李 丹, 李 娟, 岳明明, 陳 芳, 黃丹丹

(新疆醫(yī)科大學(xué)附屬中醫(yī)院 婦科, 新疆 烏魯木齊, 830000)

溫經(jīng)湯對(duì)月經(jīng)病實(shí)寒證患者血清卵泡刺激素、促黃體生成素、雌二醇、黃體酮、睪酮的影響

李 丹, 李 娟, 岳明明, 陳 芳, 黃丹丹

(新疆醫(yī)科大學(xué)附屬中醫(yī)院 婦科, 新疆 烏魯木齊, 830000)

目的探討溫經(jīng)湯對(duì)月經(jīng)病實(shí)寒證患者血清卵泡刺激素(FSH)、促黃體生成素(LH)、雌二醇(E2)、黃體酮(P)、睪酮(T)的影響。方法選取90例月經(jīng)病實(shí)寒證患者。按照隨機(jī)數(shù)表法分為觀察組和對(duì)照組。對(duì)照組采用常規(guī)治療，觀察組采用溫經(jīng)湯治療，觀察2組患者療效，比較血清FSH、LH、E2、P、T、5-羥色胺(5-HT)、β-內(nèi)啡肽(β-EP)、子宮血流動(dòng)力學(xué)指標(biāo)變化。結(jié)果治療后，觀察組總有效率顯著高于對(duì)照組(P<0.05); 觀察組FSH、LH、E2顯著高于對(duì)照組(P<0.05), 5-HT顯著低于對(duì)照組, β-EP顯著高于對(duì)照組(P<0.05); 觀察組PSV顯著大于對(duì)照組, RI、PI顯著小于對(duì)照組(P<0.05)。結(jié)論溫經(jīng)湯治療月經(jīng)病實(shí)寒證療效顯著，能夠改善血清FSH、LH、E2、P、T水平，可調(diào)節(jié)患者的內(nèi)分泌紊亂。

溫經(jīng)湯; 月經(jīng)病; 實(shí)寒證; 促卵泡素; 黃體生成素; 雌二醇; 孕酮; 睪酮

月經(jīng)病實(shí)寒證主要是由寒所致，容易與血搏結(jié)，引起寒凝血淤，導(dǎo)致沖任胞脈被阻，其臨床癥狀主要表現(xiàn)為痛經(jīng)、經(jīng)期量少、閉經(jīng)等，是臨床上常見的婦科疾病[1]。研究[2-3]認(rèn)為，月經(jīng)病實(shí)寒證會(huì)使患者內(nèi)分泌功能出現(xiàn)紊亂，應(yīng)采用活血化瘀、散寒等方劑對(duì)患者進(jìn)行治療。溫經(jīng)湯是一種由多種中藥材制成的方劑，是治療婦科疾病的常用方劑。本研究對(duì)月經(jīng)病實(shí)寒證患者采用溫經(jīng)湯治療，觀察其治療前后的月經(jīng)恢復(fù)情況及子宮動(dòng)脈血流變化，現(xiàn)報(bào)告如下。

1 資料與方法

1.1 一般資料

選取2014年4月—2015年4月本院接診的90例月經(jīng)病實(shí)寒證患者。納入標(biāo)準(zhǔn)[4]: ① 符合《中醫(yī)婦科學(xué)》診斷標(biāo)準(zhǔn); ② 肝腎功能正常患者; ③ 無心腦血管疾病; ④ 面色較白，四肢欠溫，腹部疼痛; ⑤ 經(jīng)期量少且不規(guī)律，有血塊; ⑥ 均同意本次研究。排除標(biāo)準(zhǔn): ① 患有高血壓; ② 卵巢腫瘤者; ③ 血液系統(tǒng)疾病者; ④ 患有精神疾病。按照隨機(jī)數(shù)字表法分為觀察組和對(duì)照組各45例。觀察組年齡13～40歲，平均年齡(25.38±2.01)歲，已婚29例，未婚16例; 痛經(jīng)20例，月經(jīng)后期10例，月經(jīng)量少7例，閉經(jīng)8例。對(duì)照組年齡12～40歲，平均年齡(26.08±2.32)歲，已婚27例，未婚18例; 痛經(jīng)19例，月經(jīng)后期11例，月經(jīng)量少8例，閉經(jīng)7例。本研究已獲得本院倫理委員會(huì)批準(zhǔn), 2組患者性別、年齡無顯著差異(P>0.05), 具有可比性。

1.2 方法

給予對(duì)照組患者常規(guī)治療。給予觀察組患者溫經(jīng)湯治療，組方為: 10 g肉桂, 6 g吳茱萸, 10 g小茴香, 9 g莪術(shù), 10 g丹皮, 6 g牛膝, 10 g當(dāng)歸, 10 g川芎, 10 g紅花, 10 g五靈脂, 15 g元胡, 15 g白芍, 1劑/d ,分2次服用，治療期間不給予其他藥物治療。2組患者治療療程均為3個(gè)月。

