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Article(id=1322923564151747087, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.05.016, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339156425, onlineDateStr=2026-10-30, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339156425, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339156425, creator=13701087609, updateTime=1793339156425, updator=13701087609, issue=Issue{id=1322923490592043032, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='5', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1746806400000', pubDateStr='2025-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339138887, creator='13701087609', updateTime=1793340572227, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929502539612595, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929502539612596, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=70, endPage=74, ext={EN=ArticleExt(id=1322923564487291408, articleId=1322923564151747087, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Clinical Study of Modified Shenghua Decoction（加味生化汤）Combined with Medroxyprogesterone in Treatment of Patients with Perimenopausal Abnormal Uterine Bleeding-Ovulatory Dysfunction, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate clinical efficacy of Modified Shenghua Decoction（加味生化汤）combined with medroxyprogesterone in treatment of patients with perimenopausal abnormal uterine bleeding-ovulatory dysfunction（AUB-O）.

Methods

Sixty cases patients with perimenopausal AUB-Owere selected and randomly divided into the observation group（30 cases）and control group（30 cases）. The control group received oral treatment with medroxyprogesterone. On the basis of the control group，the observation group was treated with a combination of Modified Shenghua Decoction orally. The treatment course was 3 menstrual cycles. The changes of sex hormone level，endometrial thickness，uterine volume，menstrual volume，menstrual duration，prothrombin time，activated partial thromboplastin time，hemoglobin level and traditional Chinese medicine syndrome score（TCM）symptom score before and after treatment were observed.

Results

The levels of estradiol（E2），follicle stimulating hormone（FSH），luteinizing hormone（LH）and prolactin（PRL）decreased before and after treatment in both groups（P<0.05）and the levels of the observation group were lower than those of the control group（P<0.05）. The endometrial thickness，menstrual volume and menstrual duration of two groups decreased after treatment compared to those before treatment（P<0.05）. The degree of decrease in the observation group was greater than that in the control group（P<0.05）. There was no statistically significant difference in uterine volume between the two groups before and after treatment（P>0.05）. The prothrombin time and activated partial thromboplastin time of two groups decreased after treatment compared to those before treatment（P<0.05）. The degree of decrease in the observation group was greater than that in the control group（P<0.05）. The hemoglobin level increased compared to that before treatment（P<0.05）and the increase in the observation group was greater than that in the control group（P<0.05）. The incidence of adverse reactions was 36.67%in the control group and 43.33%in the observation group. There was no statistically significant difference in comparison（P>0.05）. The scores of TCM symptoms in both groups decreased after treatment（P<0.05），and scores of the observation group were lower than those of the control group（P<0.05）. The therapeutic effect of the observation group was significantly better than that of the control group（P<0.05）.

Conclusion

Modified Shenghua Decoction combined with medroxyprogesterone in treatment of patients with perimenopausal AUB-Ocan help to improve the levels of sex hormones，reduce endometrial thickness，menstrual volume and duration，improve coagulation function andclinical efficacy，and dose not significantly increase adverse reactions.

, authors=Shenghua LI, Juan HE, Jian TANG, Na LUO, Yulei FU, Jiaying WANG, authorsList=Shenghua LI, Juan HE, Jian TANG, Na LUO, Yulei FU, Jiaying WANG, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923567704322588, articleId=1322923564151747087, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=加味生化汤联合安宫黄体酮治疗围绝经期排卵障碍性异常子宫出血的临床研究, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

探讨加味生化汤联合安宫黄体酮治疗围绝经期排卵障碍性异常子宫出血（Abnormal uterine bleeding-ovulatory dysfunction，AUB-O）的临床疗效。

方法

选取60例围绝经期AUB-O患者，随机分为观察组和对照组各30例，对照组给予安宫黄体酮口服治疗，观察组在对照组基础上联合加味生化汤口服治疗，疗程3个月经周期。观察治疗前后性激素水平、子宫内膜厚度、子宫体积、月经量、经期时间、凝血酶原时间、活化部分凝血活酶时间、血红蛋白水平及中医证候积分变化。

