| Objective1.Identify Premature Ovarian Insufficiency(POI)predisposition,compared with normal populations,in order to find whether there are predispositions in patients with POI,so that early intervention on vunerable populations can slow or even reverse POI as soon as possible.2.Search for the relative factors of POI,perform a timely intervention on high-risk groups and treat patients with POI earlier.3.Through this research,assess the curative effect of treatment of Zi shen yu tai pill combined with Zi gui yi jing decoction,which provides theoretical and factual basis for diagnostical thinking that the treatment for POI should be greatly tonifying qi,blood and essence,rather than simply tonifying the yin of kidney,and guide the clinical practice.Method1.132 patients meeting the inclusion of criteria of POI were collected at the gynecological clinic of the First Affiliated Hospital of Guangzhou University of Traditional Medicine from June 2016 to December 2017,and they were given General Condition Questionnaire,TCM Constitution Scale and Disease-Related Factors Survey to conduct relevant investigations.According to 1:1 comparison principle,120 normal people were enrolled in the same period to fill in the TCM Constitution Scale,and the distribution of TCM constitution of both were compared at last.2.After informed consent,eligible patients were selected from the clinical study of POI,and they were randomly divided into two groups,45 cases in treatment group and 39 cases in control group,with a total of 84 cases.Patients with POI in treatment group were treated by Zi shen yu tai pill combined with Zi gui yi jing decoction,while control group were treated by Zi gui yi jing decoction combined with Vitamin E.Three months for a course of treatment,each group were continuously treated for two courses of treatment,and menstrual period stopped taking medicine.menstrual period stopped taking.The TCM symptom score,modified Kupperman score,serum hormone(bFSH,bLH,bE2 and AMH)levels,examination of uterine size,endometrial thickness,bilateral ovarian volume,antral follicle count of bilateral ovarian,menstrual recovery,pregnancy and pregnancy outcomes by uterine appendages color Doppler ultrasound were regarded as indicators of curative effect.Compare the patients’ conditions between two groups before treatment,three months of treatment and six months of treatment,to to assess its curative effect and safety.Result1.123 POI patients’ TCM key constitution were Yang Dediciency(61.79%)>Qi Deficiency(59.35%)>Yin Deficiency(50.41%)>Qi Depression(50.41%)>Blood Stagnation(34.96%).Compared with normal people,there were statistical difference in Yang Dediciency,Yin Deficiency,Qi Deficiency and Blood Stagnation.2.TCM key constitution of 82 POI patients with FSH≥40IU/L were Yang Dediciency(62.20%)> Yin Deficiency(58.54%)> Qi Deficiency(52.44%)>Qi Depression(48.78%)>Blood Stagnation(34.96%);while TCM key constitution of 41 POI patients with 25≤FSH<40 were Qi Deficiency(73.17%)>Yang Dediciency(60.98%)>Qi Depression(41.46%)>Yin Deficiency(34.15%)>Blood Stagnation(29.27%),and there were significant differences in Yin Deficiency and Qi Depression of both.3.POI may be related to mental and psychological factors(34.96%)>idiopathic factors(26.02%)>genetic factors(19.51%)>surgical factors(14.63%)>autoimmune factors(8.94%)>infectious factors(4.07%)>drug factors(3.25%)=environmental factors(3.25%)>personal factors(2.44%).4.The treatment group had better curative effect in improving POI patients’ menstruation,TCM symptom,modified Kupperman score,serum hormone level,uterine size,endometrial thickness,ovarian volume,ovarian antral follicle number,etc.The total effective rate was 68.89%,there was significant difference when compared with control group.Conclusion1.POI patients do exist physical bias in traditional Chinese medicine,the complex constitution dominating,and yang deficiency,qi deficiency,yin deficiency,qidepression and blood stagnation are predispositions.2.The pathogenesis of POI is not yet completely clear,and may be there is a larger correlation with mental and psychological factors,genetic factors,surgical factors,autoimmune factors,infectious factors,etc.While the drug factors,environmental factors are relatively rare,and there are some patients with unknown etiology.3.Compared with vitamin E soft capsule,the treatment of Zi shen yu tai pill combined with Zi gui yi jing decoction has a better effect on POI,indicating that the treatment for POI should be greatly tonifying qi,blood and essence,rather than simply tonifying the yin of kidney,which laid a basis of the treatment that replenishing kidney and spleen,tonifying qi and blood,for POI.What’s more,Zi shen yu tai pill combined with Zi gui decoction is regarded as the basic treatment of POI.4.In different stages of POI,pathogenesis gradually evolved,clinical manifestations are different,pathogenesis of patients with 25≤FSH <40 IU/L is mainly qi deficiency of spleen and kidney,thus the treatment focuses on replenishing kidney and spleen,while pathogenesis of patients with FSH≥40 IU/L is mainly the essence deficiency of kidney,thus the treatment focuses on nourishing qi,blood and essence greatlly. |
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