1.3 觀察指標(biāo)

觀察2組患者治療療效，檢測(cè)治療后血清卵泡刺激素(FSH)、促黃體生成素(LH)、雌二醇(E2)、黃體酮(P)、睪酮(T), 5-羥色胺(5-HT)、β-內(nèi)啡肽(β-EP), 比較子宮血流動(dòng)力學(xué)。分別于患者治療前后采取空腹靜脈血6 mL, 分離血清后等待檢測(cè)，采用放射免疫分析法檢測(cè)FSH、LH、E2、P、T、β-EP, 各指標(biāo)按照劑盒說明書操作; 采用藥理實(shí)驗(yàn)方法學(xué)檢測(cè)5-HT。

1.4 療效評(píng)定標(biāo)準(zhǔn)

腹痛及臨床癥狀消失，月經(jīng)量及周期恢復(fù)正常且停藥后3個(gè)月未復(fù)發(fā)為治愈; 腹痛及臨床癥狀明顯改善，月經(jīng)量增多，周期持續(xù)5 d以上，停藥后不能維持3個(gè)月為有效[5]。腹痛及臨床癥狀、月經(jīng)量及周期未改善為無效。

1.5 統(tǒng)計(jì)學(xué)方法

采用SPSS 18.0軟件包進(jìn)行處理，計(jì)量資料采用t檢驗(yàn)，計(jì)數(shù)資料采用χ2檢驗(yàn)，等級(jí)資料的比較采用秩和檢驗(yàn),P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2 結(jié) 果

觀察組總有效率為95.55%, 顯著高于對(duì)照組的71.11%(P<0.05), 見表1。治療前, 2組患者FSH、LH、E2、P、T比較無顯著差異(P>0.05); 治療后, 2組患者FSH、LH、E2、P、T均顯著改善，且觀察組與對(duì)照組FSH、LH、E2比較有顯著差異(P<0.05), 見表2。治療前, 2組患者5-HT、β-EP無顯著差異(P>0.05); 治療后, 2組患者5-HT、β-EP均有所改善，且治療后觀察組5-HT顯著低于對(duì)照組, β-EP顯著高于對(duì)照組(P<0.05), 見表3。治療后，觀察組PSV顯著大于對(duì)照組, RI、PI顯著小于對(duì)照組(P<0.05), 2組子宮內(nèi)膜厚度無顯著差異(P>0.05), 見表4。

表1 2組患者治療情況比較[n(%)]

與對(duì)照組比較, *P<0.05。

表2 2組患者治療前后血清FSH、LH、E2、P、T比較

與治療前比較, *P<0.05; 與對(duì)照組比較, #P<0.05。

表3 2組患者治療前后5-HT、β-EP比較

與治療前比較, *P<0.05; 與對(duì)照組比較, #P<0.05。

3 討 論

中醫(yī)[6]認(rèn)為，寒性收引凝滯，寒邪侵入人體后，會(huì)使其經(jīng)脈拘攣，血行瘀滯。“婦女已血為本”，當(dāng)其月經(jīng)或者生產(chǎn)后，體內(nèi)受寒或飲食寒涼，寒搏于血，使血液流通受阻，遂使婦女月經(jīng)后期，月經(jīng)量少; 寒氣沖任，胞宮，所謂通則不痛，痛則不通，固而使患者感到痛經(jīng)[7-8]。體內(nèi)寒邪，血液受寒致凝，從而導(dǎo)致患者閉經(jīng)[9]。

