针药人工周期联合来曲唑调控多囊卵巢综合征排卵障碍性不孕患者雄激素受体通路的临床观察  

Study on Artificial Cycle of Acupuncture and Medication Combined with Letrozole in Regulating Androgen Receptor Pathway in Infertility Patients with Ovulation Disorder in Polycystic Ovary Syndrome

作　　者：顿晶晶 许金榜[1] 林秋平 杨娟[1] 游秀密 张俊新 DUN Jing jing;XU Jin bang;LIN Qiu ping;YANG Juan;YOU Xiu mi;ZHANG Jun xin(Traditional Chinese Medicine Department,Fujian Provincial Maternity and Children's Hospital,Fuzhou,350001,China)

机构地区：[1]福建省妇幼保健院中医科,福建福州350001

出　　处：《南京中医药大学学报》2018年第6期549-552,601,共5页Journal of Nanjing University of Traditional Chinese Medicine

基　　金：国家自然科学基金(81302998);福建省科技计划项目(2015Y0002);福建省中医药科研项目(wzfg201304)

摘　　要：目的探讨针药人工周期联合来曲唑对多囊卵巢综合征(PCOS)排卵障碍性不孕肾阳虚证患者的临床疗效及作用机制。方法将50例PCOS排卵障碍性不孕肾阳虚证患者随机分为治疗组(针药人工周期结合来曲唑组)与对照组(来曲唑组),各25例,2组各治疗3月。观察2组治疗前后中医症状评分、促卵泡生成素(FSH)、促黄体生成素(LH)、睾酮(T)、LH/FSH比值及子宫内膜厚度的变化,统计排卵周期数及排卵率,运用实时荧光定量聚合酶链反应(qPCR)测定治疗前后Lethal-7(Let-7)、雄激素受体(AR)、环氧合酶(COX-2)、双调蛋白(Areg)的表达量。结果与治疗前相比,治疗组治疗后中医症状评分下降;LH、LH/FSH、T水平下降;子宫内膜厚度增加;Let-7表达量升高、AR、COX-2、Areg表达量下降(P<0.01)。与对照组比较,中医症状评分低于对照组,排卵周期数大于对照组,Let-7表达量高于对照组,AR的表达量低于对照组(P<0.01);LH、LH/FSH、T水平低于对照组(P<0.05~0.01);子宫内膜厚度优于对照组(P<0.05),妊娠率(60%)优于对照组(32%)(P<0.05)。结论针药人工周期联合来曲唑能调节多囊卵巢综合征排卵障碍性不孕患者的性激素水平,改善子宫内膜,增加排卵周期数,提高其妊娠率,其作用机制可能与调控雄激素受体通路有关。OBJECTIVE To investigate the clinical efficacy and mechanism of acupuncture and traditional Chinese medicine combined with letrozole in the treatment of infertility with polycystic ovary syndrome(PCOS)ovulatory disorder.METHODS 50 patients with PCOS ovulatory disorder were randomly divided into two groups:treatment group(acupuncture and medicine combined with letrozole)and control group(letrozole group),25 patients in each group were treated for three months.The changes of TCM symptom score,the ratio of follicle stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T),LH/FSH and the changes of endometrial thickness were observed before and after treatment,and the number of ovulation cycles and ovulation rate were counted.The expression level of Lethal 7(Let 7),rogen receptor(AR),cyclooxygenase(COX 2)and dimodulation protein(Areg)were detected by qPCR before and after treatment.RESULTS Compared with the group before treatment,the scores of TCM symptoms and the levels of LH,LH/FSH,T decreased,the thickness of endometrium growed,the expression of Let 7 increased and the expression of AR,COX 2,Areg decreased after treatment(P<0.01).Compared with the control group,the score of TCM symptom was lower,the number of ovulation cycle was larger,the expression of AR was lower(P<0.01),and the levels of LH,LH/FSH,T was lower(P<0.05,P<0.01).The endometrial thickness was better(P<0.05),and the pregnancy rate(60%)was higher than that of the control group(32%)(P<0.05).CONCLUSION Acupuncture and traditional Chinese medicine combined with letrozole can regulate the level of sex hormones,improve the endometrium,increase the number of ovulation cycles and increase the pregnancy rate in infertile women with PCOS.The mechanism may be related to the regulation of androgen receptor pathway.

关 键 词：多囊卵巢综合征 排卵障碍性不孕 针药结合 人工周期 Let7 雄激素受体 信号通路 

分 类 号：R271.14[医药卫生—中医妇科学]