标题：激素替代疗法联合左归丸加减治疗肾阴虚卵巢早衰的临床效果研究

      作者：胡菊 1，任涛涛 1，何文艳 2    1.榆林市星元医院妇产科，陕西 榆林 719000；2.商洛市中心医院妇科，陕西 商洛 726000

      卷次： 2023年34卷21期

      【摘要】 目的 观察激素替代疗法(HRT)联合左归丸加减治疗肾阴虚卵巢早衰的疗效，并探讨其对患者中医症候积分、卵巢功能和血清性激素水平的影响。方法 回顾性分析2019年5月至2022年5月期间榆林市星元医院收治的92例肾阴虚卵巢早衰患者的临床资料，根据其治疗方法不同分为激素替代疗法(HRT)组(n=41)和联合治疗组(n=51)，HRT组患者实施HRT治疗，联合治疗组患者实施HRT联合左归丸加减治疗，21 d为一个疗程，两组患者均治疗3个疗程。比较两组患者的治疗效果，治疗前后的中医证候积分、卵巢功能、卵巢间质动脉血流动力学和血清性激素水平。结果 联合治疗组患者的治疗总有效率为88.24%，明显高于HRT组的68.29%，差异有统计学意义(P<0.05)；两组患者治疗后腰膝酸软、心悸失眠、潮热乏力中医证候积分及搏动指数(PI)、卵泡刺激素(FSH)、黄体生成素(LH)水平均低于治疗前，且联合治疗组患者的腰膝酸软、心悸失眠、潮热乏力中医证候积分及PI、FSH、LH分别为(0.98±0.35)分、(0.94±0.37)分、(0.89±0.33)分及1.40±0.21、(30.23±2.88) IU/L、(20.89±2.54) IU/L，明显低于HRT组的(1.19±0.38)分、(1.17±0.40)分、(1.12±0.36)分和1.52±0.23、(31.76±3.01) IU/L、(22.34±2.71) IU/L，差异均有统计学意义(P<0.05)；两组患者的窦卵泡数、窦卵泡直径、优势卵泡排出率、收缩期峰值流速(PSV)、雌二醇(E2)水平较治疗前显著升高，且联合治疗组患者的窦卵泡数、窦卵泡直径、优势卵泡排出率、PSV、E2水平分别为(6.47±1.53)个、(7.38±1.22) mm、64.71%、(20.63±1.60) cm/s、(55.62±5.51) pmol/L，明显高于 HRT组的 (5.52±1.39)个、(6.69±1.15) mm、41.46%、(19.42±1.53) cm/s、(53.03±5.37) pmol/L，差异均有统计学意义(P<0.05)。结论 HRT联合左归丸加减治疗肾阴虚卵巢早衰可提高患者的临床疗效，缓解临床症状，提高卵巢功能，促进性激素水平稳定恢复。
      【关键词】 肾阴虚；卵巢早衰；激素替代疗法；左归丸；中医症候积分；卵巢功能；血清性激素
      【中图分类号】 R711.75 【文献标识码】 A 【文章编号】 1003—6350（2023）21—3069—05

Clinical effect of hormone replacement therapy combined with modified Zuogui pill in the treatment of prematureovarian failure of kidney yin deficiency.
HU Ju 1, REN Tao-tao 1, HE Wen-yan 2. 1. Department of Obstetrics andGynecology, Xingyuan Hospital of Yulin, Yulin 719000, Shaanxi, CHINA; 2. Department of Gynecology, Shangluo CentralHospital, Shangluo 726000, Shaanxi, CHINA
【Abstract】 Objective To observe the efficacy of hormone replacement therapy (HRT) combined with modi?fied Zuogui pill in the treatment of premature ovarian failure of kidney yin deficiency and explore its influence on thescores of TCM symptoms, ovarian function, and levels of serum sex hormones. Methods The clinical data of 92 pa?tients with premature ovarian failure of kidney yin deficiency who were treated in Xingyuan Hospital of Yulin from May2019 to May 2022 were retrospectively analyzed. According to the different treatment methods, the patients were divid?ed into HRT group (n=41) and combined therapy group (n=51). The patients in HRT group were treated with HRT, whilethe patients in combined therapy group were given HRT combined with modified Zuogui pill. Both groups of patientswere treated for 3 courses of treatment, with 21 days as a course. The therapeutic effect, and scores of TCM symptoms,ovarian function, ovarian interstitial arterial hemodynamics, and levels of serum sex hormones before and after treatmentwere compared between the two groups. Results The total effective rate of treatment in combined therapy group was88.24%, which was significantly higher than 68.29% in HRT group (P<0.05). After treatment, the scores of TCM symp?toms of soreness and weakness of waist and knees, palpitation and insomnia, hot flashes and fatigue, and levels of pulsa?tility index (PI), follicle stimulating hormone (FSH), and luteinizing hormone (LH) in both groups were lower comparedwith those before treatment, and the scores and levels were (0.98±0.35) points, (0.94±0.37) points, (0.89±0.33) points,1.40±0.21, (30.23±2.88) IU/L, and (20.89±2.54) IU/L in combined therapy group, significantly lower than (1.19±0.38) points,(1.17±0.40) points, (1.12±0.36) points, 1.52±0.23, (31.76±3.01) IU/L, and (22.34±2.71) IU/L in HRT group, with statisti?cally significant differences (P<0.05). The sinus follicle count, sinus follicle diameter, dominant follicle excretion rate,peak systolic velocity (PSV), and estradiol (E2) in the two groups were significantly increased compared with those be?fore treatment, and the above indicators were 6.47±1.53, (7.38±1.22) mm, 64.71%, (20.63±1.60) cm/s, and (55.62±5.51) pmol/Lin combined therapy group, significantly higher than 5.52±1.39, (6.69±1.15) mm, 41.46%, (19.42±1.53) cm/s, and (53.03±5.37) pmol/L in HRT group, with statistically significant differences (P<0.05). Conclusion HRT combined with modi?fied Zuogui pill can enhance the clinical efficacy, relieve the clinical symptoms, enhance the ovarian function, and pro?mote stable recovery of sex hormones in patients with premature ovarian failure of kidney yin deficiency.
      【Key words】 Kidney yin deficiency; Premature ovarian failure; Hormone replacement therapy; Zuogui pill;TCM symptoms scores; Ovarian function; Serum sex hormones