疏肝补肾汤联合腹腔镜手术对难治性多囊卵巢综合征患者卵巢体积、血清HOXA10表达及妊娠率的影响  

Effects of Shugan Bushen Decoction Combined with Laparoscopic Surgery on Ovarian Volume,Serum HOXA10 Expression and Pregnancy Rate in Patients with Refractory Polycystic Ovary Syndrome

作　　者：张玉洁 祁志荣 胡瑞雪 ZHANG Yu-Jie;QI Zhi-Rong;HU Rui-Xue(Dept.of Obstetrics and Gynecology,Beijing Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 100039,China;Dept.of Oncology of Integrated Traditional Chinese and Western Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京中西医结合医院妇产科,北京100039 [2]中日友好医院中西医结合肿瘤内科,北京100029

出　　处：《广州中医药大学学报》2024年第5期1195-1201,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(编号:82074224)。

摘　　要：【目的】探讨疏肝补肾汤联合腹腔镜手术对难治性多囊卵巢综合征(PCOS)患者的卵巢体积、血清同源框基因A10(HOXA10)表达及妊娠率的影响。【方法】将80例肝郁肾虚型难治性PCOS患者随机分为观察组和对照组,每组各40例。对照组给予常规腹腔镜手术和常规药物治疗,观察组在对照组的基础上加用疏肝补肾汤治疗,1个月经周期为1个疗程,连续治疗3个疗程。观察2组患者治疗前后中医证候积分、卵巢体积、卵泡直径、血清HOXA10表达及性激素[黄体生成素(LH)、雌二醇(E2)、孕酮(P)、促卵泡生成素(FSH)和睾酮]水平的变化情况,以及2组患者随访半年的妊娠情况。【结果】(1)治疗后,2组患者的卵巢体积均呈现不同程度的缩小(P<0.05),卵泡直径均呈现不同程度的增加(P<0.05),且观察组对卵巢体积的缩小幅度及对卵泡直径的增加幅度均明显优于对照组(P<0.01)。(2)治疗后,2组患者的LH、FSH、睾酮水平均较治疗前明显降低(P<0.05),HOXA10、E2、P水平均较治疗前明显升高(P<0.05),且观察组对LH、FSH、睾酮水平的降低幅度及对HOXA10、E2、P水平的升高幅度均明显优于对照组(P<0.05或P<0.01)。(3)治疗后,2组患者的月经量异常、月经周期异常、腰膝酸软、舌质暗红、脉沉涩等各项中医证候积分及总积分均较治疗前明显降低(P<0.05),且观察组对各项中医证候积分及总积分的降低幅度均明显优于对照组,差异均有统计学意义(P<0.01)。(4)观察组的妊娠率为55.00%(22/40),明显高于对照组的32.50%(13/40),差异有统计学意义(P<0.05)。【结论】疏肝补肾汤联合腹腔镜手术治疗肝郁肾虚型难治性PCOS,可有效改善患者的卵巢功能,促进机体性激素水平恢复正常,提高HOXA10表达水平,改善患者的子宫内膜容受性,提高患者的妊娠率。To investigate the effects of Shugan Bushen Decoction combined with laparoscopic surgery on ovarian volume,serum homeobox gene A10(HOXA10)expression and pregnancy rate in patients with refractory polycystic ovary syndrome(PCOS).Methods A total of 80 patients with refractory PCOS of liver stagnation and kidney deficiency type were randomly divided into an observation group and a control group,with 40 cases in each group.The control group was given conventional laparoscopic surgery and conventional medicine treatment.The observation group was treated with Shugan Bushen Decoction on the basis of treatment for the control group.One menstrual cycle constituted one course of treatment,and 3 continuous courses of treatment were given.The changes of traditional Chinese medicine(TCM)syndrome scores,ovarian volume,follicular diameter,serum HOXA10 expression and levels of sex hormones of luteinizing hormone(LH),estradiol(E2),progesterone(P),follicle stimulating hormone(FSH)and testosterone in the two groups before and after treatment were observed.Moreover,the pregnancy outcomes of the two groups during the follow-up for half a year were monitored.Results(1)After treatment,the ovarian volume in the two groups was decreased to different degrees(P<0.05),and the follicular diameter was increased to different degrees(P<0.05).The intergroup comparison showed that the decrease of ovarian volume and the increase of follicular diameter in the observation group were significantly superior to those in the control group(P<0.01).(2)After treatment,the levels of LH,FSH and testosterone in the two groups were significantly lower than those before treatment(P<0.05),and the levels of HOXA10,E2 and P were significantly higher than those before treatment(P<0.05).The decrease of LH,FSH and testosterone levels and the increase of HOXA10,E2 and P levels in the observation group were significantly superior to those in the control group(P<0.05 or P<0.01).(3)After treatment,the overall TCM syndrome scores and the scores of the syndrome manifestati

关 键 词：难治性多囊卵巢综合征 肝郁肾虚型 疏肝补肾汤 腹腔镜手术 血清同源框基因A10(HOXA10) 妊娠率 

分 类 号：R271.9[医药卫生—中西医结合]