针药结合对女性更年期绝经后期生殖内分泌影响的临床研究
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摘要
目的：观察针刺结合小剂量生药淫羊藿治疗女性更年期绝经后症状的临床疗效及其
对绝经后生殖内分泌、骨代谢水平的影响，从下丘脑-垂体-卵巢轴角度探讨针药结合对
更年期综合征的作用机制。
方法：选择年龄在50～60岁符合诊断标准的绝经后妇女30例。针灸选穴：以“G_4”
区_双(对耳屏内侧)、三阴交_双、肾俞_双为主穴，辅以随证配穴。在治疗期间，每日早、中、晚
口服淫羊藿胶囊各4粒(4.8g／日)；三阴交、肾俞在毫针进针得气后，手法均施以补法，
每周针刺二次；“G_4”区用胶布将王不留行籽贴压，每日按压刺激3次，每次持续1～2分
钟。以三个月为观察疗程，在治疗前一天及一观察疗程最后一天，分别检测一次下列观察
指标：(1)治疗前后均抽取患者肘静脉血作卵泡刺激素(FSH)、黄体生成素(LH)、雌二
醇(E_2)、睾酮(T)，骨钙素(BGP)、降钙素(CT)、甲状旁腺激素(PTH)放免测定及血
清钙、磷生化测定。(2)采用改良的Kupper评分法，进行症状体征评分。(3)采用Wenger
因子分析法，测定植物神经指数。(4)利用简明SF-36生存质量调查量表进行治疗前后
生存质量调查。
结果：(1)绝经妇女血清FSH、LH、T水平明显高于正常育龄女性，雌激素E_2明显下降，
并随绝经年限继续降低。(2)治疗后生殖激素卵泡刺激素(FSH)、雌二醇(E_2)含量较前
有显著性提高(P＜0.05)，但E_2上升幅度高于FSH；LH均数较前有所提高，睾酮(T)均
数水平较前下降，但无显著性意义(P＞0.05)。(3)治疗后骨钙素(BGP)、降钙素(CT)、
甲状旁腺激素(PTH)含量皆显著提高(P＜0.05)。(4)治疗后血清钙含量较前有所提高，
血清磷水平较前提高，但均无显著性意义(P＞0.05)。(5)治疗后患者的症状体征显著改
善，Kupper指数明显下降(P＜0.05)。(6)治疗前后自主神经平衡指数(Y)变化有显著性
意义(P＜0.05)，治疗前自主神经平衡指数Y＜－0.56有16例，占50.33％，自主神经平衡指
数Y＞0.56有1例，占3.33％；治疗后自主神经平衡指数Y＜－0.56有8例，占26.67％，副
值异常率明显下降，正值均在正常值范围。(7)在生命质量的8个领域中：生理功能(PF)、
躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、精神健康(MH)治疗前
后有显著性差异(P<0.05)，其中，尤以躯体疼痛(BP)、总体健康(GlI)、活力(VT)、
精神健康(MH)变化最为显著(P成0，001)，生理职能(RP)、情感职能(RE)治疗前后
无显著性差异(P>0.05)。
结论:(l)针药结合治疗法对女性更年期绝经后的下丘脑一垂体一卵巢轴有调节作用
能提高血中雌二醇(EZ)、骨钙素(BGP)、钙调节激素中降钙素(CT)、甲状旁腺激素(PTH)
水平。(2)针药结合治疗法对女性更年期绝经后自主神经系统具有双向良性调整作用。
(3)针药结合治疗法能明显女性改善更年期绝经后的症状体征及身心健康，提高女性绝
经后生活质量。提示:针药结合治疗法对女性更年期绝经后生殖内分泌影响与对下丘脑
一垂体一卵巢轴及肾上腺皮质功能的影响有关，针药结合有协同之功。
Purpose: To investigate the effect of acupuncture combined with herb for the reproductive endocrine of women' s postmenopause and bone metabolism levels, and research the functional mechanism of the effect from the angle of hypothalamic- pituitary- ovarian axis.