表4 2組患者治療后子宮血流動(dòng)力學(xué)比較

與對(duì)照組比較, *P<0.05。

溫經(jīng)湯主治療血淤凝寒，其出自陳自明《婦人大全良方》中，是多種中藥材制劑，成分包括肉桂，吳茱萸，小茴香，莪術(shù)，丹皮，牛膝，當(dāng)歸，川芎，紅花，五靈脂，元胡，白芍[10]。吳茱萸具有散寒止痛、溫脾利濕的功效; 小茴香可祛寒止痛; 莪術(shù)能夠行氣破血，可改善患者痛經(jīng)就閉經(jīng); 丹皮、牛膝、當(dāng)歸可活血; 川芎、紅花能夠活血止痛; 五靈脂、元胡可疏通血脈，散瘀止痛[11]。諸藥合用，可有效地改善患者的血淤阻滯，能夠溫經(jīng)散寒，起到調(diào)經(jīng)止痛的作用[12]。本研究中，所有月經(jīng)病實(shí)寒證患者的確存在子宮血流動(dòng)力學(xué)阻礙現(xiàn)象，血流信號(hào)微弱，無法得到充足的血液供應(yīng), PSV出現(xiàn)降低, RI、PI發(fā)生升高，對(duì)患者的卵巢功能造成影響，紊亂生殖激素，從而造成一系列的臨床癥狀。本實(shí)驗(yàn)顯示，采用溫經(jīng)湯治療的患者PSV顯著大于采用常規(guī)治療的患者, RI、PI顯著小于采用常規(guī)治療的患者，說明溫經(jīng)湯能夠改善患者的子宮血流動(dòng)力學(xué)有關(guān)。Faramarzi H等[13]研究證實(shí)，溫經(jīng)湯能夠減少血管阻力，可擴(kuò)張血管以及改善血液供應(yīng)，恢復(fù)正常的生理功能，改善患者的痛經(jīng)、閉經(jīng)等。本研究采用溫經(jīng)湯治療的患者總有效率為95.55%, 采用常規(guī)治療的患者總有效率為71.11%, 說明溫經(jīng)湯具有更好的治療療效。

FSH是由腦垂體分泌的一種促進(jìn)女性卵泡的激素，與LH相互作用，受E2的調(diào)控，通過FSH水平，可以了解女性內(nèi)分泌狀態(tài)和卵巢功能狀態(tài)，若FSH的水平過高，表明女性的卵巢功能差，若FSH的水平過低，則表示可能患有多囊性卵巢綜合征等疾病[14]。LH在有FSH存在下，與其協(xié)同作用，以促進(jìn)卵巢雌激素分泌，能夠使破裂的卵巢形成黃體，分泌雌激素和孕激素，因此又被稱為細(xì)胞促進(jìn)素[15]。P是一種天然孕激素，為維持妊娠所必須, T由卵巢分泌。Chen L等[16]研究認(rèn)為，溫經(jīng)湯能夠通過調(diào)節(jié)下丘腦-垂體-卵巢軸來刺激相關(guān)激素的釋放。本研究顯示，采用溫經(jīng)湯治療的患者FSH、LH、E2的改善均優(yōu)于采用常規(guī)治療的患者。說明溫經(jīng)湯能夠促使FSH、LH、E2的正常釋放，調(diào)節(jié)患者的內(nèi)分泌紊亂，改善臨床癥狀[17]。采用溫經(jīng)湯治療的患者5-HT低于采用常規(guī)治療的患者。分析原因是溫經(jīng)湯提高血液流動(dòng)速度，改善了患者的血液循環(huán)，加快了5-HT的代謝[19]。β-EP高于采用常規(guī)治療的患者，表明溫經(jīng)湯增強(qiáng)了鎮(zhèn)痛的作用，可顯著提高血清β-EP水平，緩解了子宮缺氧的狀態(tài)[20]。

[1] Marciniak A, Nawrocka Rutkowska J, Brodowska A, et al. Cardiovascular system diseases in patients with polycystic ovary syndrome - the role of inflammation process in this pathology and possibility of early diagnosis and prevention[J]. Ann Agric Environ Med, 2016, 23(4): 537-541.

[2] Stefani L, Galanti G, Lorini S, et al. Female athletes and menstrual disorders: a pilot study[J]. Muscles Ligaments Tendons J, 2016, 6(2): 183-187.

[3] Shahebrahimi K, Jalilian N, Bazgir N, et al. Comparison clinical and metabolic effects of metformin and pioglitazone in polycystic ovary syndrome[J]. Indian J Endocrinol Metab, 2016, 20(6): 805-809.

[4] Brede S, Serfling G, Klement J, et al. Clinical Scenario of the Metabolic Syndrome[J]. Visc Med, 2016, 32(5): 336-341.

[5] Maini I, Ivanovski I, Iodice A, et al. Endocrinological Abnormalities Are a Main Feature of 17p13. 1 Microduplication Syndrome: A New Case and Literature Review[J]. Mol Syndromol, 2016, 7(6): 337-343.

[6] Sharma S, Deuja S, Saha CG. Menstrual pattern among adolescent girls of Pokhara Valley: a cross sectional study[J]. BMC Womens Health, 2016, 16(1): 74-79.

[7] Fiolková K, Biringer K, Hrtánková M, et al. Coeliac disease as a possible cause of some gynecological and obstetric abnormalities [J]. Ceska Gynekol, 2016, 81(6): 470-476.

[8] Karimi-Zarchi M, Abadinezhad M Z, Bonyadpour B, et al. Evaluate the Effectiveness of Conservative Treatment for Menorrhagia in Women who were Admitted to the Shahid Sadoughi Hospital of Yazd-Iran in 2014-2015 [J]. Int J Biomed Sci, 2016, 12(3): 105-109.

