世界中医药

作者	单位
刘淼1，孙玉涛2，李勇3	1 唐山市第五医院三病区,唐山，063000； 2 唐山市第五医院门诊，唐山，063000； 3 武警河北总队医院唐山分院综合科，唐山，063000

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中文摘要:

目的：观察柴胡加龙骨牡蛎汤治疗抗精神病药物所致闭经临床疗效，并对其治疗机制进行探讨。方法：随机选取2014年9月至2016年4月，于我院精神病科门诊和住院部就诊的女性精神分裂症患者中的抗精神病药物所致闭经患者60例，以就诊先后顺序编号，单盲随机数字表法分为观察组和对照组，每组各30例。基础治疗：抗精神病药物治疗，口服阿立哌唑，对照组：在基础治疗基础上，采用西药甲磺酸溴隐亭片口服治疗，观察组：基于基础治疗，采用柴胡加龙骨牡蛎汤加减治疗。观察并记录2组患者月经周期、月经量；随访半年，观察患者闭经复发的情况。于安静清醒状态下、上午8—9时取血测定，采用酶联免疫吸附试验（ELISA），应用全自动生化分析仪（日立7180型）取待测血液，以备检测催乳素（PRL）、促黄体生成素（LH）和雌激素（E2），结合超声检测治疗前后子宫内膜厚度的变化，并对其进行短期和长期疗效评定。结果：治疗后，2组PRL均降低，且降至正常参考值以内（102～496 mIU/L）（P<0.01）；而LH和E2均明显提高（P<0.01）。治疗后2组比较，PRL、LH、E2差异均有统计学意义（P<0.01）。治疗后观察组子宫内膜厚度明显较对照组薄（t=4.14，P=0.000＜0.05）。2组治疗后观察组治愈率为55.17%，总有效率为82.76%，而对照组治愈率为35.17%，总有效率为71.43%，2组临床疗效比较差异有统计学意义（P<0.05）。为了观察2组抗精神病药物所致闭经患者的远期疗效，治疗后随访半年，观察组复发率仅为6.25%，而对照组复发率为20%，观察组的复发率明显低于对照组（P<0.05）。结论：柴胡加龙骨牡蛎汤能通过降低患者的PRL水平和提高LH、E2的分泌水平，改善抗精神病药物所致闭经，且无严重不良反应发生。

English Summary:

To observe clinical effect of Chaihu Longgu Muli Decoction in the treatment of amenorrhea induced by antipsychotic drugs and to discuss the treatment mechanism. Methods:Sixty female patients with amenorrhea due to antipsychotic drugs who received treatment from September 2014 to April 2016 in psychiatric outpatient and inpatient department were selected and randomly divided into the observation group and the control group, with 30 cases in each group. Patients in the two groups all orally took aripiprazole, an antipsychotic drug and patients in the control group additionally were treated with mesylate bromocriptine tablets, while patients in the observation group additonally received Chaihu Longgu muli Decoction. The menstrual cycle and menstruation condition of the two groups were observed and recorded and the recurrence of amenorrhea was observed during the six months follow-up. Blood samples were taken at 8-9a.m. by enzyme linked immunosorbent assay (ELISA) and automatic biochemical analyzer (Hitachi 7180) was applied for tests on serum levels of prolactin (PRL), luteinizing hormone (LH) and estrogen (E2) and ultrasound B test were used to detect endometrial thickness changes before and after the treatment. The short-term and long-term curative effects were evaluated. Results:After the treatment, PRL of the two groups decreased to norma (102-496 mIU/L), (P<0.01) and LH and E2 significantly improved (P<0.01). The differences in PRL, LH and E2 in the two groups were statistically significant (P<0.01). The endometrial thickness in the observation group was significantly lower than that in the control group after the treatment (t＝4.14, P=0.000＜0.05). The curative rate of the observation group after the treatment was 55.17% and the total effective rate was 82.76%, while the curative rate of the control group was 35.17% and the total effective rate was 71.43%. The difference between the two groups showed statistically significant (P<0.05). The recurrence rate of the observation group was only 6.25%, while that of the control reached 20%. The recurrence rate of the observation group was significantly lower than that of the control group (P<0.05). Conclusion:Chaihu Longgu Muli Decoction may improve the secretion level of E2 and LH, by reducing the level of PRL in these patients and improve the amenorrhea caused by antipsychotic drug without severe adverse reactions.

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