玉屏风散加减颗粒联合分时间针刺治疗体外受精-胚胎移植反复移植失败的临床研究  

Clinical Effect of Modified Yupingfeng Powder(玉屏风散加减)Combined with Acupuncture at Different Menstrual Cycle Phases for Recurrent Implantation Failure of In Vitro Fertilization Embryo Transfer

作　　者：陈艳花 董煜 张雪洛 张一帆 张四平[1] 范俊梅 武学清[1] CHEN Yanhua;DONG Yu;ZHANG Xueluo;ZHANG Yifan;ZHANG Siping;FAN Junmei;WU Xueqing(Reproductive Medicine Center of Shanxi Provincial Children's Hospital,Taiyuan 030013,Shanxi,China;First Clinical College of Shanxi University of Traditional Chinese Medicine,Taiyuan 030013,Shanxi,China)

机构地区：[1]山西省儿童医院生殖医学中心,山西太原030013 [2]山西中医药大学第一临床学院,山西太原030013

出　　处：《中华中医药学刊》2024年第5期182-185,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：山西省卫生厅青年项目(201301038);山西省中医药管理局项目(2020ZYYC053);山西省妇幼保健院院内项目(202004)。

摘　　要：目的分析玉屏风散加减颗粒联合分时间针刺治疗体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)胚胎植入前遗传学筛查(Pre-implantation Genetic Screening,PGS)反复失败(recurrent implantation failure,RIF)患者的临床治疗价值。方法选取2020年1月—2022年1月就诊于医院的RIF患者173例,采用随机数表法分为对照组(常规治疗)41例,观察组1(玉屏风散+常规治疗组)37例,观察组2(分时间针刺+常规治疗组)44例,观察组3(玉屏风散+分时间针刺+常规治疗)51例。对各组患者治疗前后子宫内膜容受性[子宫内膜厚度、血管化血流指数(vascu⁃larization-flow index,VFI)、血管化指数(vascularization index,VI)及血流指数(flow index,FI)]、汉密尔顿焦虑评量表-焦虑自评量表(Hamilton Anxiety Scale-Self-Rating Anxiety Scale,HAMA-SAS)评分及汉密尔顿抑郁量表(Hamilton de⁃pression scale,HAMD)评分和治疗后生化妊娠率、临床妊娠率、早期流产率、异位妊娠率及活产率结果进行分析。结果治疗后观察组3子宫内膜厚度、VFI、VI及FI高于对照组(P<0.05);各观察组HAMA-SAS及HAMD评分均低于对照组(P<0.05);观察组3生化妊娠率及临床妊娠率高于对照组,且各观察组产活率均高于对照组(P<0.05),但各观察组早期流产率与异位妊娠率与对照组相比差异无统计学意义(P>0.05)。结论玉屏风散加减颗粒联合分时间针刺治疗能显著提高RIF患者生化妊娠率、临床妊娠率及产活率,其作用机理可能是改善内膜厚度,增加子宫血流动力学参数,促进内膜生长,提高子宫内膜容受性且减低患者移植失败的焦虑抑郁情绪,调节舒畅情志,从而改善RIF患者妊娠结局。Objective To investigate the clinical therapeutic value of Modified Yupingfeng Powder(玉屏风散加减)combined with acupuncture at different menstrual cycle phases for recurrent implantation failure(RIF)patients undergoing pre implantation genetic screening(PGS)in vitro fertilization embryo transfer(IVF-ET).Methods One hundred and seventy-three patients with RIF in the hospital from January 2020 to January 2022 were enrolled,and classified into three groups according to random number table methods.The control group(41 cases)received conventional hormonal therapy.The observation group 1(37 cases)received Modified Yupingfeng Powder combined with hormonal therapy.The observation group 2(44 cases)received acupuncture at different menstrual cycle phases combined with hormonal therapy.The observation group 3(51 cases)received Modified Yup⁃ingfeng Powder combined with acupuncture at different menstrual cycle phases and hormonal therapy.Then the endometrial re⁃ceptivity[endometrial thickness,vascularization flow index(VFI),vascularization index(VI),flow index(FI)],anxiety and de⁃pression scores,biochemical pregnancy rate,clinical pregnancy rate,early miscarriage rate,ectopic pregnancy rate,and live birth rate were analyzed in each group.Results After treatment,the endometrial thickness,the values of VFI,VI and FI of the observa⁃tion group 3 were higher than those of the control group(P<0.05).Each observation group scored higher on Hamilton Depres⁃sion Scale(HAMD)and Hamilton Anxiety Scale(HAMA)than control group,with statistical difference(P<0.05).The bio⁃chemical pregnancy rate and clinical pregnancy rate of the observation group three were higher than those of the control group,and the live birth rate of each observation group was higher than that of control group(P<0.05).No statistical difference was found in the early miscarriage rate and ectopic pregnancy rate among the groups(P>0.05).Conclusion Yupingfeng Powder combined with acupuncture at different menstrual cycle phases for RIF patients can effect

关 键 词：反复移植失败 玉屏风散 针灸 子宫内膜容受性 焦虑 抑郁 

分 类 号：R271.9[医药卫生—中西医结合] R246.3[医药卫生—中医妇科学]