结果

两组治疗前雌二醇（Estradiol，E2）、促卵泡生成素（Follicle stimulating hormone，FSH）、促黄体生成素（Luteinizing hormone，LH）、泌乳素（Prolactin，PRL）水平治疗后下降（P<0.05），且观察组低于对照组（P<0.05）；两组患者子宫内膜厚度、月经量、经期时间治疗后较治疗前下降（P<0.05），观察组下降程度大于对照组（P<0.05），子宫体积两组治疗前后比较均差异无统计学意义（P>0.05）；两组患者凝血酶原时间、活化部分凝血活酶时间治疗后较治疗前下降（P<0.05），观察组下降程度大于对照组（P<0.05），血红蛋白水平较治疗前升高（P<0.05），且观察组升高幅度大于对照组（P<0.05）；不良反应发生率对照组为36.67%、观察组为43.33%，比较差异无统计学意义（P>0.05）；两组中医证候积分治疗后下降（P<0.05），且观察组低于对照组（P<0.05）；观察组治疗疗效明显优于对照组（P<0.05）。

结论

围绝经期AUB-O患者采用加味生化汤联合安宫黄体酮治疗可有助于改善性激素水平，降低子宫内膜厚度，减少月经量及经期时间，改善凝血功能，提高临床疗效，且不会明显增加不良反应。

, authors=李升华, 何涓, 唐健, 罗娜, 符玉蕾, 王佳莹, authorsList=李升华, 何涓, 唐健, 罗娜, 符玉蕾, 王佳莹, authorCompany=null, correspAuthors=null, authorNote=

李升华（1987-），女，黑龙江通河人，主治医师，硕士，研究方向：妇产科疾病。

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李升华（1987-），女，黑龙江通河人，主治医师，硕士，研究方向：妇产科疾病。

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李升华（1987-），女，黑龙江通河人，主治医师，硕士，研究方向：妇产科疾病。

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tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, doi=null, pmid=null, pmcid=null, year=2022, volume=12, issue=21, pageStart=56, pageEnd=59，115, url=null, language=null, rfNumber=［24］, rfOrder=23, authorNames=柳志诚, 方永晟, 杨国华, journalName=中国医药科学, refType=null, unstructuredReference=柳志诚，方永晟，杨国华，等. 水蛭素的药理作用研究进展［J］. 中国医药科学，2022，12（21）：56-59，115., articleTitle=水蛭素的药理作用研究进展, refAbstract=null), Reference(id=1322923582032065132, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=10, pageStart=31, pageEnd=38, url=null, language=null, rfNumber=［25］, rfOrder=24, authorNames=徐英, 王小文, 李娜, journalName=中国实验方剂学杂志, refType=null, unstructuredReference=徐英，王小文，李娜，等. 经典名方乌药汤的历史沿革与现代临床应用分析［J］. 中国实验方剂学杂志，2023，29（10）：31-38., articleTitle=经典名方乌药汤的历史沿革与现代临床应用分析, refAbstract=null), Reference(id=1322923582115951213, tenantId=1146029695717560320, 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tableContent=
组别例数E2/（pg/mL）FSH/（IU/L）LH/（IU/L）PRL/（μg/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组30164.29±24.0973.49±11.35*13.55±1.9410.02±1.76*8.31±1.446.98±1.30*12.67±1.769.95±1.18*
观察组30163.02±24.1462.10±9.43*13.60±1.928.53±1.35*8.33±1.405.77±1.28*12.71±1.748.57±1.10*
t值0.2044.2280.1003.6790.5453.6320.0184.686
P值0.839<0.0010.920<0.0010.957<0.0010.985<0.001
), ArticleFig(id=1322923577149895239, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=CN, label=表1, caption=

两组围绝经期排卵障碍性异常子宫出血患者治疗前后性激素水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数E2/（pg/mL）FSH/（IU/L）LH/（IU/L）PRL/（μg/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组30164.29±24.0973.49±11.35*13.55±1.9410.02±1.76*8.31±1.446.98±1.30*12.67±1.769.95±1.18*
观察组30163.02±24.1462.10±9.43*13.60±1.928.53±1.35*8.33±1.405.77±1.28*12.71±1.748.57±1.10*
t值0.2044.2280.1003.6790.5453.6320.0184.686
P值0.839<0.0010.920<0.0010.957<0.0010.985<0.001
), ArticleFig(id=1322923577279918664, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数子宫内膜厚度/（mm）子宫体积/（cm3）月经量/（mL）经期时间/（d）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组3012.50±1.117.35±1.09*64.10±8.9965.10±8.97154.24±26.8786.32±10.54*9.14±1.666.32±1.11*
观察组3012.54±1.055.56±0.67*64.15±8.9265.24±8.84156.11±26.9765.24±9.46*9.15±1.705.28±1.03*
t值0.1437.6630.0220.0610.2698.1520.0233.762
P值0.887<0.0010.9830.9520.789<0.0010.982<0.001
), ArticleFig(id=1322923577367999049, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=CN, label=表2, caption=

