罗氏内异方干预Ⅱ~Ⅲ期子宫内膜异位症不孕患者术后妊娠的回顾性分析  

Retrospective Analysis of Luoshi Neiyi Prescription for Postoperative Pregnancy Rate of Infertility Patients with Stage Ⅱ-Ⅲ Endometriosis

作　　者：吴李征 苏瑞 柯妍 裴芳利[1] 曾诚[1] WU Lizheng;SU Rui;KE Yan;PEI Fangli;ZENG Cheng(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Guangzhou 510801 Guangdong,China;Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,Shenzhen 518104 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]广州市中西医结合医院,广东广州510801 [3]深圳市中西医结合医院,广东深圳518104

出　　处：《中药新药与临床药理》2022年第9期1271-1276,共6页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：国家自然科学基金项目(82074481);邓高丕名中医传承工作室项目(粤中医办函[2019]5号);罗颂平名中医传承工作室项目(粤中医办函[2019]5号)。

摘　　要：目的 探讨罗氏内异方(益母草、牡蛎、土鳖虫等)对Ⅱ~Ⅲ期子宫内膜异位症不孕患者术后妊娠率的影响和安全性。方法 将病例数据库中184例符合美国生殖医学会(ASRM)分期为Ⅱ~Ⅲ期的内异症合并不孕患者归为4组:罗氏内异方组(49例)、促性腺激素释放激素激动剂(GnRH-a)组(43例)、罗氏内异方联合GnRH-a组(44例)及对照组(48例),随访并统计其相关临床资料,对比分析不同治疗方案术后2年内的妊娠率及用药安全性。结果 (1)与对照组比较,3种治疗方案均可明显提高术后2年内妊娠率(P<0.008 3),单用罗氏内异方或联合GnRH-a更能提高术后第1年内妊娠率(P<0.008 3)。(2)单独使用GnRH-a治疗是否超过3个月对内异症性不孕患者术后1年内及2年内妊娠率无明显影响,说明GnRH-a在一定程度上影响了卵巢功能,卵巢功能的恢复需要一定时间。(3)对于ASRM评分Ⅱ期、输卵管最低功能(LF)评分4~8分、内异症生育力指数(EFI)评分7~10分的不孕患者,使用GnRH-a或联合罗氏内异方在提高术后2年内妊娠率上优于对照组(P<0.008 3),而对于ASRM评分Ⅲ期、LF评分0~3分、EFI评分0~6分的患者,使用罗氏内异方或联合GnRH-a更有可能改善术后妊娠率。结论 单独使用罗氏内异方或联合GnRH-a可缩短Ⅱ~Ⅲ期子宫内膜异位症合并不孕患者腹腔镜术后的妊娠时间,提高术后第1年妊娠率,增加LF、EFI低分患者的妊娠率,且不良反应较小,值得临床应用。Objective To investigate the effect and safety of Luoshi Neiyi Prescription(LSNYP, Leonuri herba,Ostreae concha,Eupolyphaga steleophaga,etc.)on postoperative pregnancy rate of infertile patients with stage Ⅱ-Ⅲ endometriosis. Methods A total of 184 patients with stage Ⅱ-Ⅲ endometriosis accorded to American Society for Reproductive Medicine(ASRM)in the case information database were divided into four groups:LSNYP group(49 cases),Gonadotrophin releasing hormone agonist(GnRH-a)group(43 cases),LSNYP combined with GnRH-a group(44 cases),and the control group(48 cases). After the relevant clinical data were followed up and collected,the pregnancy rate and medication safety of different treatment regimens in two years after operation were compared and analyzed. Results(1)Compared to the control group,three treatment options could significantly increase the probability of pregnancy in 2 years after operation(P<0.008 3);the use of LSNYP only or combined with GnRH-a could improve the pregnancy probability more in the first year after operation(P<0.008 3).(2)Whether the duration of GnRH-a usage alone for longer than 3 months had no significant effect on the pregnancy rate of endometriotic infertility patients within 1 year and 2 years after surgery,this indicated that GnRH-a could affect ovarian function to a certain extent,and it would take time for ovarian function to recover.(3)For infertile patients with ASRM stage II,or tubal least function(LF)score 4-8,or endometriosis fertility index(EFI)score 7-10,the use of GnRH-a or combined with LSNYP were better than the control group in improving the pregnancy rate within two years after surgery(P <0.008 3). For patients with ASRM stage III,or LF score 0-3,or EFI score 0-6,the use of LSNYP or combined with GnRH-a were more likely to improve postoperative pregnancy rate. Conclusion The use of LSNYF only or combined with GnRH-a could shorten the pregnancy time after laparoscopy in patients with stage Ⅱ-Ⅲendometriosis-associated infertility,improve the pregnancy probabi

关 键 词：子宫内膜异位症 罗氏内异方 不孕 妊娠率 回顾性分析 

分 类 号：R285.6[医药卫生—中药学]