穴位注射联合中药周期疗法对反复IVF-ET失败患者妊娠结局的影响研究  

Clinical Study on Pregnancy Outcome of Repeated IVF-ET Failure Patients Treated by Acupoint Injection Combined with Chinese Medicine Periodic Therapy

作　　者：邓芳[1,2] 高修安 许丽绵[2] 刘瑜[1] DENG Fang;GAO Xiu-An;XU Li-Mian;LIU Yu(Dept.of Traditional Chinese Medicine,Foshan Women and Children Hospital,Foshan 528000 Guangdong,China;Dept.of Infertility,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]佛山市妇幼保健院中医科,广东佛山528000 [2]广州中医药大学第一附属医院不孕不育科,广东广州510405

出　　处：《广州中医药大学学报》2021年第1期97-103,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(编号:20181252);佛山市科技创新专项资金资助项目(编号:2015AG10022)。

摘　　要：【目的】观察穴位注射联合中药周期疗法对反复体外受精与胚胎移植(IVF-ET)失败患者妊娠结局的影响及其对子宫内膜容受性的调节机制。【方法】将70例反复IVF-ET失败,拟再次行IVF-ET的患者,随机分成治疗组和对照组,每组各35例。拟再次移植前,治疗组于经期第7天开始给予胎盘组织液穴位注射联合中药周期疗法治疗,对照组给予口服维生素E治疗,连续治疗3个月经周期。观察2组患者治疗前和治疗3个周期后的着床窗口期雌二醇(E2)和孕酮(P)水平、子宫内膜厚度及内膜形态、卵巢和子宫内膜血流动力学[动脉阻力指数(RI)]、子宫内膜血管内皮生长因子(VEGF)的变化情况,并观察2组患者的种植率和临床妊娠率。【结果】(1)治疗组有1例于第3个月经周期因妊娠退出试验,实际完成相关指标检测34例;对照组无退出病例,实际完成相关指标检测35例。(2)治疗后,2组患者的E2水平和对照组的P水平均无明显变化(P>0.05),而治疗组的P水平明显提高(P<0.05);组间比较,治疗组的P水平明显高于对照组(P<0.01)。(3)治疗后,2组患者的着床窗口期子宫内膜厚度均较治疗前增厚(P<0.05),且治疗组的着床窗口期子宫内膜厚于对照组,但差异无统计学意义(P>0.05)。(4)治疗后,治疗组的A型内膜所占比例为67.65%(23/34),明显高于对照组的37.14%(13/35),差异有统计学意义(P<0.05)。(5)治疗后,治疗组患者着床窗口期卵巢和子宫内膜RI均较治疗前明显降低(P<0.05),而对照组均有降低趋势,但差异均无统计学意义(P>0.05);组间比较,治疗组的卵巢和子宫内膜RI均明显低于对照组(P<0.01)。(6)治疗后,治疗组患者腺上皮细胞和间质细胞VEGF表达水平均较治疗前明显提高(P<0.05),而对照组均有提高趋势,但差异均无统计学意义(P>0.05);组间比较,治疗组的腺上皮细胞和间质细胞VEGF表达水平均明显高于对照组(P<0.05)。(7)治疗3个月经周期后,治�Objective To observe the effect of acupoint injection combined with Chinese medicine periodic therapy on pregnancy outcome of patients with repeated in-vitro fertilization and embryo transfer(IVF-ET)failure,and to explore the regulatory mechanism of acupoint injection combined with Chinese medicine periodic therapy on endometrial receptivity. Methods Seventy patients who failed in repeated IVF-ET and were to undergo IVF-ET again were randomly divided into treatment group and control group, 35 cases in each group. Before the retransplantation, the treatment group was given acupoint injection of placenta tissue fluid combined with oral administration of Chinese medicine,and the control group was given oral use of vitamin E from the 7 th day of menstrual period. The treatment for the two groups lasted 3 menstrual cycles. Before treatment and in the implantation window of the third cycle of treatment, serum levels of estradiol(E2) and progesterone(P),endometrial thickness and morphology,ovarian hemodynamics,endometrial hemodynamics such as arterial blood resistance index(RI)and endometrial vascular endothelial growth factor(VEGF)were detected. Meanwhile,the implantation rate and clinical pregnancy rate of the two groups were observed. Results(1)One case of the treatment group quitted the trial on the third menstrual cycle of treatment,and a total of 34 cases in the treatment group finally finished the trial. None case of the control group quitted the trial, and all of the 35 cases finally finished trial.(2)After treatment,the serum E2 level in the two groups and serum P level in the control group showed no obvious changes in comparison with those before treatment(P>0.05),but the serum P level in the treatment group was obviously increased in comparison with that before treatment(P < 0.05). The intergroup comparison showed that serum P level in the treatment group was obviously higher than that in the control group(P<0.01).(3)After treatment,the endometrial thickness in the two groups in the implantation window of the

关 键 词：穴位注射 中药周期疗法 反复体外受精与胚胎移植(IVF-ET)失败 妊娠结局 

分 类 号：R245.95[医药卫生—针灸推拿学]