两组围绝经期排卵障碍性异常子宫出血患者治疗前后子宫内膜厚度、子宫体积、月经量、经期时间比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数子宫内膜厚度/（mm）子宫体积/（cm3）月经量/（mL）经期时间/（d）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组3012.50±1.117.35±1.09*64.10±8.9965.10±8.97154.24±26.8786.32±10.54*9.14±1.666.32±1.11*
观察组3012.54±1.055.56±0.67*64.15±8.9265.24±8.84156.11±26.9765.24±9.46*9.15±1.705.28±1.03*
t值0.1437.6630.0220.0610.2698.1520.0233.762
P值0.887<0.0010.9830.9520.789<0.0010.982<0.001
), ArticleFig(id=1322923577447690826, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数凝血酶原时间/（s）活化部分凝血活酶时间/（s）血红蛋白/（g/L）
治疗前治疗后治疗前治疗后治疗前治疗后
对照组3013.12±1.3011.23±1.14*37.30±3.0433.20±2.64*95.68±5.20100.58±4.04*
观察组3013.15±1.2510.04±1.07*37.35±3.0130.49±2.53*96.10±5.23104.42±4.15*
t值0.0914.1690.0644.0590.3123.632
P值0.928<0.0010.949<0.0010.756<0.001
), ArticleFig(id=1322923577523188299, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=CN, label=表3, caption=

两组围绝经期排卵障碍性异常子宫出血患者治疗前后的凝血酶原时间、活化部分凝血活酶时间、血红蛋白水平比较（±s）

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组别例数凝血酶原时间/（s）活化部分凝血活酶时间/（s）血红蛋白/（g/L）
治疗前治疗后治疗前治疗后治疗前治疗后
对照组3013.12±1.3011.23±1.14*37.30±3.0433.20±2.64*95.68±5.20100.58±4.04*
观察组3013.15±1.2510.04±1.07*37.35±3.0130.49±2.53*96.10±5.23104.42±4.15*
t值0.0914.1690.0644.0590.3123.632
P值0.928<0.0010.949<0.0010.756<0.001
), ArticleFig(id=1322923577686766156, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数恶心呕吐头晕乳房胀痛阴道不规则出血药物性皮疹转氨酶升高血肌酐升高合计
对照组304（13.33）1（3.33）3（10.00）2（6.67）0（0.00）1（3.33）0（0.00）11（36.67）
观察组307（23.33）0（0.00）5（16.67）1（3.33）0（0.00）0（0.00）0（0.00）13（43.33）
χ2值-------0.278
P值-------0.598
), ArticleFig(id=1322923577791623757, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=CN, label=表4, caption=

两组围绝经期排卵障碍性异常子宫出血患者治疗期间不良反应发生情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数恶心呕吐头晕乳房胀痛阴道不规则出血药物性皮疹转氨酶升高血肌酐升高合计
对照组304（13.33）1（3.33）3（10.00）2（6.67）0（0.00）1（3.33）0（0.00）11（36.67）
观察组307（23.33）0（0.00）5（16.67）1（3.33）0（0.00）0（0.00）0（0.00）13（43.33）
χ2值-------0.278
P值-------0.598
), ArticleFig(id=1322923577896481358, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主症次症
治疗前治疗后治疗前治疗后
对照组3014.34±2.206.45±1.10*13.10±2.186.97±1.50*
观察组3014.42±2.234.54±1.02*13.18±2.255.02±1.35*
t值0.1406.9740.1405.293
P值0.889<0.0010.889<0.001
), ArticleFig(id=1322923577984561743, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=CN, label=表5, caption=

两组围绝经期排卵障碍性异常子宫出血患者治疗前后中医证候积分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主症次症
治疗前治疗后治疗前治疗后
对照组3014.34±2.206.45±1.10*13.10±2.186.97±1.50*
观察组3014.42±2.234.54±1.02*13.18±2.255.02±1.35*
t值0.1406.9740.1405.293
P值0.889<0.0010.889<0.001
), ArticleFig(id=1322923578055864912, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效
对照组3010（33.33）14（46.67）6（20.00）
观察组3020（66.67）8（26.67）2（6.67）
Z值2.607
P值0.009
), ArticleFig(id=1322923578152333905, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923564151747087, language=CN, label=表6, caption=

