基于中医辨证的克罗米芬治疗多囊卵巢综合征不孕症疗效研究  

Clinical study of clomiphene for infertile women with polycystic ovary syndrome based on traditional Chinese medicine syndrome differentiation

作　　者：王宇[1,2] 丛晶[2] 高敬书[2] 马红丽[2] 张蓓[3] 曹义娟[3] 吴效科[2,4] WANG Yu;CONG Jing;GAO Jingshu;MA Hongli;ZHANG Bei;CAO Yjuan;WU Xiaoke(Heilongjiang University of Chinese Medicine,Harbin 150040,China;First Affliated Hospital,Heilongjiang University of Chinese Medicine,Harbin 150040,China;Xuzhou Central Hospital,Xuzhou 221009,China;Heilongjiang Provincial Hospital,Harbin 150030,China)

机构地区：[1]黑龙江中医药大学,哈尔滨150040 [2]黑龙江中医药大学附属第一医院,哈尔滨150040 [3]徐州市中心医院,徐州221009 [4]黑龙江省医院,哈尔滨150030

出　　处：《中华中医药杂志》2024年第9期5057-5061,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：黑龙江省“头雁”团队项目(No.黑政规[2019]5号);黑龙江省卵巢疾病医学研究中心,徐州市引进临床医学专家团队(No.2019TD005);黑龙江省中医药学会2022—2024年度青年人才托举工程项目(No.2022-QNRC1-02);黑龙江省中医药管理局中医药科研课题(No.ZHY2022-124);黑龙江中医药大学科研基金项目博士创新基金(No.2019BS09);黑龙江省自然科学基金联合引导项目(No.LH2019H046)。

摘　　要：目的:分析不同中医证型多囊卵巢综合征(PCOS)不孕症女性接受克罗米芬治疗前后疗效变化的差异。方法:973例PCOS不孕症患者根据中医辨证分为肾虚肝郁证、肾虚血瘀证、脾虚痰湿证及痰瘀互结证。比较各证型患者使用克罗米芬或安慰剂治疗前后人口学特征、性激素水平、糖脂代谢水平及生殖结局变化的差异。结果:与安慰剂比较,克罗米芬使肾虚肝郁证、脾虚痰湿证及痰瘀互结证患者黄体生成素及卵泡刺激素水平较基线水平降低更显著,使各证型患者孕酮、雌二醇、总睾酮及性激素结合球蛋白水平较基线水平升高更显著,使脾虚痰湿证患者游离睾酮指数水平较基线水平降低更显著,使痰瘀互结证患者抗苗勒管激素水平较基线水平降低更显著(P<0.01,P<0.05);克罗米芬使肾虚血瘀证患者空腹血糖、空腹胰岛素及胰岛素抵抗指数水平较基线水平升高更显著(P<0.01);克罗米芬使肾虚血瘀证患者高密度脂蛋白及载脂蛋白A水平较基线水平升高更显著(P<0.05);克罗米芬使各证型患者排卵率显著提高,使肾虚肝郁证、脾虚痰湿证及痰瘀互结证患者受孕率、妊娠率及活产率显著提高(P<0.01,P<0.05)。结论:肾虚肝郁证、脾虚痰湿证及痰瘀互结证PCOS不孕症患者使用克罗米芬可降低促性腺激素水平、提高性激素水平及改善生殖结局;肾虚血瘀证患者使用克罗米芬虽可提高性激素及脂代谢水平,但却加重糖代谢异常且并不改善终点生殖结局。Objective:To analyze the differences in efficacy of clomiphene in the treatment of polycystic ovary syndrome infertile women with different traditional Chinese medicine(TCM)syndromes.Methods:A total of 973 infertile patients with polycystic ovary syndrome were divided into kidney deficiency and liver stagnation syndrome,kidney deficiency and blood stasis syndrome,spleen deficiency and phlegm dampness syndrome,and phlegm dampness and blood stasis syndrome.Then demographic characteristics,sex hormone levels,glucolipid metabolism levels and reproductive outcomes of patients with different TCM syndromes were compared before and after clomiphene intervention or without clomiphene intervention.Results:Compared with control group,clomiphene significantly decreased luteinizing hormone and follicle stimulating hormone levels in patients with kidney deficiency and liver stagnation syndrome,spleen deficiency and phlegm dampness syndrome,and phlegm dampness and blood stasis syndrome,and significantly increased progesterone,estradiol,total testosterone and sex hormone binding globulin in each syndromes,significantly decreased free testosterone index of patients with spleen deficiency and phlegm dampness syndrome,significantly decreased antimullerian hormone level of patients with phlegm dampness and blood stasis syndrome(P<0.01,P<0.05);Compared with control group,clomiphene significantly increased fasting blood glucose,fasting insulin and insulin resistance index of patients with kidney deficiency and blood stasis syndrome(P<0.01);Compared with control group,clomiphene significantly increased high-density lipoprotein and apolipoprotein A of patients with Kidney deficiency and blood stasis syndrome(P<0.05);Compared with control group,clomiphene significantly increased rate of ovulation in each syndromes,significantly increased rate of conception,pregnancy and live birth in patients with kidney deficiency and liver stagnation syndrome,spleen deficiency and phlegm dampness syndrome,and phlegm dampness and blood stasis syndrome(P

关 键 词：中医辨证分型 多囊卵巢综合征 不孕症 克罗米芬 糖脂代谢 生殖结局 

分 类 号：R271.14[医药卫生—中医妇科学]