补肾活血法治疗反复种植失败作用机制研究进展  

Research Progress of the Mechanisms of Method of Tonifying the Kidney and Activating Blood in Treating Repeated Implantation Failure

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作  者:解丽菲 钱艳平 代林莉 李杨 姜丽娟[2] XIE Lifei;QIAN Yanping;DAI Linli;LI Yang;JIANG Lijuan(Yunnan Maternal and Child Health Hospital,Kunming,Yunnan,China;Yunnan Provincial Traditional Chinese Medicine Hospital,Kunming,Yunnan,China,650051;Renshou County Traditional Chinese Medicine Hospital,Renshou,Yunnan,China,620500)

机构地区:[1]云南省妇幼保健院,云南昆明650021 [2]云南省中医医院,云南昆明650021 [3]仁寿县中医医院,云南仁寿620500

出  处:《河南中医》2024年第9期1435-1440,共6页Henan Traditional Chinese Medicine

基  金:国家自然科学基金项目(82060882);云南省妇幼保健院2022年度“妇幼健康研究项目”(FYJK2022-05)。

摘  要:补肾活血法治疗反复种植失败(repeated planting failure,RIF)的作用机制为:(1)调整RIF患者自然杀伤(natural killer,NK)细胞及相关因子,对免疫系统起到双向调节的作用,促进滋养细胞生长、受精卵着床、胎盘血管形成及胚胎种植;(2)降低RIF患者肿瘤坏死因子-α水平,调整Th1/Th2细胞因子的动态平衡,发挥保护胚胎的作用;(3)改善子宫内膜微环境,增加子宫内膜厚度,提高子宫内膜容受性,为受精卵着床创造优质环境,提高胚胎种植率;(4)调控血液流变学指标,降低血液黏稠度,增加子宫血流灌注,调节体内微循环,改善血栓前状态,有效降低RIF患者子宫动脉血流的高阻力状态,有助于胚胎顺利着床;(5)协调肾气-天癸-冲任-胞宫功能,改善生殖内分泌水平,提高获卵数及卵细胞质量,改善体外受精-胚胎移植失败患者卵巢储备功能,提高优质卵率、优质胚胎率及RIF患者的妊娠结局。目前,关于补肾活血法的临床研究越来越丰富,但关于反复种植失败的理论探讨及作用机制研究仍存在很大的局限性,缺乏实验数据及大样本的支撑。今后需增加大样本、多中心的研究,尽可能进行相关动物实验研究,充分发挥中医学在不孕症治疗中的优势,以期提高体外受精-胚胎移植的成功率。The mechanisms of the method of tonifying the kidney and activating blood in treating repeated planting failure(RIF) include:(1) Adjusting natural killer(NK) cells and related factors in RIF patients to modulate the immune system bidirectionally,promoting the growth of trophoblast cells,implantation of the fertilized egg,placental vascular formation,and embryo implantation;(2) reducing tumor necrosis factor-α in RIF patients,adjusting the dynamic balance of Th1/Th2 cytokines,and protecting the embryo;(3) improving the uterine endometrial microenvironment,increasing endometrial thickness,enhancing endometrial receptivity,creating an optimal environment for implantation of the fertilized egg,and improving embryo implantation rates;(4) regulating hemorheological indicators,reducing blood viscosity,increasing uterine blood perfusion,regulating microcirculation,improving the pre-thrombotic state,effectively reducing the high resistance state of uterine artery blood flow in RIF patients,and aiding successful embryo implantation;(5) coordinating the functions of kidney qi,tiangui,thorough vessel,conception vessel,and uterus,improving reproductive endocrine levels,increasing the number and quality of oocytes,enhancing ovarian reserve function in patients with in vitro fertilization-embryo transfer(IVF-ET) failure,and improving the pregnancy outcomes of RIF patients.At present,although clinical research on the method of tonifying the kidney and activating blood is becoming more abundant,there are still significant limitations in theoretical discussion and mechanism research on RIF,lacking experimental data and large sample support.In the future,it is necessary to increase large sample,multi-center research and conduct relevant experimental studies as much as possible to fully leverage the advantages of Chinese medicine in infertility,aiming to improve the success rate of IVF-ET.

关 键 词:反复种植失败 补肾活血法 体外受精-胚胎移植 卵巢储备功能 

分 类 号:R271.911.6[医药卫生—中西医结合]

 

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