两组围绝经期排卵障碍性异常子宫出血患者治疗疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效
对照组3010（33.33）14（46.67）6（20.00）
观察组3020（66.67）8（26.67）2（6.67）
Z值2.607
P值0.009
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加味生化汤联合安宫黄体酮治疗围绝经期排卵障碍性异常子宫出血的临床研究
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李升华 , 何涓 , 唐健 , 罗娜 , 符玉蕾 , 王佳莹
中华中医药学刊 | 国家项目点击 2025,43(5): 70-74
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中华中医药学刊 |国家项目点击 2025 , 43 (5) : 70 -74
加味生化汤联合安宫黄体酮治疗围绝经期排卵障碍性异常子宫出血的临床研究
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李升华, 何涓, 唐健, 罗娜, 符玉蕾, 王佳莹
作者信息
  • 上海交通大学医学院附属上海儿童医学中心海南医院，海南 三亚 572000
作者简介:

李升华（1987-），女，黑龙江通河人，主治医师，硕士，研究方向：妇产科疾病。

Clinical Study of Modified Shenghua Decoction（加味生化汤）Combined with Medroxyprogesterone in Treatment of Patients with Perimenopausal Abnormal Uterine Bleeding-Ovulatory Dysfunction
Shenghua LI, Juan HE, Jian TANG, Na LUO, Yulei FU, Jiaying WANG
Affiliations
  • Hainan Hospital，Shanghai Children＇s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine，Sanya 572000，Hainan，China
出版时间: 2025-05-10 doi: 10.13193/j.issn.1673-7717.2025.05.016
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摘要
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目的

探讨加味生化汤联合安宫黄体酮治疗围绝经期排卵障碍性异常子宫出血（Abnormal uterine bleeding-ovulatory dysfunction，AUB-O）的临床疗效。

方法

选取60例围绝经期AUB-O患者，随机分为观察组和对照组各30例，对照组给予安宫黄体酮口服治疗，观察组在对照组基础上联合加味生化汤口服治疗，疗程3个月经周期。观察治疗前后性激素水平、子宫内膜厚度、子宫体积、月经量、经期时间、凝血酶原时间、活化部分凝血活酶时间、血红蛋白水平及中医证候积分变化。

结果

两组治疗前雌二醇（Estradiol，E2）、促卵泡生成素（Follicle stimulating hormone，FSH）、促黄体生成素（Luteinizing hormone，LH）、泌乳素（Prolactin，PRL）水平治疗后下降（P<0.05），且观察组低于对照组（P<0.05）；两组患者子宫内膜厚度、月经量、经期时间治疗后较治疗前下降（P<0.05），观察组下降程度大于对照组（P<0.05），子宫体积两组治疗前后比较均差异无统计学意义（P>0.05）；两组患者凝血酶原时间、活化部分凝血活酶时间治疗后较治疗前下降（P<0.05），观察组下降程度大于对照组（P<0.05），血红蛋白水平较治疗前升高（P<0.05），且观察组升高幅度大于对照组（P<0.05）；不良反应发生率对照组为36.67%、观察组为43.33%，比较差异无统计学意义（P>0.05）；两组中医证候积分治疗后下降（P<0.05），且观察组低于对照组（P<0.05）；观察组治疗疗效明显优于对照组（P<0.05）。

结论

围绝经期AUB-O患者采用加味生化汤联合安宫黄体酮治疗可有助于改善性激素水平，降低子宫内膜厚度，减少月经量及经期时间，改善凝血功能，提高临床疗效，且不会明显增加不良反应。

加味生化汤  /  安宫黄体酮  /  围绝经期  /  排卵障碍性异常子宫出血
Objective

To investigate clinical efficacy of Modified Shenghua Decoction（加味生化汤）combined with medroxyprogesterone in treatment of patients with perimenopausal abnormal uterine bleeding-ovulatory dysfunction（AUB-O）.