Method:30 cases of postmenopausal women (at the aged of 50 ~60 years) were selected with certain diagnostic standard. Choose the acupoints: " G4" area ( Antitragus-double), Sanyinjiao (SP6-double) and Shenshu ( BL2.rdouble) were the main points, modified according to syndrome differetiation. Take 4 Herba epimedii( yin yang huo) capsules three times a day (Total 4.8 g/d) ;Puncture the points of SP6 and BL23 with filliform needles one time every three days; "G4" areas where were pressed by Auricular seed pressing and stimulate 3 times each day. Three months make up an observing therapeutic course, measure each index before and after treatment respectively. The indexes are as follows: (l)The effect of acupuncture combined with herb on peripheral serum follicle stimulating hormone(FSH), luteinizing hormone(LH), estradiol (E2), testosterone (T), osteocalcin(BGP), parathyroid hormone(PTH), calcitonin(CT), calcium and phosphorus levels were observed before and after treatment respectively. The serum FSH, LH, E2, T,
BGP, PTH and CT levels were estimated by radioimmunoassay(RIA) and serum calcium and phosphorus by biochemistry technology with the blood of elbow vein.(2) Adopt the improved method of Kupper grade point, to estimate symptom. (3) Adopt the method of the
Wenger factorization, and measure the index number of the autonomic nerve. (4) Investigate the quality of life with MOS SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey) in before and after treatment .
Result: (1) The levels of postmenopausal women serum FSH and LH were higher than normal women's; While E2 was far lower than that of normal women' s, and declined continuously following menopause years increasing. (2)After treatment the levels FSH and E2 were higher than those before treatment ( P<0. 05), but the level E2 rising range was higher than that of FSH; There were no significant difference before and after treatment to the levels LH and T( P>0.05). (3) The all levels BGP, CT and PTH increase significantly after treatment ( P<0.05). (4) The change of the serum Calcium and Phosphorus showed insignificant difference before and after treatment (P>0. 05). (5) There was obvious improvement to symptom after treatment, Kupper index number was increased (P<0.05). (6) There were significant difference before and after treatment about the index number of the autonomic nerve function (Y)(P<0. 05), the index number of the autonomic nerve function Y<-0. 56 had 16 cases ( 50. 33%) ; the index number of the autonomic nerve function Y >0.56 had 1 example( 3.33%);After the treatment the index number of the autonomic nerve function Y <-0.56 had 8 cases( 26.67%), the vice- abnormal rate descended obviously. (7) There were significant improvement after treatment in 8 fields of the quality of life (P<0.05): Physical function(PF), Bodily pain(BP), General health(GH), Vitality(VT), Social function(SF), Mental Health(MH), among them, Bodily pain( BP), General health( GH), VitalityC VT) , Mental Health(MH) changes showed significant difference (P^O. 001), while there were no significant variety to Role physical (RP) and Role emotion (RE) (P>0. 05).
Conclusion: (1) The result showed that acupuncture combined with herb had the function in regulating the hypothalamic- pituitary- ovarian axis, and could improve the endocrine environment of women , increase E2, BGP , CT and PTH contain. (2) There were the doubles direction positive adjustment functions to the autonomic nervous system of the postmenopause of acupuncture combined with herb. (3) It could improve obviously the women postmenopausal symptom, mind and body health, enhance the postmenopausal women' s quality of life(QOL), positively prevent and cure the climacteric syndrome including postmenopausal osteoporosis(OP). (4) The effect of acupun
对绝经后生殖内分泌、骨代谢水平的影响，从下丘脑-垂体-卵巢轴角度探讨针药结合对
更年期综合征的作用机制。
方法：选择年龄在50～60岁符合诊断标准的绝经后妇女30例。针灸选穴：以“G_4”
区_双(对耳屏内侧)、三阴交_双、肾俞_双为主穴，辅以随证配穴。在治疗期间，每日早、中、晚
口服淫羊藿胶囊各4粒(4.8g／日)；三阴交、肾俞在毫针进针得气后，手法均施以补法，
每周针刺二次；“G_4”区用胶布将王不留行籽贴压，每日按压刺激3次，每次持续1～2分
钟。以三个月为观察疗程，在治疗前一天及一观察疗程最后一天，分别检测一次下列观察
指标：(1)治疗前后均抽取患者肘静脉血作卵泡刺激素(FSH)、黄体生成素(LH)、雌二
醇(E_2)、睾酮(T)，骨钙素(BGP)、降钙素(CT)、甲状旁腺激素(PTH)放免测定及血
清钙、磷生化测定。(2)采用改良的Kupper评分法，进行症状体征评分。(3)采用Wenger
因子分析法，测定植物神经指数。(4)利用简明SF-36生存质量调查量表进行治疗前后
生存质量调查。
