产后风湿症与血清催乳素、孕酮水平的关系及柴胡桂枝汤加减疗效分析
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摘要
目的:分析产后风湿症与血清催乳素(PRL)、孕酮(P)水平的关系及柴胡桂枝汤加减治疗的临床价值。方法:选择2015年1月—2017年2月于医院分娩且发生产后风湿症的86例患者作为观察组,选择同期在本院体检的50例正常健康女性作为对照组,观察组分别于产程开始前、产后42 d及产后6个月抽取外周静脉血,对照组于入院当日抽取外周静脉血,采用放射免疫法测定PRL、P水平的变化,并将观察组随机分为A、B组各43例,A组采用柴胡桂枝汤加减治疗,B组采用常规碳酸钙D3颗粒补钙处理,比较两组治疗效果及治疗前后中医证候积分的变化,测定两组视觉模拟评分(VAS)及爱丁堡产后抑郁量表(EPDS)评分的变化,记录两组疼痛持续时间、肢体压痛数目、关节肿胀数目。结果:观察组产程开始前及产后42 d PRL、P均高于对照组(P<0.05),产后42 d、产后6个月,观察组PRL、P均较产程开始时降低,比较差异有统计学意义(P<0.05);A组治疗总有效率为95.35%,明显高于B组的72.09%,比较差异有统计学意义(P<0.05);治疗前,A、B组肢体疼痛、关节肿胀、畏恶风寒、神疲乏力、面色萎黄等中医证候积分比较差异无统计学意义(P>0.05),停药4周,两组上述积分均降低,A组各积分均低于B组(P<0.05);治疗前,两组VAS评分、EPDS评分、疼痛持续时间、肢体压痛数目及关节肿胀数目比较差异无统计学意义(P>0.05),停药4周,A组上述指标均低于或少于B组(P<0.05)。结论:产后风湿症的发病可能与产后PRL、P水平变化有关,且与产后抑郁存在一定的联系,采用柴胡桂枝汤加减治疗产后风湿症疗效肯定,可改善患者症状及体征,减轻关节疼痛,减轻患者产后抑郁程度,促进其恢复。
Objective:To analyze the relationship between postpartum rheumatism and serum prolactin(PRL) and progesterone(P) levels and the clinical value of modified Chaihu Guizhi Decoction.Methods:Eighty-six patients with postpartum rheumatism who delivered in the hospital from January 2015 to February 2017 were selected as the observation group,and 50 normal healthy women were selected as the control group.The peripheral venous blood of the observation group was collected before stages of labor and at 42 d and 6 months after delivery,while the peripheral venous blood of control group was collected on the day of admission.Changes in levels of PRL and P were determined by radioimmunoassay.Patients in observation group were randomly divided into group A and group B,43 cases in each group.Group A was treated with modified Chaihu Guizhi Decoction,while group B was treated with conventional calcium carbonate D3 granules for calcium supplementation.The therapeutic effects and changes of TCM syndrome scores before and after treatment were compared between the two groups.Changes of visual analogue scale(VAS) score and Edinburgh Postnatal Depression Scale(EPDS) score in the two groups were determined.The duration of pain,number of limbs with tenderness and number of joints with swelling in the two groups were recorded.Results:Levels of PRL and P in the observation group before stages of labor and at 42 d after delivery were higher than those in the control group(P<0.05).Levels of PRL and P in the observation group at 42 d and 6 months after delivery were lower than those at the beginning of labor(P<0.05).The total effective rate of treatment in group A was significantly higher than that in group B(95.35% vs 72.09%)(P<0.05).Before treatment,there was no significant difference between group A and group B in scores of TCM symptoms,such as limb pain,joint swelling,aversion to cold,lassitude or sallow complexion(P>0.05).The above scores decreased at 4 weeks after drug withdrawal,and the scores of group A were lower than those of group B(P<0.05).Before treatment,there was no significant difference in the VAS score,EPDS score,duration of pain,the number of limbs with tenderness or the number of joints with swelling between the two groups(P>0.05),but they were lower/less in group A than in group B at 4 weeks after drug withdrawal(P<0.05).Conclusion:The incidence of postpartum rheumatism may be related to changes of PRL and P levels,and there is certain relation with postpartum depression.Modified Chaihu Guizhi Decoction is effective in the treatment of postpartum rheumatism,and it can improve symptoms and signs,relieve joint pain and postpartum depression and promote recovery.
Objective:To analyze the relationship between postpartum rheumatism and serum prolactin(PRL) and progesterone(P) levels and the clinical value of modified Chaihu Guizhi Decoction.Methods:Eighty-six patients with postpartum rheumatism who delivered in the hospital from January 2015 to February 2017 were selected as the observation group,and 50 normal healthy women were selected as the control group.The peripheral venous blood of the observation group was collected before stages of labor and at 42 d and 6 months after delivery,while the peripheral venous blood of control group was collected on the day of admission.Changes in levels of PRL and P were determined by radioimmunoassay.Patients in observation group were randomly divided into group A and group B,43 cases in each group.Group A was treated with modified Chaihu Guizhi Decoction,while group B was treated with conventional calcium carbonate D3 granules for calcium supplementation.The therapeutic effects and changes of TCM syndrome scores before and after treatment were compared between the two groups.Changes of visual analogue scale(VAS) score and Edinburgh Postnatal Depression Scale(EPDS) score in the two groups were determined.The duration of pain,number of limbs with tenderness and number of joints with swelling in the two groups were recorded.Results:Levels of PRL and P in the observation group before stages of labor and at 42 d after delivery were higher than those in the control group(P<0.05).Levels of PRL and P in the observation group at 42 d and 6 months after delivery were lower than those at the beginning of labor(P<0.05).The total effective rate of treatment in group A was significantly higher than that in group B(95.35% vs 72.09%)(P<0.05).Before treatment,there was no significant difference between group A and group B in scores of TCM symptoms,such as limb pain,joint swelling,aversion to cold,lassitude or sallow complexion(P>0.05).The above scores decreased at 4 weeks after drug withdrawal,and the scores of group A were lower than those of group B(P<0.05).Before treatment,there was no significant difference in the VAS score,EPDS score,duration of pain,the number of limbs with tenderness or the number of joints with swelling between the two groups(P>0.05),but they were lower/less in group A than in group B at 4 weeks after drug withdrawal(P<0.05).Conclusion:The incidence of postpartum rheumatism may be related to changes of PRL and P levels,and there is certain relation with postpartum depression.Modified Chaihu Guizhi Decoction is effective in the treatment of postpartum rheumatism,and it can improve symptoms and signs,relieve joint pain and postpartum depression and promote recovery.
