补肾宁心方治疗亚临床POI不孕症的疗效及其对血清ET-1水平的影响  

Effects of Bushen Ningxin Decoction in the treatment of infertility with subclinical POI and its influence on serum ET-1 level

作　　者：马蔚蓉[1] 郭倩 李瑾[1] MA Weirong;GUO Qian;LI Jin(Department of Gynecology,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]江苏省中医院妇科,江苏南京210029

出　　处：《上海中医药大学学报》2021年第2期22-27,共6页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：江苏省卫计委临床医学中心(创新平台)建设项目(YXZXB2016006);江苏省中医院院级科技项目(Y18068)。

摘　　要：目的:观察补肾宁心方治疗亚临床早发性卵巢功能不全(POI)不孕症的临床疗效及其对患者血清内皮素-1(ET-1)水平的影响。方法:纳入96例心肾不交证亚临床POI不孕症患者,随机分为对照组和治疗组,每组各48例。对照组患者给予雌二醇片/雌二醇地屈孕酮片口服,治疗组患者在对照组治疗基础上加用补肾宁心方口服,两组患者均连续预治疗3个周期。预治疗后,所有患者均给予来曲唑、尿促性素(HMG)促排卵助孕治疗,观察周期为1个月经周期。预治疗前后,比较两组患者的改良Kupperman评分、血清雌二醇(E2)、卵泡刺激素(FSH)、抗米勒管激素(AMH)及ET-1水平,B型超声检测患者的双侧卵巢基础窦卵泡数(AFC)和卵巢血流指标[阻力指数(RI)、搏动指数(PI)、舒张末期流速(EDV)、收缩期峰值流速(PSV)],并计算PSV/EDV(S/D)值。助孕治疗中,比较两组患者的排卵率、妊娠率,以及HMG用量、人绒毛膜促性腺激素(HCG)注射日子宫内膜厚度。结果:治疗过程中,治疗组7例患者剔除或脱落,对照组7例患者剔除或脱落,最终治疗组41例、对照组41例纳入统计分析。(1)改良Kupperman评分:治疗后,两组患者的改良Kupperman评分较治疗前均显著降低(P<0.05),且治疗组患者的评分低于对照组(P<0.05)。(2)血清性激素及ET-1水平:治疗后,两组患者的E2、AMH水平均明显升高(P<0.05),FSH、ET-1水平明显降低(P<0.05),且治疗组患者的E2、AMH水平高于对照组(P<0.05),FSH、ET-1水平低于对照组(P<0.05)。(3)AFC及卵巢血流指标:治疗后,治疗组患者的AFC及卵巢EDV较治疗前均明显升高(P<0.05),卵巢RI、PI及S/D值较治疗前均明显降低(P<0.05);对照组患者的AFC及卵巢EDV较治疗前亦明显升高(P<0.05),卵巢RI较治疗前亦明显降低(P<0.05);且治疗组患者的AFC及卵巢EDV高于对照组(P<0.05),卵巢RI及S/D值低于对照组(P<0.05)。(4)排卵率、妊娠率:治疗组患者的排卵率为53.66%、妊娠率为Objective: To observe the clinical efficacy of Bushen Ningxin Decoction in the treatment of infertility with subclinical premature ovarian insufficiency(POI) and its influence on the level of serum endothelin-1(ET-1). Methods: Ninety-six infertile patients of subclinical POI with syndrome of disharmony between heart and kidney were included and randomly divided into the control group and treatment group, 48 cases in each group. The patients in the control group were orally treated with complex packing of estradiol tablets/estradiol and dydrogesterone tablets, and the patients in the treatment group were orally treated with Bushen Ningxin Decoction based on the treatment for the control group. The patients in both groups were continuously pretreated for 3 courses. After pretreatment, all patients were treated with letrozole and Menotrophin(HMG) to stimulate ovulation and assist pregnancy, and the observation period was one menstrual cycle. Before and after pretreatment, the improved Kupperman score and the serum levels of estradiol(E2), follicle-stimulating hormone(FSH), anti-Müllerian hormone(AMH) and ET-1 were compared between the two groups. The basal antral follicle counting(AFC) of bilateral ovary and the ovarian blood flow indexes, including resistance index(RI), pulsatility index(PI), end diastolic velocity(EDV) and peak systolic velocity(PSV), were detected by B-type ultrasound, and the PSV/EDV(S/D) ratio was calculated. In the treatment of assisting pregnancy, the rates of ovulation and pregnancy, the HMG dosage and the endometrial thickness on the day of human chorionic gonadotropin(HCG) injection were compared between the two groups. Results: During the treatment, 7 patients in the treatment group and 7 patients in the control group were excluded or shed, finally 41 patients in the treatment group and 41 patients in the control group were included for statistical analysis.(1)The improved Kupperman score: After treatment, the improved Kupperman score in both groups was significantly decreased compared w

关 键 词：不孕症 亚临床早发性卵巢功能不全 补肾宁心方 卵巢功能 中西医结合 

分 类 号：R711.6[医药卫生—妇产科学]