| ObjectiveBased on the theory of collateral disease,mainly through the study of ovarian morphology changes in rats with premature ovarian failure caused by Tripterygium and changes in uterine artery blood flow in clinical patients,to explore the mechanism of Zigui Yi jing Tongluo decoction on premature ovarian failure.MethodIn animal studies,24 mature SPF female SD rats were randomly divided into blank group,model group,and treatment group with 8 animals each.The first stage,model group:Gavage Tripterygium glycosides tablet 50 mg/kg/d for 14 consecutive days to establish a POF animal model,Control group:normal saline 1mL/100g/d for 14 consecutive days。24 hours after modeling,treatment group(8 randomly selected model groups):Nourishing zigui Yi jing Tongluo Decoction,continuous for 15 days,Control group and model group:gavage normal saline 1mL/100g/d;continuous for 15d.During the experimental period,the estrous cycle in rats was observed.At the end of the experiment,the body weight,serum sex hormone levels,ovarian index and ovarian pathological structure were compared.The clinical study selected 50 patients with POF who met the inclusion criteria in the gynecological clinic of the First Affiliated Hospital of Guang-Guang Traditional Chinese Medicine from March 1,2017 to November 31,2017,who were randomly divided into treatment group and control group of 25 cases.The treatment group took Zigui Yijing Tongluo Decoction and Zishen Yutai Pills for continuous treatment for 3 months.The control group was treated with Zigui Yijing Decoction and Zishen Yutai Pills,and the treatment was continued for 3 months.Before and after treatment,observe the change of symptom scores in patients with POF,follicle-stimulating hormone(FSH),luteinizing hormone(LH),estrogen(Estrogen 2),anti-Mullerian hormone(AMH)level and ultrasound endometrial thickness,ovarian volume,PI,RI of myometrial arterial blood flow,PI and RI changes of bilateral uterine artery blood flow.ResultAnimal research1.In general,rats in the model group suffered from lack of energy,decreased food intake,dull coat color,less movement,and disordered estrus cycle.The rats in the treatment group showed improvement in spirit,food intake,activity,hair color,and estrus cycle.2.Comparing the body weight and ovarian index of rats,the rats in the model group were significantly lower than those in the blank group(P<0.05);the difference between the treatment group and the model group was statistically significant(P<0.05);There was no significant difference between the group rats and the blank group(P>0.05).3.In serum sex hormone levels in rats,the levels of serum FSH and LH in the rats of the model group were increased and the E2 level was decreased,which was significantly different from that in the blank group(P<0.05).The levels of FSH and LH in the treatment group decreased,and the E2 level increased,which was significantly different from that in the model group(P<0.05).There was no significant difference between the treatment group and the normal group(P>0.05).4.On rat morphology,the POF model group of Tripterygium wilfordii reduced the ovarian volume,the number of follicles and the majority of follicular dysplasia;the corpus luteum was less;the interstitial fibrosis could be seen in different degrees.Compared with the model group,the ovarian volume of the treatment group increased,the number of follicles increased,the number of corpus luteum increased,and interstitial fibrosis decreased.Clinical research1.In clinical symptom scores,the TCM symptom scores and Kupermann scores of the treatment group and the control group decreased after treatment,and the difference was statistically significant(P<0.05).After treatment,the TCM symptom score and Kupermann score of the treatment group were lower than those of the control group,and the difference was statistically significant(P<0.05).The difference between the TCM symptom score and the kupermann score before and after treatment in the treatment group was greater than that in the control group,and the difference between the two groups was statistically significant(P<0.05).The difference in decline of the treatment group before and after the treatment of amenorrhea,vaginal dryness,insomnia and dreams,painful intercourse,arthralgia and headache symptoms was significantly greater than that of the control group(P0.05).2.Serum hormone levels,the treatment group before treatment,FSH,LH decreased,E2 levels increased,the difference was statistically significant(P0.05)。After the treatment in the control group,the FSH decreased and the E2 level increased compared with that before the treatment,and the difference was statistically significant(P<0.05).The serum LH decreased but the difference was not statistically significant(P>0.05).There was no significant difference between the two groups before and after treatment with AMH(P>0.05).After treatment,FSH and LH were lower in the treatment group than in the control group,and E2 was higher than in the control group.The difference was statistically significant(P<0.05).The mean differences of FSH,LH and E2 before and after treatment in the treatment group were greater than those in the control group,and the difference was statistically significant(P<0.05).3.In terms of ultrasound indexes of clinical patients,after treatment,both sides of the ovary increased in volume and thickened intima,PI and RI in myometrial arteries decreased,PI and RI in both uterine arteries decreased,and the above differences were statistically significant(P<0.05).In the control group,the size of the right ovary increased,the volume of the left ovary was slightly smaller,the RI and PI of the right uterine artery increased,and the RI of the myometrial artery decreased.The difference was not statistically significant(P>0.05);the intima was thickened.The PI of the left uterine artery decreased,the RI increased,and the PI of the myometrium increased.The difference was statistically significant(P<0.05).After treatment in both groups,the treatment group had larger ovary size and thicker endometrium.The myometrial arteries PI and RI were smaller,and the bilateral uterine arteries PI and RI were smaller.There was a statistically significant difference compared with the control group(P<0.05).4.Correlation analysis showed that endometrial thickness was negatively correlated with uterine arterial blood flow resistance and myometrial arterial blood flow resistance.5.In terms of clinical curative effect,in the 25 patients in the treatment group,2 were markedly effective,21 were improved,and the total effective rate was 92%.In the control group of 23 cases,only 17 cases improved and the total effective rate was 74%.The effect of the treatment group was better than that of the control group,and the difference was statistically significant(P<0.05).conclusion1.Zigui Yijing Tongluo Decoction can improve the ovarian morphological structure of POF rats and promote the development of ovarian follicles,ovaries increase in volume,thereby improving ovarian endocrine function in rats.2.Zigui Yijing Tongluo decoction can improve ovarian size and ovarian blood supply in patients with POF,and then improve the ovarian secretory function,relieve the patient’s clinical symptoms.3.Based on the theory of collaterals,Zigui Yijing Tongluo decoction can reduce the uterine arterial blood flow resistance from the microcirculatory point of view,so as to improve the blood supply of the ovary and thus improve the ovarian function. |
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