant except LH/FSH(P<0.05);The levels of AMH and T between the two groups were compared and analyzed,and the difference was not statistically significant(P>0.05).5.After treatment and follow-up,BMI and WHR of the two groups decreased,but there was no significant difference in BMI and WHR between the two groups(P>0.05).6.In the two groups of patients with hirsutism score,acanthosis nigricans score and acne score,only the difference in acne score is statistically significant(P<0.05).There was no significant difference between the groups after treatment and follow-up(P>0.05).7.During the observation period,there were pregnant patients in each group,including 4 in the combined group and 2 in the traditional Chinese medicine group.The pregnancy rate in the combined group was 23.53%(4/17),which was higher than that in the traditional Chinese medicine group by 11.76%(2/17).8.In 71 cases of phlegm-stasis PCOS,there was no obvious discomfort or severe allergic reaction during the whole treatment process and follow-up.Conclusion1.In terms of improving the overall curative effect,improving menstrual cycle score,TCM syndrome score and acne score,reducing AMH level and T level and improving pregnancy of those with fertility requirements,modified Cangfu Daotan decoction combined with Auricle Point and modified Cangfu Daotan decoction alone can be used as a safe and effective method for the treatment of phlegm-stasis PCOS patients.2.In terms of improving the overall curative effect,improving the menstrual cycle score and improving pregnancy of those with fertility requirements,the therapeutic effect of modified Cangfu Daotan decoction combined with Auricle Point is more lasting and better than that of modified Cangfu Daotan decoction alone.3.The effect of modified Cangfu Daotan decoction combined with Auricle Point on improving menstrual cycle score may last longer than that of modified Cangfu Daotan decoction alone,suggesting that Auricle Point has long-term advantages.更多还原