【作者】 李秀美；

【导师】 王若光； 李翠萍；

【作者基本信息】 湖南中医药大学 ， 中医妇科学， 2014， 博士

【摘要】 目的：通过聚类分析的方法,归纳PCOS&DUB的证型特征,通过随机对照法对所收集的病例进行分组,运用中西医结合的方法对治疗组进行治疗,通过与对照组对照,验证中西医结合的治疗方案对治疗PCOS&DUB的安全性和有效性,以期为临床治疗PCOS&DUB提供指导。方法：1.根据PCOS&DUB诊断标准,结合中医望、闻、问、切四诊方法,收集临床资料,建立数据库,运用聚类分析的方法,对所收集的资料进行聚类分析,归纳PCOS&DUB证型特征,分析其病因病机,制定其治疗原则,以期望为临床治疗提供指导。2.对所收集的临床病例随机分为治疗组和对照组,治疗组在不规则出血期服止血方10剂；地屈孕酮片1盒,于撤退性出血第5天起开始服助卵调经方14剂,下次月经周期第5天开始继续服助卵调经方14剂,连续3个月经周期。对胰岛素抵抗及高胰岛素血症患者予胰岛素增敏剂盐酸二甲双胍片及盐酸吡格列酮口腔崩解片3个月经周期。同时指导患者三高三低饮食(高蛋白、高纤维、高微量元素及低糖、低脂、低盐)及非出血期有氧运动。对照组选用去氧孕烯炔雌醇片止血、调经治疗3个月经周期。结果：通过对比发现,治疗组和对照组在中医症候疗效、治疗后中医症状积分、对照组治疗前后血红蛋白含量、治疗后血红蛋白含量、对照组治疗前后BMI、治疗组治疗前后BMI、对照组治疗前后WHR、治疗组治疗前后WHR、治疗组中肾虚痰阻组、脾虚湿困组及肾虚血瘀组半年后复发情况与对照组比较均有显著性差异(P<0.05)。对照组治疗前后中医症状积分、治疗组治疗前后中医症状积分、治疗组治疗前后血红蛋白含量比较均有极显著性差异(P<0.01)。治疗组和对照组临床总疗效、治疗组与对照组治疗后BMI、治疗组与对照组治疗后WHR比较、治疗组和对照组阴道流血的血止时间、治疗组和对照组调整月经周期疗效、治疗组和对照组治疗后B超疗效比较均无显著性差异(P>0.05)。结论：通过对比发现本中西医结合治疗方案是治疗PCOS&DUB行之有效的安全、综合方案,在控制患者不规则出血、调整月经周期、防止复发等方面疗效显著,可以在临床推广实施。更多还原

【Abstract】 Objective:By the methods of Clustering analysis to inductive the evidence type characteristics of PCOS&DUB; Through the randomized controlled method to group the collected cases; Verify the safety and effectiveness of the treatment plans of Combine traditional Chinese and western medicine which treatment PCOS&DUB by the comparison with the control, in order to provide guidance for clinical treatment PCOS&DUB.Methods:1. According to the diagnosis standard of PCOS&DUB, combined with four diagnostic methods of TCM’ inspection, Listening and smelling, inquiry and pulse feeling to collect Clinical data and set up the database; Inductive card type of PCOS&DUB and analysis of the etiology and pathogenesis; Formulate the treatment principle and to provide guidance for clinical treatment.2. To collect clinical cases randomly divided into treatment group and control group, the control group take10prescriptions for medicine of hemostatic, Dydrogesterone1box, Began to take14prescriptions for helping ovum and regulating menstruation in the fifth day retreat hemorrhages. Began to take14prescriptions for helping ovum and regulating menstruation in the fifth day of the next menstrual cycle and for three consecutive menstrual cycle. For patients with insulin resistance and hyperinsulinemia.To give metformin hydrochloride and Pioglitazone hydrochloride of insulin sensitizer for three menstrual cycles. At the same time to guide the patients with three high three low diet(High protein, high fiber, high trace elements and low sugar, low fat, and low salt),and do aerobic exercise in unbleeding during.Control group choose desogestrel ethinylestradiol slices to treatment hemostatic, regulate the menstrual function for three menstrual cycles.Results:The treatment group and control group had significant difference by comparing the found,which in TCM’Symptom curative effect, after treatment of TCM’symptom integral, the hemoglobin levels of the control group before and after treatment, the hemoglobin levels after treatment of the control group, the BMI of treatment group before and after treatment, the WHR of control group before and after the treatment, the WHR of treatment group before and after the treatment, the group of deficiency of the kidney and stagnation of phlegm in the treatment group, Recurrence of the group of spleen deficient and wet trapped and the group of deficiency of the kidney and blood stasis after half a year compared with the control group had significant difference (P<0.05). The TCM’ symptom integral of the control group before and after treatment, The TCM’ symptom integral of treatment group before and after treatment, the hemoglobin content comparison before and after the treatment are very significant differences in treatment group (P<0.01). The treatment group and control group had no significant difference in total clinical curative effect, BMI after treatment, WHR comparison after treatment, stop bleeding time of vaginal bleeding, adjust the menstrual cycle, curative effect comparison of ultrasound after treatment (P>0.05)Conclusion:By comparing we can found that the treatment plan of TCM and western medicine for treating the PCOS&DUB is effective security, comprehensive solution.The curative effect is distinct in controlling irregular bleeding, adjust the menstrual cycle and preventing relapse.更多还原