Methods

Sixty cases patients with perimenopausal AUB-Owere selected and randomly divided into the observation group（30 cases）and control group（30 cases）. The control group received oral treatment with medroxyprogesterone. On the basis of the control group，the observation group was treated with a combination of Modified Shenghua Decoction orally. The treatment course was 3 menstrual cycles. The changes of sex hormone level，endometrial thickness，uterine volume，menstrual volume，menstrual duration，prothrombin time，activated partial thromboplastin time，hemoglobin level and traditional Chinese medicine syndrome score（TCM）symptom score before and after treatment were observed.

Results

The levels of estradiol（E2），follicle stimulating hormone（FSH），luteinizing hormone（LH）and prolactin（PRL）decreased before and after treatment in both groups（P<0.05）and the levels of the observation group were lower than those of the control group（P<0.05）. The endometrial thickness，menstrual volume and menstrual duration of two groups decreased after treatment compared to those before treatment（P<0.05）. The degree of decrease in the observation group was greater than that in the control group（P<0.05）. There was no statistically significant difference in uterine volume between the two groups before and after treatment（P>0.05）. The prothrombin time and activated partial thromboplastin time of two groups decreased after treatment compared to those before treatment（P<0.05）. The degree of decrease in the observation group was greater than that in the control group（P<0.05）. The hemoglobin level increased compared to that before treatment（P<0.05）and the increase in the observation group was greater than that in the control group（P<0.05）. The incidence of adverse reactions was 36.67%in the control group and 43.33%in the observation group. There was no statistically significant difference in comparison（P>0.05）. The scores of TCM symptoms in both groups decreased after treatment（P<0.05），and scores of the observation group were lower than those of the control group（P<0.05）. The therapeutic effect of the observation group was significantly better than that of the control group（P<0.05）.

Conclusion

Modified Shenghua Decoction combined with medroxyprogesterone in treatment of patients with perimenopausal AUB-Ocan help to improve the levels of sex hormones，reduce endometrial thickness，menstrual volume and duration，improve coagulation function andclinical efficacy，and dose not significantly increase adverse reactions.