结果：(1)绝经妇女血清FSH、LH、T水平明显高于正常育龄女性，雌激素E_2明显下降，
并随绝经年限继续降低。(2)治疗后生殖激素卵泡刺激素(FSH)、雌二醇(E_2)含量较前
有显著性提高(P＜0.05)，但E_2上升幅度高于FSH；LH均数较前有所提高，睾酮(T)均
数水平较前下降，但无显著性意义(P＞0.05)。(3)治疗后骨钙素(BGP)、降钙素(CT)、
甲状旁腺激素(PTH)含量皆显著提高(P＜0.05)。(4)治疗后血清钙含量较前有所提高，
血清磷水平较前提高，但均无显著性意义(P＞0.05)。(5)治疗后患者的症状体征显著改
善，Kupper指数明显下降(P＜0.05)。(6)治疗前后自主神经平衡指数(Y)变化有显著性
意义(P＜0.05)，治疗前自主神经平衡指数Y＜－0.56有16例，占50.33％，自主神经平衡指
数Y＞0.56有1例，占3.33％；治疗后自主神经平衡指数Y＜－0.56有8例，占26.67％，副
值异常率明显下降，正值均在正常值范围。(7)在生命质量的8个领域中：生理功能(PF)、
躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、精神健康(MH)治疗前
后有显著性差异(P<0.05)，其中，尤以躯体疼痛(BP)、总体健康(GlI)、活力(VT)、
精神健康(MH)变化最为显著(P成0，001)，生理职能(RP)、情感职能(RE)治疗前后
无显著性差异(P>0.05)。
结论:(l)针药结合治疗法对女性更年期绝经后的下丘脑一垂体一卵巢轴有调节作用
能提高血中雌二醇(EZ)、骨钙素(BGP)、钙调节激素中降钙素(CT)、甲状旁腺激素(PTH)
水平。(2)针药结合治疗法对女性更年期绝经后自主神经系统具有双向良性调整作用。
(3)针药结合治疗法能明显女性改善更年期绝经后的症状体征及身心健康，提高女性绝
经后生活质量。提示:针药结合治疗法对女性更年期绝经后生殖内分泌影响与对下丘脑
一垂体一卵巢轴及肾上腺皮质功能的影响有关，针药结合有协同之功。
Purpose: To investigate the effect of acupuncture combined with herb for the reproductive endocrine of women' s postmenopause and bone metabolism levels, and research the functional mechanism of the effect from the angle of hypothalamic- pituitary- ovarian axis.
Method:30 cases of postmenopausal women (at the aged of 50 ~60 years) were selected with certain diagnostic standard. Choose the acupoints: " G4" area ( Antitragus-double), Sanyinjiao (SP6-double) and Shenshu ( BL2.rdouble) were the main points, modified according to syndrome differetiation. Take 4 Herba epimedii( yin yang huo) capsules three times a day (Total 4.8 g/d) ;Puncture the points of SP6 and BL23 with filliform needles one time every three days; "G4" areas where were pressed by Auricular seed pressing and stimulate 3 times each day. Three months make up an observing therapeutic course, measure each index before and after treatment respectively. The indexes are as follows: (l)The effect of acupuncture combined with herb on peripheral serum follicle stimulating hormone(FSH), luteinizing hormone(LH), estradiol (E2), testosterone (T), osteocalcin(BGP), parathyroid hormone(PTH), calcitonin(CT), calcium and phosphorus levels were observed before and after treatment respectively. The serum FSH, LH, E2, T,
BGP, PTH and CT levels were estimated by radioimmunoassay(RIA) and serum calcium and phosphorus by biochemistry technology with the blood of elbow vein.(2) Adopt the improved method of Kupper grade point, to estimate symptom. (3) Adopt the method of the
Wenger factorization, and measure the index number of the autonomic nerve. (4) Investigate the quality of life with MOS SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey) in before and after treatment .
Result: (1) The levels of postmenopausal women serum FSH and LH were higher than normal women's; While E2 was far lower than that of normal women' s, and declined continuously following menopause years increasing. (2)After treatment the levels FSH and E2 were higher than those before treatment ( P<0. 05), but the level E2 rising range was higher than that of FSH; There were no significant difference before and after treatment to the levels LH and T( P>0.05). (3) The all levels BGP, CT and PTH increase significantly after treatment ( P<0.05). (4) The change of the serum Calcium and Phosphorus showed insignificant difference before and after treatment (P>0. 05). (5) There was obvious improvement to symptom after treatment, Kupper index number was increased (P<0.05). (6) There were significant difference before and after treatment about the index number of the autonomic nerve function (Y)(P<0. 05), the index number of the autonomic nerve function Y<-0. 56 had 16 cases ( 50. 33%) ; the index number of the autonomic nerve function Y >0.56 had 1 example( 3.33%);After the treatment the index number of the autonomic nerve function Y <-0.56 had 8 cases( 26.67%), the vice- abnormal rate descended obviously. (7) There were significant improvement after treatment in 8 fields of the quality of life (P<0.05): Physical function(PF), Bodily pain(BP), General health(GH), Vitality(VT), Social function(SF), Mental Health(MH), among them, Bodily pain( BP), General health( GH), VitalityC VT) , Mental Health(MH) changes showed significant difference (P^O. 001), while there were no significant variety to Role physical (RP) and Role emotion (RE) (P>0. 05).
