补肾活血方对肾虚血瘀型早发性卵巢功能不全患者免疫平衡的调节作用

Regulation of Bushen Huoxue Recipe on immune balance in POI patients with type of kidney deficiency and blood stasis

关键词:  早发性卵巢功能不全  补肾活血方  肾虚血瘀证  免疫平衡

Key words:  premature ovarian insufficiency  Bushen Huoxue Recipe  type of kidney deficiency and blood stasis  immune balance

摘要:

[目的] 观察补肾活血方调节免疫平衡治疗肾虚血瘀型早发性卵巢功能不全（POI）患者的临床疗效。[方法] 将123 例 POI 患者随机分为中药组（61 例）和西药组（62 例）。中药组给予补肾活血方治疗，西药组给予芬吗通口服治疗，连续治疗 6 个月经周期。比较两组患者治疗前后血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E₂）、抗苗勒管激素（AMH）、辅助性 T 细胞 17（Th17）、调节性 T 细胞（Treg）、Th17/Treg、转化生长因子 β（TGF-β）、生长分化因子-9（GDF-9）和骨形成蛋白-15（BMP-15）水平，评估月经症状疗效和中医证候疗效。[结果] 1）治疗后，两组患者血清FSH水平较治疗前显著降低（P＜0.01），血清E₂ 和 AMH 水平较治疗前升高（P＜0.05），血清LH 水平差异无统计学意义（P>0.05）。2）治疗后，两组患者血清 Treg 水平均较治疗前升高（P＜0.01），血清Th17、Th17/Treg 水平均较治疗前降低（P＜0.01）；且中药组患者血清Th17、Treg、Th17/Treg 水平改善情况优于西药组（P＜0.01）。3）治疗后，两组患者血清TGF-β、GDF-9、BMP-15 水平均较治疗前升高（P＜0.05），且中药组患者血清BMP-15 升高幅度优于西药组（P＜0.05）。4）治疗后，中药组患者的月经症状疗效总有效率为 60.66%，西药组为 87.10%，西药组优于中药组（P＜0.05）。5）治疗后，中药组患者的中医证候疗效总有效率为 68.85%，西药组总有效率为 48.39%，中药组优于西药组（P＜0.05）。[结论] 补肾活血方可有效改善肾虚血瘀型 POI 患者的血清性激素水平，调节 Th17/Treg 免疫平衡，改善临床证候。

Abstract:

[Objective] To observe the clinical efficacy of Bushen Huoxue Recipe on immune balance in treating premature ovarian insufficiency（POI） patients with type of kidney deficiency and blood stasis. [Methods] The 123 patients were randomly divided into the traditional Chinese medicine （TCM） group （61 cases），and the Western medicine group （62 cases）. TCM group was orally treated with Bushen Huoxue Recipe，while the Western medicine group was orally treated with estradiol tablets/estradiol and dydrogesterone tablets for 6 consecutive menstrual cycles. To compare the changes in follicle-stimulating hormone （FSH），luteinizing hormone（LH），estradiol （E₂），anti-mullerian hormone（AMH），T help cell 17（Th17），regulatory T cell（Treg），Th17/Treg，transforming growth factor-beta（TGF-β）， growth differentiation factor-9（GDF-9） and human bone morphogenetic protein-15（BMP-15） levels between the two groups，to evaluate the efficacy of menstrual symptoms and Chinese medical syndrome. [Results] 1）After treatment，serum FSH levels were significantly lower（P＜0.01），E₂ and AMH levels were significantly higher（P＜0.05），and LH level was no significant difference（P>0.05） in both groups compared to the pre-treatment levels. 2）After treatment，the serum Treg levels in both groups were significantly higher （P＜0.01）， and the Th17 and Th17/Treg levels were significantly lower（P＜0.01） than before treatment；serum Th17，Treg，and Th17/Treg levels improved better in the TCM group than that in the western medicine group（P＜0.01）. 3）After treatment，TGF-β，GDF-9，and BMP-15 levels in both groups were significantly higher than before treatment（P＜0.05），and serum BMP-15 level improved better in the TCM group than that in the western medicine group（P＜0.05）. 4）After treatment，the efficacy of menstrual symptoms of patients in the TCM group was 60.66%，compared with 87.10% in the western medicine group，which was better than the TCM group（P＜0.05）. 5）After treatment， the efficacy of the Chinese medical syndrome of patients in the TCM group was 68.85%，compared with 48.39% in the western medicine group，and the efficacy of the TCM group was improved over the western medicine group（P＜0.05）. [Conclusion] Bushen Huoxue Recipe can effectively improve serum sex hormone levels，regulate Th17/Treg immune balance and improve clinical syndrome in POI patients with type of kidney deficiency and blood stasis.