【作者】 潘家怡；

【导师】 金宏柱；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 目的：评价雷射针灸治疗肝肾阴虚型更年期综合征的临床疗效,探讨其作用机理。方法：采用随机对照单盲的试验方法,共收集92例病例,将符合纳入标准的肝肾阴虚型更年期综合征患者随机分配到治疗组和对照组,由于治疗过程中病例的脱落和剔除,实际完成数为88例,治疗组为雷射针灸体穴加耳穴治疗组,本组23例患者,对照组分为雷射针灸体穴治疗组、雷射针灸耳穴治疗组和中药组(六味地黄丸),每组分别为22、21、22例患者。4周为一个疗程,连续观察两个疗程,治疗前后分别填写临床症状观察表,并选用国际公用的kupperman评分法对患者治疗前及治疗后的临床症状进行评价,以观察患者治疗后临床症状的改善情况；检测患者治疗前与治疗后血中促卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)的水平变化。对雷射针灸疗效及安全性等进行分析判定,观察治疗后治疗组与对照组组间的差异性。结果：总有效率治疗组为86.96%,雷射针灸体针组为72.73%,雷射针灸耳针组为71.43%,中药组为86.36%。治疗组和雷射针灸体针组及雷射针灸耳针组比较有显著性差异(P<0.05),治疗组和中药组比较无显著性差异(P>0.05)；雷射针灸体针组和雷射针灸耳针组比较无显著性差异(P>0.05)。治疗组治疗后Kupperman症状评分指数(M1)显著下降(P<0.05),肝肾阴虚型潮热汗出、烦躁易怒、失眠等主症改善显著(P<0.05),与雷射针灸体穴组和耳穴组有显著性差异(P<0.05),与中药组无显著性差异(P>0.05)。治疗组治疗后血清E2水平显著升高(P<0.05),血清FSH和LH均显著降低(P<0.05),且与三个对照组治疗后相比差异显著(P<0.05)。雷射针灸体穴组和中药组治疗后在FSH和LH上无显著性差异(P>0.05),三个对照组治疗后组间比有显著性差异(P<0.05)。结论：雷射针灸体穴加耳穴治疗可以显著地改善肝肾阴虚型更年期综合征患者的临床症状及血清内分泌激素水平,所以雷射针灸治疗是改善更年期综合征患者症状和微循环,调节内分泌及植物神经,增强免疫功能的有效方法,值得进一步研究和临床推广应用。更多还原

【Abstract】 Objective:To evaluate the clinical effect with laser acupuncture for the yin-deficiency of both the liver and kidney of menopausal syndrome, and approach mechanism of action of laser acupuncture.Method:Using randomized controlled single blinded testing method,92 qualified menopausal syndrome patients were divided into treatment and control groups. Because of the defluxion and rejection during the treatment,we actually have accomplished the treatment of 88 cases.The treatment group was treated with the combination of body acupoints and auricular points by laser acupuncture, it has 22 cases;while the contrast groups were divided into three groups:group treated with body acupoints by laser acupuncture、group treated with auricular acupoints by laser acupuncture、group treated with Chinese materia medica(Six Ingredients of Rehmaniae Bolus), each group has 22、21、22 cases respectively. We take four weeks as one course of treatment, and consecutively observe two courses. We filled in clinical manifestation observation charts before and after the treatment. We select the international communal scoring method which is called Kupperman scoring method to evaluate patients’clinical manifestation before and after the treatment, so as to observe the amelioration condition of patients’clinical manifestation after the treatment. To test the level changes of follicle stimulating hormone、luteinizing hormone、estradiol in patients’blood before and after the treatment. We observe the variability between treatment group and contrast group after treatment, and make analysis and assessment of the therapeutic effect and security of laser acupuncture.Results:The total validity rate of treatment group is 86.96%, while the control group treated with body acupoints by laser acupuncture is 72.73%、control group treated with auricular acupoints by laser acupuncture is 71.43%、control group treated with Chinese materia medica is 86.36%. There is significent difference between treatment group and control group treated with body acupoints by laser acupuncture and control group treated with auricular acupoints by laser acupuncture. There isn’t significent difference between treatment group and control group treated with Chinese materia medica(P>0.05). There isn’t significent difference between control group treated with body acupoints by laser acupuncture and control group treated with auricular acupoints by laser acupuncture (P>0.05), The kupperman symptom scoring index has been decreased greatly after treatment (P<0.05), symptoms such as hectic fever with sweat、restlessness and irritability、insomnia of yin-deficiency of both the liver and kidney of menopausal syndrome patients had been significantly improved(P<0.05), and the the E2 level in the treatment has been increased greatly after treatment(P<0.05), the FSH and LH level in the treatment have been increased greatly after treatment (P<0.05). Also there is significent difference between the treatment group and each control group. As to FSH and LH, there isn’t significent difference between control group treated with body acupoints by laser acupuncture and control group treated with Chinese materia medica(P>0.05). In the rest items of three control group, there isn’t significent difference between them(P>0.05).Conclusion:The Combination of body acupoints and auricular points by laser acupuncture can remarkablely ameliorate patients’clinical manifestation and sex hormone level of yin-deficiency of both the liver and kidney of menopausal syndrome. So we can presume that laser acupuncture is effective method in improving the manifestation、microcirculation、endocrine、autonomic nerve and immune function of menopausal syndrome patients.The laser acupuncture is worth doing futher research and spreading in clinical application.更多还原