[9] Vercellini P, Buggio L, Berlanda N, et al. Estrogen-progestins and progestins for the management of endometriosis[J]. Fertil Steril, 2016, 106(7): 1552-1571.

[10] Subasinghe A K, Happo L, Jayasinghe Y L, et al. Prevalence and severity of dysmenorrhoea, and management options reported by young Australian women [J]. Aust Fam Physician, 2016, 45(11): 829-834.

[11] Kili?kesmez ?, Firat Z, Oygen A, et al. Diffusion Tensor Imaging of the Uterine Zones Related to the Menstrual Cycle and Menopausal Status at 3 Tesla MRI[J]. Balkan Med J, 2016, 33(6): 607-613.

[12] Xu T, Hui L, Juan Y L, et al. Effects of moxibustion or acupoint therapy for the treatment of primary dysmenorrhea: a meta-analysis[J]. Altern Ther Health Med, 2014, 20(4): 33-42.

[13] Faramarzi H, Mehrabani D, Fard M, et al. The Potential of Menstrual Blood-Derived Stem Cells in Differentiation to Epidermal Lineage: A Preliminary Report[J]. World J Plast Surg, 2016, 5(1): 26-31.

[14] Baldauff NH, Witchel SF. Polycystic ovary syndrome in adolescent girls[J]. Curr Opin Endocrinol Diabetes Obes, 2017, 24(1): 56-66.

[15] Layegh P, Mousavi Z, Farrokh Tehrani D, et al. Insulin resistance and endocrine-metabolic abnormalities in polycystic ovarian syndrome: Comparison between obese and non-obese PCOS patients[J]. Int J Reprod Biomed (Yazd), 2016, 14(4): 263-270.

[16] Chen L, Ye R, Zhang W, et al. Endocrine Disruption throughout the Hypothalamus-Pituitary-Gonadal-Liver (HPGL) Axis in Marine Medaka (Oryzias melastigma) Chronically Exposed to the Antifouling and Chemopreventive Agent, 3, 3′-Diindolylmethane (DIM) [J]. Chem Res Toxicol, 2016, 29(6): 1020-1028.

[17] Witchel S F, Roumimper H, Oberfield S. Polycystic Ovary Syndrome in Adolescents[J]. Endocrinol Metab Clin North Am, 2016, 45(2): 329-344.

[18] Gourgari E, Lodish M, Keil M, et al. Bilateral Adrenal Hyperplasia as a Possible Mechanism for Hyperandrogenism in Women With Polycystic Ovary Syndrome[J]. J Clin Endocrinol Metab, 2016, 101(9): 3353-3360.

[19] Emekci Ozay O, Ozay A C, et al. Role of kisspeptin in polycystic ovary syndrome (PCOS) [J]. Gynecol Endocrinol, 2016, 32(9): 718-722.

[20] Witorsch R J. Effects of elevated glucocorticoids on reproduction and development: relevance to endocrine disruptor screening[J]. Crit Rev Toxicol, 2016, 46(5): 420-436.

Effectofwenjingdecoctiononserumfolliclestimulatinghormone,luteinizinghormone,estradiol,progesteroneandtestosteroneofpatientswithmenopathyofexcess-coldsyndrome

LIDan,LIJuan,YUEMingming,CHENFang,HUANGDandan

(DepartmentofGynecology,HospitalofTraditionalChineseMedicineAffiliatedtoXinjiangMedicalUniversity,Urumqi,Xinjiang, 830000)

ObjectiveTo explore effect of wenjing decoction on serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone Prog (P), testosterone (T) of patients with menopathy of excess-cold syndrome.MethodsTotally 90 patients with menopathy of excess-cold syndrome were selected and randomly divided into observation group (n=45) and control group (n=45). The control group was treated with routine treatment, while the observation group was treated with wenjing decoction. The therapeutic effect, serum FSH, LH, E2, P, T, 5-HT, β-EP, uterine hemodynamics of two groups after treatment were compared.ResultsAfter treatment, the total effective rate of the observation group was significantly higher than the control group (P<0.05). The FSH, LH, E2level in the observation group were significantly higher than the control group (P<0.05), 5-HT was significantly lower than the control group, and β-EP was significantly higher than the control group (P<0.05). PSV in the observation group was significantly higher than the control group, while RI and PI were significantly lower than the control group (P<0.05).ConclusionWenjing decoction is effective in treatment of patients with menopathy of excess-cold syndrome, which can improve serum FSH, LH, E2, P, T levels and regulate the endocrine disorder.

wenjing decoction; menopathy; excess-cold syndrome; follicle-stimulating hormone; luteinizing hormone; estradiol; progesterone Prog; testosterone

R 711.51

A

1672-2353(2017)19-084-03

10.7619/jcmp.201719024

2017-05-20

新疆自然科學(xué)青年基金(BK20151045)