引文
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[11] 邓燕青,张春芳,李晓丹,等.视觉模拟版IPSS评分表的应用评价[J].中华泌尿外科杂志,2011,32(10):691-694.
[12] Lacasse P,Vinet C M,Petitclerc D.Effect of prepartum photoperiod and melatonin feeding on milk production and prolactin concentration in dairy heifers and cows[J].Journal of Dairy Science,2014,97(6):3589-3598.
[13] 李玉霞,王彩环,李水蓉.观察“冬病夏治”穴位贴敷、针刺、拔罐综合治疗产后痹的临床疗效[J].西部中医药,2016,29(7):110-114.
[14] Retnakaran R,Ye C,Kramer C K,et al.Maternal Serum Prolactin and Prediction of Postpartum β-Cell Function and Risk of Prediabetes/Diabetes[J].Diabetes Care,2016,39(7):1250-1258.
[15] 王玉明.产后风湿症的特点探讨及临证体会[J].四川中医,2014,32(1):58-59.
[16] 肖雯晖.温成平治疗产后风湿经验[J].安徽中医药大学学报,2014,33(1):38-40.
[17] Ascari I J,Alves A C,Pérez J R O,et al.Nursing regimens:Effects on body condition,return to postpartum ovarian cyclicity in Santa Ines ewes,and performance of lambs[J].Animal Reproduction Science,2013,140(3-4):153-163.
[18] Osborne L,Clive M,Kimmel M,et al.Replication of Epigenetic Postpartum Depression Biomarkers and Variation with Hormone Levels[J].Neuropsychopharmacology,2016,41(6):1648-1658.
[2] 李公明,夏俊杰.从“结气致痹”论治产后风湿症[J].江苏中医药,2016,48(3):43-45.
[3] Enninga E A,Nevala W K,Creedon D J,et al.Fetal sex-based differences in maternal hormones,angiogenic factors,and immune mediators during pregnancy and the postpartum period[J].American Journal of Reproductive Immunology,2015,73(3):251-262.
[4] 孟彪,高立珍.赵和平治疗产后风湿病经验[J].中医药学报,2013,41(5):32-33.
[5] 黄佳楠,孙维峰.孙维峰诊治产后风湿病经验拾萃[J].世界中西医结合杂志,2016,11(4):479-481.
[6] 夏淑洁,王义军,胡荫奇.胡荫奇虚实兼顾治疗产后风湿经验[J].北京中医药,2017,36(9):810-812.
[7] 娄玉钤.中国风湿病学[M].北京:人民卫生出版社,2001:73-74.
[8] 张玉珍.新编中医妇科学[M].北京:人民军医出版社,2001:308-313.
[9] 国家中医药管理局.ZY/T001.1～001.9-94 中医病证诊断疗效标准[M].南京:南京大学出版社,1994:148-152.
[10] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:126-128.
[11] 邓燕青,张春芳,李晓丹,等.视觉模拟版IPSS评分表的应用评价[J].中华泌尿外科杂志,2011,32(10):691-694.
[12] Lacasse P,Vinet C M,Petitclerc D.Effect of prepartum photoperiod and melatonin feeding on milk production and prolactin concentration in dairy heifers and cows[J].Journal of Dairy Science,2014,97(6):3589-3598.
[13] 李玉霞,王彩环,李水蓉.观察“冬病夏治”穴位贴敷、针刺、拔罐综合治疗产后痹的临床疗效[J].西部中医药,2016,29(7):110-114.
[14] Retnakaran R,Ye C,Kramer C K,et al.Maternal Serum Prolactin and Prediction of Postpartum β-Cell Function and Risk of Prediabetes/Diabetes[J].Diabetes Care,2016,39(7):1250-1258.
[15] 王玉明.产后风湿症的特点探讨及临证体会[J].四川中医,2014,32(1):58-59.
[16] 肖雯晖.温成平治疗产后风湿经验[J].安徽中医药大学学报,2014,33(1):38-40.
[17] Ascari I J,Alves A C,Pérez J R O,et al.Nursing regimens:Effects on body condition,return to postpartum ovarian cyclicity in Santa Ines ewes,and performance of lambs[J].Animal Reproduction Science,2013,140(3-4):153-163.
[18] Osborne L,Clive M,Kimmel M,et al.Replication of Epigenetic Postpartum Depression Biomarkers and Variation with Hormone Levels[J].Neuropsychopharmacology,2016,41(6):1648-1658.