滋肾填精法改善肾阴虚型不孕患者子宫内膜容受性的效应机制  

Effects of the Zishen Tianjing therapy on endometrial receptivity in patients with infertility of the Shenyin Xu type

作　　者：刘卓[1] 相珊 刘建宪[2] 董相丽 连方[1] 张宁[1] 刘伟[3] Liu Zhuo

机构地区：[1]山东中医药大学附属医院,山东济南250014 [2]山东中医药大学第二附属医院,山东济南250000 [3]山东大学硕士研究生,山东济南250000

出　　处：《中医临床研究》2019年第11期20-23,共4页Clinical Journal Of Chinese Medicine

基　　金：山东省保健科技协会科学技术课题(SDBJKT20180048);山东省自然科学基金培养基金项目(ZR2016HP44);山东省医药卫生科技发展计划项目面上项目(2016WS0583)

摘　　要：目的:观察滋肾填精中药改善肾阴虚型不孕患者子宫内膜容受性的效应机制,从基因层面讨论滋肾填精法影响子宫内膜容受性的作用机理。方法:收集进入体外受精-胚胎移植(In Vitro Fertilitation and Embryo Transfer,IVF-ET)周期并且符合中西医诊断标准的不孕症患者,其中72例为肾阴虚型患者,随机分为治疗组36例和对照组36例;另外36例单纯输卵管因素行IVF-ET治疗的患者为空白组。治疗组在行IVF前一周期始口服六味地黄丸颗粒至取卵日,对照组同法口服安慰剂治疗,空白组不服药。三组均于降调节当天(监测排卵后5~7天)经患者知情同意后搔刮少许子宫内膜冻存,采用逆转录聚合酶链反应(RT-PCR)法检测三组患者人绒毛膜促性腺激素(HCG)日子宫内膜中白血病抑制因子信使核糖核酸(LIFmRNA)的表达;评定三组患者HCG日子宫内膜厚度及分型、子宫内膜容积、子宫动脉血流搏动指数(PI)和阻力指数(RI),临床妊娠率等。结果:(1)治疗组HCG注射日子宫内膜厚度及容积明显高于对照组(P<0.05),与空白组相比则没有明显差异(P>0.05);(2)治疗组子宫内膜分型中A型+B型的比例高于对照组,但差异不明显(P>0.05),其比例略低于空白组,差异亦不明显(P>0.05);(3)治疗组HCG注射日PI和RI低于对照组(P<0.05),略高于空白组,但差异无统计学意义(P>0.05);(4)治疗组临床妊娠率明显高于对照组(P<0.05),与空白组相比则没有显著差异(P>0.05);(5)三组患者子宫内膜中LIFmRNA均有表达,其中空白组表达最强,治疗组次之,对照组表达最弱,差异有统计学意义(P<0.05)。结论:滋肾填精法可有效提高子宫内膜的容受性,改善肾阴虚型患者子宫内膜厚度、容积、PI、RI,使临床妊娠率提升,其效应机制可能与提高肾阴虚型患者子宫内膜中LIFmRNA表达增强有关。Objective:To observe effects of the Zishen Tianjing therapy (滋肾填精法) on endometrial receptivity in patients with infertility of the Shenyin Xu type (肾阴虚型),discuss the mechanism of Zishen Tianjing therapy on endometrial receptivity from the genetic level.Methods:Infertility patients who entered the in vitro fertilization-embryo transfer (IVF-ET) cycle and met the diagnostic criteria of Chinese and Western medicine were selected.72 patients with the Shenyin Xu type were randomly divided into the treatment group (36 cases) and control group (36 cases).Another 36 patients with simple fallopian tube factor who underwent IVF-ET treatment were selected as the blank group.In the treatment group,Liuwei Dihuang Wan (六味地黄丸) was orally administered to the day of egg retrieval before the IVF.The control group was treated with placebo orally.The blank group was given nothing.Endometrium in the three groups were frozen on the day of the down-regulation (5~7 days after monitoring ovulation),and the expression of LIF mRNA in the endometrium of HCG was measured by RT-PCR.Results:The endometrial thickness and volume of HCG in the treatment group were significantly higher than those in the control group (P<0.05);and there was no significant difference compared with the blank group (P>0.05). The proportion of type A and type B endometrial score in the treatment group were higher than the control group;the difference was not obvious (P>0.05).And the proportion was slightly lower than the blank group;the difference was not obvious (P>0.05).PI and RI in the treatment group during HCG day were lower than the control group (P<0.05);the difference was not statistically significant (P>0.05).The clinical pregnancy rate in the treatment group was significantly higher than the control group (P<0.05).There was no significant difference Campared with the black group (P>0.05).The expression of LIF mRNA in the endometrium in the blank group was the strongest,the treatment group was the second,and the control group was th

关 键 词：滋肾填精 肾阴虚型 子宫内膜容受性 LIFm RNA 

分 类 号：R271.14[医药卫生—中医妇科学]