中醫(yī)藥治療未破裂卵泡黃素化綜合征致不孕的臨床研究
發(fā)布時間：2018-07-16 16:49
【摘要】：目的:未破裂卵泡黃素化綜合征(luteinizedunrupturedfolliclesyndrome,LUFS)[1]成為當前不孕癥發(fā)生的重要原因之一。本研究通過穴位針刺、中藥湯劑口服、中藥外敷、西藥HCG肌注治療未破裂卵泡黃素化綜合征(LUFS)不孕患者,觀察比較四組治療方法的臨床療效,探析LUFS相關發(fā)病因素,為預防及治療LUFS探索增添出一條新的有效、安全、簡便的思路。方法:選擇符合診斷、納入標準的LUFS不孕患者200例,卵泡期根據患者不同情況,口服湯劑卵泡方、CC、LE、溴隱亭、地塞米松、肌注HMG等進行預處理,在B超監(jiān)測卵泡直徑達到多18mm時,隨機分為四組治療。A組(中藥口服湯劑組)45例,共177個月經周期;B組(穴位針刺組)32例,共162個月經周期;C組(中藥方外敷組)47例,共150個月經周期;D組(西藥HCG組)76例,共211個月經周期。比較四組治療后的排卵情況、LUFS復發(fā)情況、臨床妊娠結局,探析LUFS發(fā)病的相關因素。結果:(1)四組排卵情況比較:A組共觀察月經周期177個,排卵周期72個,排卵率為40.68%:B組共觀察月經周期162個,排卵周期98個,排卵率為60.49%;C組共觀察月經周期150個,排卵周期67個,排卵率為44.66%;D組共觀察月經周期211個,排卵周期124個,排卵率為58.76%。B組分別與A組、C組比較,有統(tǒng)計學差異(P0.05),D組分別與A組、C組比較,有統(tǒng)計學差異(P0.05),而A組與C組、B組與D組間比較,沒有統(tǒng)計學意義(P0.05)。(2)四組LUFS復發(fā)情況比較:A組共177個觀察周期,LUFS復發(fā)26個周期,LUFS復發(fā)率為14.69%;B組共162個觀察周期,LUFS復發(fā)21個周期,LUFS復發(fā)率為12.96%;C組共150個觀察周期,LUFS復發(fā)24個周期,LUFS復發(fā)率為16.00%;D組共211個觀察周期,LUFS復發(fā)54個周期,LUFS復發(fā)率為25.59%。A組、B組、C組分別與D組比較,具有顯著統(tǒng)計學差異(P0.05);余各組間比較無統(tǒng)計學差異(P0.05)。(3)誘發(fā)排卵7天后,經統(tǒng)計,四組血清雌孕激素值為:A 組 E2:330.41 ±200.48pg/mL,P:15.34±6.04ng/mL;B 組 E2:490.46±381.88pg/mL,P:22.07±14.35 ng/mL;C 組 E2:334.55士 190.35 pg/mL,P:17.64±7.95ng/mL;D 組 E2:462.39±291.35 pg/mL,P:24.79± 13.61ng/mL。B組、D組分別與A組、C組比較,有統(tǒng)計學差異(P0.05),而A組與C組、B組與D組間比較,沒有統(tǒng)計學意義(P0.05)。(4)四組妊娠結局比較:A組臨床妊娠19例(42.22%);B組臨床妊娠15例(46.86%);C組臨床妊娠20例(42.55%);D組臨床妊娠23例(30.26%)。A組、B組、C組臨床妊娠率分別與D組比較,存在統(tǒng)計學差異(P0.05),其余各組間臨床妊娠率分別比較無統(tǒng)計學意義(P0.05)。(5)LUFS患者發(fā)病相關因素比較:從職業(yè)與文化程度分析,從事腦力勞動患者(87.01%)的發(fā)病率明顯要高于體力勞動者(12.99%)。文化程度中,大學文化占85.50%,高中文化占10.00%,初中文化占4.50%,可見文化程度越高,發(fā)病率越高。從發(fā)病相關病史分析,下丘腦—垂體—卵巢性腺生殖軸的內分泌紊亂性疾病占多數(54.15%),其中多囊卵巢綜合征(PCOS)占35.34%;其次為盆腔因素(37.44%),其中內異癥(EMS)占24.74%。從精神心理因素分析,LUFS患者中精神緊張者占30.50%,抑郁多慮者占30.00%,急躁易怒者占21.00%。(6)四組PCOS、O1D、EMS所致LUFS不孕患者療效比較:PCOS不孕患者中,B組、D組排卵率分別與A組、C組比較,有統(tǒng)計學差異(P0.05),而A組與C組、B組與D組間比較,沒有統(tǒng)計學意義(P0.05);A組、C組、B組臨床妊娠率分別與D組比較,具有顯著統(tǒng)計學差異(P0.05);余各組間比較無統(tǒng)計學差異(P0.05)。PID不孕患者中,C組排卵率與A組、B組、D組相比,有統(tǒng)計學差異(P0.05);C組、B組臨床妊娠率與A組、D組相比,有統(tǒng)計學差異(P0.05)。EMS不孕患者中,C組排卵率與A組、B組、D組相比,有統(tǒng)計學差異(P0.05);A組、C組臨床妊娠率與B組、D組相比,有統(tǒng)計學差異(P0.05)。結論:口服中藥湯劑、外敷中藥、針刺三種不同的中醫(yī)藥技術治療未破裂卵泡黃素化綜合征致不孕癥,可提高周期排卵率(40-60%)及臨床妊娠率(42-46%),減少LUFS的發(fā)生率;運用中醫(yī)藥治療凸顯出了安全、有效、簡便的特色及優(yōu)勢,有一定的臨床應用推廣價值。
