摘要
目的观察朱氏补肾活血方治疗卵巢早衰(POF)肾虚血瘀证患者的临床疗效,探讨POF患者抗米勒管激素(AMH)与微RNA(miR)-23a的相关性,为POF的治疗寻求更安全有效的方法。方法纳入73例POF肾虚血瘀证患者,随机分为中药组35例和西药组38例。中药组患者给予补肾活血方口服,西药组患者给予雌二醇片/雌二醇地屈孕酮片口服,治疗周期均为3个月经周期。治疗前后,评价并比较两组患者的中医证候积分;检测患者的血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、泌乳素(PRL)、睾酮(T)、AMH及miR-23a水平,采用Pearson检验分析AMH与miR-23a的相关性;采用阴道B型超声测定患者的子宫体积、卵巢体积及卵巢动脉收缩期峰值流速(PSV)、阻力指数(RI)。结果 (1)中医证候积分:治疗后,两组患者的中医证候积分均明显降低(P<0.01),且中药组患者的积分低于西药组(P<0.01)。(2)血清性激素水平:治疗后,两组患者的FSH水平较治疗前均明显降低(P<0.01),西药组患者的LH水平较治疗前亦降低(P<0.05)。(3)AMH、miR-23a水平:治疗后,两组患者的AMH水平上升(P<0.05),miR-23a水平下降(P<0.05);组间AMH、miR-23a水平比较,差异均无统计学意义(P>0.05)。相关性分析结果显示,治疗前POF患者外周血AMH与miR-23a水平呈负相关(r=-0.328,P<0.05),中药组患者治疗前后的AMH差值与miR-23a差值呈负相关(r=-0.470,P<0.01)。(4)超声检测指标:治疗后,两组患者的卵巢动脉PSV较治疗前均明显升高(P<0.01),中药组患者的卵巢动脉RI较治疗前明显降低(P<0.01),且中药组患者的卵巢动脉RI低于西药组(P<0.05)。结论朱氏补肾活血方可有效改善POF肾虚血瘀证患者的中医证候,调控下丘脑-垂体-卵巢轴(HPO轴)的平衡,丰富卵巢血供,降低miR-23a水平,提高AMH水平,改善POF患者的卵巢储备功能。
Objective To observe the clinical effect of Zhu’s Bushen Huoxue Recipe in treating patients of premature ovarian failure(POF) with syndrome of kidney deficiency and blood stasis and explore the correlation between anti-Müllerian hormone(AMH) and microRNA-23 a(miR-23 a) of POF patients, so as to seek a safe and effective method for the treatment of POF. Methods Seventy-three patients of POF with syndrome of kidney deficiency and blood stasis were included and randomly divided into the Chinese medicine group(35 cases) and western medicine group(38 cases). The patients in the Chinese medicine group were orally treated with Bushen Huoxue Recipe, and the patients in the western medicine group were orally treated with estradiol tablets/estradiol and dydrogesterone tablets. The treatment course was 3 menstrual cycles. Before and after treatment,the scores of Chinese medical syndrome in both groups were evaluated and compared;the levels of serum follicle-stimulating hormone( FSH),luteinizing hormone( LH),estradiol( E2),prolactin( PRL),testosterone( T),AMH and mi R-23 a were detected,and the correlation between AMH and mi R-23 a was analyzed by Pearson test;the uterine volume,ovarian volume and the peak systolic velocity( PSV) and resistance index( RI) of ovarian artery were tested through transvaginal B-mode ultrasound. Results(1)The score of Chinese medical syndrome: After treatment,the scores of Chinese medical syndrome in the two groups were significantly decreased( P<0.01),and the score of the Chinese medicine group was lower than that of the western medicine group( P<0.01).(2)The levels of serum sex hormones: After treatment,the levels of FSH in the two groups were significantly decreased compared with those before treatment( P<0.01),and the level of LH in the western medicine group was also decreased compared with that before treatment( P<0.05).(3)The levels of AMH and mi R-23 a: After treatment,the levels of AMH in the two groups were increased( P<0.05),and the levels of mi R-23 a were decreased( P<0.05);there
作者
宋靖宜
夏艳秋
董莉
SONG Jingyi;XIA Yanqiu;DONG Li(Department of Gynaecology and Obstetrics,Baoshan Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201999,China;Department of Gynaecology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)
出处
《上海中医药杂志》
2021年第6期41-45,共5页
Shanghai Journal of Traditional Chinese Medicine
基金
国家中医药管理局“朱南孙国医大师传承工作室”建设项目(DSGZS-2017001)
上海市进一步加快中医药事业发展三年行动计划项目(ZY[2018-2020]-CCCX-1008)
上海市科委科研计划项目(16401931900)
上海市自然科学基金资助项目(16ZR1438000)
上海申康医院发展中心三年行动计划项目(16CR3040A)
上海中医药大学附属岳阳中西医结合医院科研项目(2017YJ06)。