Modified Shenghua Decoction（加味生化汤）  /  medroxyprogesterone  /  perimenopausal period  /  abnormal uterine bleeding-ovulatory dysfunction
李升华, 何涓, 唐健, 罗娜, 符玉蕾, 王佳莹. 加味生化汤联合安宫黄体酮治疗围绝经期排卵障碍性异常子宫出血的临床研究. 中华中医药学刊, 2025 , 43 (5) : 70 -74 . DOI: 10.13193/j.issn.1673-7717.2025.05.016
Shenghua LI, Juan HE, Jian TANG, Na LUO, Yulei FU, Jiaying WANG. Clinical Study of Modified Shenghua Decoction（加味生化汤）Combined with Medroxyprogesterone in Treatment of Patients with Perimenopausal Abnormal Uterine Bleeding-Ovulatory Dysfunction[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (5) : 70 -74 . DOI: 10.13193/j.issn.1673-7717.2025.05.016
正文
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异常子宫出血（Abnormal uterine bleeding，AUB）是一种临床常见的妇科出血性疾病，是一种症状也是一种体征，是指源于子宫腔的、与正常月经的周期规律、经期长度及出血量等任何一项不符的异常出血，根据其发病病因不同可分为两大类9个类型，其中排卵障碍性异常子宫出血（AUB-ovulatory dysfunction，AUB-O）是最常见的类型之一，同时发病对象以围绝经期妇女最常见。对AUB-O的治疗目前主要有手术及非手术治疗方法，大部分患者可通过药物治疗即可取得良好效果[1-2]，对药物治疗无效者可采取手术治疗。雌激素、孕激素等性激素是常用的治疗AUB-O药物，对雌激素使用有禁忌证的女性来说孕激素制剂是最理想治疗AUB-O药物。AUB在传统医学中归属于“崩漏”“月经先期”“经间期出血”“月经过多”“经期延长”等范畴，患者多为虚证，且以血虚、气虚、肾虚等常见，实证则以血瘀、血热、肝郁常见，患者也可表现为虚实夹杂，对患者进行辨证施治，中医药治疗也能取得较好效果[2-4]。我院在近年来对诊治的围绝经期AUB-O患者采取加味生化汤联合安宫黄体酮治疗，取得了良好效果，现将相关研究结果报道如下。
1　资料与方法
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1.1　一般资料
选取2021年1月—2023年1月期间在我院就诊的围绝经期AUB-O患者60例为研究对象。纳入标准：（1）符合《妇产科学》（第9版）[5]、《排卵障碍性异常子宫出血诊治指南》[6]中AUB-O诊断标准。中医诊断符合《国际中医临床实践指南：崩漏（2019-10-11）》[7]、《中医妇科临床诊疗指南》[8]中相关诊断标准，中医辨证为气虚血瘀证。（2）刮宫病理确诊。（3）患者年龄40～60岁，目前处于围绝经期。（4）目前正处于出血期。排除标准：（1）其他类型的AUB。（2）在纳入研究前3个月内有使用激素治疗者。（3）过敏体质或对研究使用药物有过敏史、禁忌证者。（4）合并有子宫内膜炎、卵巢囊肿等其他妇科疾病。（5）合并恶性肿瘤。（6）有重要脏器功能不全者。（7）凝血功能障碍、其他疾病所致阴道出血。（8）患精神疾病者。（9）伴随高催乳素血症、糖尿病、甲状腺功能亢进等其他内分泌疾病。（10）血红蛋白（Hemoglobin，Hb）含量≤60 g/L。将患者随机分为观察组（30例）与对照组（30例）。观察组年龄45～56（51.56±3.64）岁；体质量指数18.13～27.89（24.43±1.95）kg/m2；孕次1～5（2.19±0.94）次；产次1～4（1.90±0.84）次；病程3～23（16.13±4.23）个月。对照组年龄45～57（51.53±3.70）岁；体质量指数18.20～27.97（24.50±1.92）kg/m2；孕次1～5（2.16±0.98）次；产次0～4（1.92±0.83）次；病程4～26（16.20±4.21）个月。两组患者的一般资料比较差异无统计学意义（P>0.05），有可比性。本研究取得患者知情同意，均签署知情同意书，经医院伦理委员会审核通过。
1.2　方法
1.2.1　对照组
给予安宫黄体酮（浙江仙琚制药股份有限公司生产，国药准字：H33020715，规格：2 mg/片）口服治疗，第1个周期在患者进行诊刮术后第15天开始服用，10 mg/次，1次/d，连续服用14 d，第2个周期开始在发生撤退性出血后的第15天开始服用，8 mg/次，1次/d，连续服用10 d，持续治疗3个月经周期。
1.2.2　观察组
