温肾养血方干预对卵巢低反应性患者体外受精-胚胎移植结局的影响  

Effect of Wenshen Yangxue Prescription on Outcome of In Vitro Fertilization-embryo Transfer in Patients with Poor Ovarian Response

作　　者：李彧 张澜 朱萍 李梦元 何军琴[2] LI Yu;ZHANG Lan;ZHU Ping;LI Meng-yuan;HE Jun-qin(School of Traditional Chinese Medicine(TCM),Beijing University of Chinese Medicine,Beijing 100029,China;Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]北京中医药大学中医学院,北京100029 [2]首都医科大学附属北京妇产医院,北京100026

出　　处：《中国实验方剂学杂志》2022年第6期100-106,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：北京市科委首都临床特色应用研究与成果推广项目(Z161100000516072)。

摘　　要：目的:评价温肾养血方提高卵巢低反应性不孕症患者体外受精-胚胎移植(IVF-ET)临床妊娠率的有效性与安全性。方法:收集首都医科大学附属北京妇产医院中医科和生殖中心2016年6月至2019年6月就诊的符合纳入、排除标准的患者116例,采用随机数字表法分为观察组和对照组,两组分配比例为1∶1。两组均进行常规控制性超促排卵治疗,对照组直接进入促排周期,观察组在进入促排周期前加用温肾养血方干预3个月经周期,成功受孕者观察至生产结束,未孕者观察12个月。记录患者促性腺激素(Gn)使用量、使用天数;治疗前后血清促卵泡刺激素(FSH)、基础促卵泡刺激素(bFSH)、基础黄体生成素(bLH)、基础雌激素(bE_(2))水平,子宫内膜厚度(Em)、窦卵泡数(AFC);检测注射绒毛膜促性腺激素(HCG)当天血清雌激素(E_(2))、孕酮(P)、黄体生成素(LH)水平;注射HCG 36 h后卵泡液FSH、LH、E_(2)、睾酮(T)、P水平;评估受精数、受精率、优质胚胎数、周期取消率、临床妊娠率、活产率;记录患者治疗前后中医证候评分;检测治疗前后肝、肾功能,记录治疗过程中出现不良反应。结果:与对照组比较,观察组Gn使用天数存在减少的趋势,但差异无统计学意义,用量明显减少(P<0.05),Em厚度明显增加(P<0.05);获卵数有增多趋势,注射HCG日E_(2)、LH有升高趋势,卵巢储备功能增加,但差异无统计学意义;注射HCG 36 h后卵泡液中FSH水平明显降低(P<0.05),LH、E_(2)水平升高(P<0.05);T、P水平差异无统计学意义,受精数、可利用胚胎数、优质胚胎率升高(P<0.05),卵细胞质量提高;周期取消率有降低趋势,临床妊娠率、活胎生产率有提高趋势,但差异无统计学意义;与本组治疗前比较,观察组治疗后中医证候评分明显下降(P<0.05);两组治疗过程中均未发生严重不良反应,治疗前后安全性指标均在正常范围内。结论:温肾养血方可降低接受IVF-ET不�Objective:To evaluate the effect of Wenshen Yangxue prescription(WSYX)on the outcome of in vitro fertilization-embryo transfer(IVF-ET)in poor ovarian responders and the safety.Method:A total of 116 eligible patients who were admitted to Beijing Obstetrics and Gynecology Hospital in June 2016-June 2019 were randomized into the experimental group and the control group with random number table method(58 in either group).Conventional controlled ovarian hyperstimulation(COH)was directly implemented in the control group,while the experimental group was intervened with WSYX for 3 menstrual cycles before the COH.The pregnant patients were observed till childbirth and the non-pregnant patients for 12 months.Gonadotropins(Gn)dosage and the days of use were recorded.Serum levels of follicle-stimulating hormone(FSH),basal FSH(bFSH),basal luteinizing hormone(bLH),and basal estrogen(bE_(2)),endometrial thickness,and antral follicle count(AFC)before and after treatment were measured.The serum levels of estrogen(E_(2)),progesterone(P),and luteinizing hormone(LH)on the day of human chorionic gonadotropin(HCG)injection,and levels of FSH,LH,E_(2),testosterone(T),and P in follicular fluid 36 h after HCG injection were determined.Number of fertilization,rate of fertilization,number of high-quality embryos,cycle cancellation rate,clinical pregnancy rate,and live birth rate were evaluated.The traditional Chinese medicine(TCM)syndrome scores before and after treatment were recorded.Liver and kidney functions were detected before and after treatment,and adverse reactions during treatment were recorded.Result:Compared with the control group,the experimental group showed the decrease in the days of Gn use and dosage of Gn(P<0.05),endometrium thickening(P<0.05),and increase in oocytes obtained,levels of E_(2)and LH on the day of HCG injection,and ovarian reserve function.Moreover,in follicular fluid 36 h after HCG injection,the reduction in level of FSH(P<0.05),rise of levels of LH and E_(2)(P<0.05),and insignificant changes in levels of T

关 键 词：不孕症 临床妊娠率 体外受精-胚胎移植 温肾养血方 

分 类 号：R242[医药卫生—中医临床基础] R285.5[医药卫生—中医学]