目的 观察采用归脾丸与地屈孕酮协同治疗脾虚型绝经期功能性子宫出血的疗效及其对性激素及血清炎症因子的影响。方法 选取2023年6月—2025年7月武汉市中医医院妇科收治的84例脾虚型绝经期功能性子宫出血患者。按照随机数字法分对照组（42例）和治疗组（42例）。对照组患者给予口服地屈孕酮片，于月经周期第15天开始用药，10 mg/次，2次/d，持续服用10 d。治疗组在对照组的基础上口服归脾丸，10丸/次，3次/d。两组用药维持3个月经周期的治疗。观察两组的临床疗效，比较治疗前后中医症状积分、雌二醇（E₂）、卵泡刺激素（FSH）、黄体生成素（LH）、白细胞介素-6（IL-6）、血清血管生成素-1（Ang-1）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）水平。结果 治疗后，治疗组总有效率是95.24%，显著高于对照组的80.95%（P＜0.05）。治疗后，两组少气懒言积分、神疲乏力积分、头晕眼花积分、食欲不振积分均显著降低（P＜0.05）；与对照组对比，治疗组少气懒言积分、神疲乏力积分、头晕眼花积分、食欲不振积分均更低（P＜0.05）。治疗后，两组E₂、FSH、LH水平均显著降低（P＜0.05）；与对照组对比，治疗组患者E₂、FSH、LH水平均更低（P＜0.05）。治疗后，两组IL-1β、TNF-α、Ang-1、IL-6水平较前显著降低（P＜0.05）；与对照组对比，治疗组患者IL-1β、TNF-α、Ang-1、IL-6水平均更低（P＜0.05）。结论 归脾丸与地屈孕酮协同治疗脾虚型绝经期功能性子宫出血效果显著，可有效改善患者出血症状，并能调节性激素，降低机体炎性反应。

Objective To observe the therapeutic effect of Guipi Pills combined with dydrogesterone in treatment of spleen deficiency type dysfunctional uterine bleeding during menopause, as well as its influence on sex hormones and serum inflammatory factors. Methods A total of 84 patients with spleen deficiency type dysfunctional uterine bleeding during menopause who were admitted to the Gynecology Department of Wuhan Traditional Chinese Medicine Hospital from June 2023 to July 2025 were selected. They were divided into control group (42 cases) and treatment group (42 cases) according to the random number table method. The patients in control group were given oral Dydrogesterone Tablets, starting from the 15th day of the menstrual cycle, 10 mg per time, twice daily, and continued for 10 d. The patients in treatment group were given oral Guipi Pills in addition to control group, 10 pills per time, 3 times daily. Two groups received medication for 3 menstrual cycles. The clinical efficacy of two groups was observed, and the scores of traditional Chinese medicine symptoms, E₂, FSH, LH, IL-6, serum Ang-1, TNF-α, and IL-1β levels before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 95.24%, significantly higher than that of the control group (80.95%) (P < 0.05). After treatment, the scores of shortness of breath and laziness, fatigue, dizziness and blurred vision, and loss of appetite in both groups were significantly reduced (P < 0.05). Compared with control group, the scores of shortness of breath, fatigue, dizziness and blurred vision, and loss of appetite in the treatment group were all lower (P < 0.05). After treatment, the levels of E₂, FSH, and LH in both groups were significantly decreased (P < 0.05). Compared with the control group, the levels of E₂, FSH, and LH in the treatment group were all lower (P < 0.05). After treatment, the levels of IL-1β, TNF-α, Ang-1, and IL-6 in both groups were significantly lower than before (P < 0.05). Compared with control group, the levels of IL-1β, TNF-α, Ang-1, and IL-6 in treatment group were all lower (P < 0.05). Conclusion The combination therapy of Guipi Pills and dydrogesterone has a remarkable effect in treatment of spleen deficiency type dysfunctional uterine bleeding during menopause, and can effectively alleviate the bleeding symptoms of patients, regulate sex hormones, and reduce the inflammatory response of the body.

R984

湖北省中医药管理局中医药科研项目（ZY2023F009）