在对照组用药基础上加服加味生化汤口服，加味生化汤组方：当归24～27 g，川芎12～15 g，水蛭12～15 g，红花12～15 g，乌药10～12 g，桃仁（去皮尖）10～12 g，郁金10～12 g，三七粉（冲）3～5 g，炮干姜6～9 g，炙甘草6～9 g，1剂/d，加水浸泡30 min后武火煎，沸腾10 min后改为文火煎20～30 min，煎汁约400 mL，分早晚分服。每周服药6 d停药1 d后继续服用，持续治疗3个月经周期。
1.3　观察指标
（1）治疗前后性激素水平。采用放射免疫法测定静脉外周血雌二醇（Estradiol，E2）、促卵泡生成素（Follicle stimulating hormone，FSH）、促黄体生成素（Luteinizing hormone，LH）、泌乳素（Prolactin，PRL）水平，检测试剂盒购自江苏谱迪生物科技有限公司。（2）治疗前后子宫内膜厚度、子宫体积、月经量、经期时间。子宫内膜及子宫体积采取彩色多普勒超声诊断仪测定，于撤退性出血干净后第1天使用超声测量。（3）治疗前后的凝血酶原时间、活化部分凝血活酶时间、血红蛋白水平。分别采用Stago-Evolution全自动血凝仪测定及BC-6800全自动血液细胞分析仪检测。（4）治疗期间不良反应发生情况。不良反应包括恶心呕吐、头晕、乳房胀痛、阴道不规则出血、药物性皮疹、胃部不适、转氨酶升高、血肌酐升高等。（5）治疗前后中医证候积分。气虚血瘀证[8]，主症：经血量多，淋漓不尽，色浅质稀；次症：神疲体倦，面色萎黄，手足不温，气短懒言，食欲欠佳，腹胀便溏，腹部疼痛；主症、次症按证候严重程度无、轻、中、重分别计0、2、4、6分和0、1、2、3分，评估治疗前后证候积分改善情况。
1.4　疗效判定标准
参考相关文献标准[9]。显效：治疗3 d后出血量明显减少，3个月经周期停药后不规则出血、月经周期紊乱等无复发，正常月经周期能维持6个月；有效：治疗3 d后出血量减少，3个月经周期停药后不规则出血、月经周期紊乱等无复发，正常月经周期维持时间<6个月；无效：治疗期间月经量、月经周期紊乱无改善或反复出现。
1.5　统计学方法
数据采用SPSS 20.0统计学软件进行数据分析。计数资料采用率表示，采用卡方检验；等级资料采取秩和检验；计量资料以均数±标准差（）表示，采用t检验；P<0.05为差异有统计学意义。
2　结果
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2.1　治疗前后性激素水平比较
两组治疗前E2、FSH、LH、PRL水平比较差异无统计学意义，治疗后E2、FSH、LH、PRL水平下降（对照组t＝18.676、7.381、3.755、7.031，研究组t＝21.329、11.831、7.392、11.015，P<0.001），且观察组低于对照组，比较差异有统计学意义（P<0.05），见表1。
2.2　治疗前后子宫内膜厚度、子宫体积、月经量、经期时间比较
两组患者治疗前子宫内膜厚度、子宫体积、月经量、经期时间差异无统计学意义（P>0.05），子宫内膜厚度、月经量、经期时间治疗后较治疗前下降（对照组t＝18.132、12.889、7.735，观察组t＝30.694、17.414、10.664），观察组下降程度大于对照组，比较差异有统计学意义（P<0.05），子宫体积两组治疗前后比较差异无统计学意义（对照组t＝0.432，观察组t＝0.475，P＝0.668、0.636），见表2。
2.3　治疗前后凝血酶原时间、活化部分凝血活酶时间、血红蛋白水平比较
两组患者治疗前凝血酶原时间、活化部分凝血活酶时间、血红蛋白水平差异无统计学意义（P>0.05），凝血酶原时间、活化部分凝血活酶时间治疗后较治疗前下降（对照组t＝5.987、5.578、4.076，观察组t＝10.353、9.556、6.826），观察组下降程度大于对照组，血红蛋白水平较治疗前升高，且观察组升高幅度大于对照组，比较差异有统计学意义（P<0.05），见表3。
2.4　治疗期间不良反应发生情况比较
不良反应发生率对照组为36.67%、观察组为43.33%，比较差异无统计学意义（P>0.05），不良反应均经过对症处理后消失，未影响到治疗疗程的完成，见表4。
2.5　两组治疗前后中医证候积分比较
两组治疗前中医证候主症及次症积分比较差异均无统计学意义（P>0.05），治疗后积分下降（对照组t＝17.570、12.688，观察组t＝22.068、17.033），且观察组低于对照组，比较差异有统计学意义（P<0.05），表5。
2.6　两组治疗疗效比较
观察组治疗疗效明显优于对照组，比较差异有统计学意义（P<0.05），见表6。
3　讨论
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围绝经期女性卵巢功能随着年龄增长逐渐衰退，患者可表现为月经失调、潮热盗汗、骨质疏松等，因为性激素分泌失衡因此影响下丘脑-垂体-卵巢轴功能也失调，出现围绝经期的AUB，同时此年龄的患者大多数为AUB-O，可有月经量的增多、子宫内膜增厚、月经周期的紊乱等多种表现，目前临床主要采取雌孕激素。安宫黄体酮为人工合成孕激素制剂，有抑制子宫内膜的过度增生的作用[10]，可促使子宫内膜从增生期向分泌期转变，诱发子宫内膜发生撤退性出血，从而诱导下丘脑-垂体-卵巢轴功能恢复，进而达到治疗目的，但是在治疗过程中可能会出现突破性出血等不良反应、恶心呕吐等胃肠道反应。