Conclusion: (1) The result showed that acupuncture combined with herb had the function in regulating the hypothalamic- pituitary- ovarian axis, and could improve the endocrine environment of women , increase E2, BGP , CT and PTH contain. (2) There were the doubles direction positive adjustment functions to the autonomic nervous system of the postmenopause of acupuncture combined with herb. (3) It could improve obviously the women postmenopausal symptom, mind and body health, enhance the postmenopausal women' s quality of life(QOL), positively prevent and cure the climacteric syndrome including postmenopausal osteoporosis(OP). (4) The effect of acupun
引文
[1] 张宝屏，高晓坚，夏海晖，等．广州地区40-60岁妇女社区卫生服务及需求状况的调查分析．中国妇幼保健，1997；12(6)：356
[2] 李沛，黄攸玉．从针刺对雌猕猴生殖内分泌的影响中探讨针刺的时效性．中国针灸，1997；17(2)：103
[3] 李沛，黄攸玉，王训立，等．针刺对雌恒猴生殖内分泌抑制性影响的实验研究．中国针灸，1999；19(8)：486
[4] 李沛，黄攸玉，王训立，等．针刺对雌性恒河猴垂体促性腺激素分泌水平的影响．福建中医学院学报，1997；7(3)：17
[5] 李沛，安晓英．针刺不同穴位对雌性恒河猴生殖内分泌影响的实验研究．中医药学报，2000：28(3)：51
[6] 余谦，黄泳，张和嫒，等．针刺调补冲任法对女性内分泌轴功能的影响．中国针灸，2001；21(3)：169
[7] 陈伯英，程立海，高慧，等．电针对大鼠脑内雌激素受体旦白及其mRNA表达的影响．生理学报，1998；50(5)：495
[8] 陈伯英，季士株，高慧，等．电针调节大鼠下丘脑—垂体—卵巢轴功能的研究．神经科学，1995(增)：167
[9] 高慧，何莲芳，胡中庭，等．针刺调整去卵巢大鼠下丘脑—垂体—肾上腺轴异常功能机制的研究．医学研究通讯，1999；28(3)：12
[10] 唐照亮，宋小鸽，侯正明，等．艾灸肾俞延缓衰老的实验研究．安徽中医学院学报，1999；18(5)：53
[2] 李沛，黄攸玉．从针刺对雌猕猴生殖内分泌的影响中探讨针刺的时效性．中国针灸，1997；17(2)：103
[3] 李沛，黄攸玉，王训立，等．针刺对雌恒猴生殖内分泌抑制性影响的实验研究．中国针灸，1999；19(8)：486
[4] 李沛，黄攸玉，王训立，等．针刺对雌性恒河猴垂体促性腺激素分泌水平的影响．福建中医学院学报，1997；7(3)：17
[5] 李沛，安晓英．针刺不同穴位对雌性恒河猴生殖内分泌影响的实验研究．中医药学报，2000：28(3)：51
[6] 余谦，黄泳，张和嫒，等．针刺调补冲任法对女性内分泌轴功能的影响．中国针灸，2001；21(3)：169
[7] 陈伯英，程立海，高慧，等．电针对大鼠脑内雌激素受体旦白及其mRNA表达的影响．生理学报，1998；50(5)：495
[8] 陈伯英，季士株，高慧，等．电针调节大鼠下丘脑—垂体—卵巢轴功能的研究．神经科学，1995(增)：167
[9] 高慧，何莲芳，胡中庭，等．针刺调整去卵巢大鼠下丘脑—垂体—肾上腺轴异常功能机制的研究．医学研究通讯，1999；28(3)：12
[10] 唐照亮，宋小鸽，侯正明，等．艾灸肾俞延缓衰老的实验研究．安徽中医学院学报，1999；18(5)：53
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