AUB在传统医学中归属于“崩漏”“月经先期”“经间期出血”“月经过多”“经期延长”等范畴，其病因病机主要为脾肾亏虚、血瘀、血热所致[11-13]。肾为先天之本，围绝经期女性冲任及肾气渐虚损，天癸逐竭，体质向阴虚转化，因此出现经乱无期等表现。《校注妇人良方》中曰：“肾气全盛，冲任流通，经血即盈，应时而下。”子宫的藏泻受到肾的调节，围绝经期女性肾气亏虚，因而子宫藏泻失度。《沈氏女科辑要笺正》中云：“癸水为肾脏真阴。”天癸受真阴滋养，随着年龄的增加进入围绝经期，机体真阴亏虚，天癸失养则经血非时以下。脾为后天之本，主生血统血，为气血化生之源，《妇科·玉尺》中有云：“思虑伤脾，不能摄血故令妄行”。如饮食失调、忧思过度等可致脾损伤，脾不统血易发生异常出血。可见肾脾亏虚是崩漏的主要病因之一。妇人以血为本，经、带、胎、产、乳等更易耗伤阴血，致使气血虚，如进入围绝经期，脾肾亏虚加之长期出血，气血进一步耗损，气虚而血失统摄，血虚则气无所附，迫血妄行，经血失约，同时情志所伤、肝气郁结，气运行血无力，可致气滞血瘀，经期感受外寒，寒凝阻滞热灼也可致血瘀，旧血不去新血难安，因此可出现淋漓不断等表现。吴雅楠等[14]对359例围绝经期AUB-O患者中医体质特点进行了研究，结果发现中医体质分布以阴虚质、气虚质、湿热质、血瘀质为主。杨玉培等[15]对6688例AUB-O患者研究发现肾气虚证（17.34%）、脾气虚证（13.25%）、气血两虚证（12.62%）、气虚血瘀证（8.45%）、肾阴虚证（6.88%）。可见，气虚血瘀证是AUB-O患者主要证型之一，对此证型患者治疗则以补气、益气、散瘀为宜。
生化汤方中大剂量使用当归，理气活血、调经止痛、行滞补血，现代药理研究发现当归有当归促进红细胞及血红蛋白的生成、提高机体免疫功能作用[16-18]，同时对子宫平滑肌呈双向调节作用；川芎、红花、桃仁、郁金香、水蛭、乌药、三七粉等药物有活血祛瘀、补血益气功效；干姜温经散寒；甘草调和药性。现代医学研究发现川芎有抑制血小板聚集、改善循环作用[19-20]，桃仁、红花有抗炎、镇痛、改善微循环作用[21-22]，水蛭同样具有抗血小板聚集作用[23-24]，乌药及三七有改善微循环作用[25-26]。此方剂可益气补血，活血同时补血，避免过度活血导致月经量增多，通络行滞祛瘀则利于去旧血安新血。笔者对就诊的气滞血瘀证围绝经期AUB-O患者采用生化汤进行治疗，结果显示对于围绝经期AUB-O患者采取生化汤联合安宫黄体酮治疗的观察组患者较单独使用安宫黄体酮的对照组患者治疗后性激素水平下降更为明显，同时子宫内膜厚度、月经量、经期时间的改善也明显优于对照组，提示生化汤的应用对性激素水平及子宫内膜厚度、月经的改善效果更佳；观察患者凝血情况，凝血酶原时间、活化部分凝血活酶时间更短，表明生化汤对凝血功能有一定改善作用；由于围绝经期AUB-O患者月经紊乱及月经量的增多，因此可导致贫血的发生，本研究结果显示观察组患者治疗后的血红蛋白水平明显高于对照组，可能是因为观察组患者凝血功能的改善及月经量的改善，因此患者失血减少，血红蛋白水平得以恢复；从中医症候来看，观察组患者中医症候改善也优于对照组，同时整体治疗疗效也优于对照组，提示生化汤对患者的各种不适症状改善效果明显，而且有助于提高治疗疗效。无论是安宫黄体酮还是中药汤剂，服药期间胃肠道反应等不良反应均可能成为影响治疗疗程无法完成的因素，本研究结果显示不良反应发生率对照组为36.67%、观察组为43.33%，可以看出，联合生化汤口服并不会明显增加治疗不良反应，用药是安全的。
综上所述，围绝经期AUB-O患者采用加味生化汤联合安宫黄体酮治疗可有助于改善性激素水平，降低子宫内膜厚度，减少月经量及经期时间，改善凝血功能，提高临床疗效，且不会明显增加不良反应。
基金
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  • 国家中医药管理局科研课题计划项目(2020ZX0712)
  • 三亚市妇幼保健院金椰种子基金项目(JYZZ-201918)
文献
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参考文献 引证文献
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2025年第43卷第5期
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doi: 10.13193/j.issn.1673-7717.2025.05.016
  • 首发时间：2026-10-30
  • 出版时间：2025-05-10
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基金
国家中医药管理局科研课题计划项目(2020ZX0712)
三亚市妇幼保健院金椰种子基金项目(JYZZ-201918)
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    上海交通大学医学院附属上海儿童医学中心海南医院，海南 三亚 572000
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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