[Abstract]:Objective: luteinizedunrupturedfolliclesyndrome (LUFS) [1] has become one of the important causes of the current infertility. This study was conducted by acupuncture at acupoint, oral Chinese medicine decoction, external application of traditional Chinese medicine, and HCG intramuscular injection of Western medicine in the treatment of unruptured follicle yellow syndrome (LUFS) infertile patients. The treatment of four groups was observed and compared. A new effective, safe and simple way of thinking for the prevention and treatment of LUFS was added to the clinical effect of LUFS. Methods: 200 cases of LUFS infertile patients were selected in accordance with the diagnosis and included in the standard. The follicular phase was taken orally with the decoction of oocyte, CC, LE, bromocriptine, dexamethasone, HMG and so on. When the B-ultrasonic monitoring of the follicle diameter reached more than 18mm, it was randomly divided into four groups to treat.A group (Chinese medicine oral Decoction group), 45 cases, 177 menstrual cycles, 32 cases in group B (acupoint acupuncture group), 162 menstrual cycles, 47 cases in group C (traditional Chinese medicine prescription group), 150 menstrual cycles, and 76 cases in group D (group HCG of Western Medicine), with 211 menstrual cycles. Four groups after treatment were compared. The conditions of ovulation, LUFS recurrence and clinical pregnancy outcome were analyzed. Results: (1) the four groups of ovulation were compared: in group A, 177 menstrual cycles were observed, 72 of ovulation cycle and 40.68% for ovulation were observed: 162 of menstrual cycles were observed in group B, 98 of ovulation cycle, and 60.49% for ovulation; in group C, the period of menstrual cycle was 150, and ovulation cycle 6 was observed in 6 7, the ovulation rate was 44.66%; group D had 211 menstrual cycles, 124 ovulation cycles, ovulation rate in group 58.76%.B, group A, and group C (P0.05), D group compared with group A, C group, and there were statistical differences (P0.05), but there was no statistical significance between the A and C group. (2) four groups were compared with the recurrence rate. A group had 177 observation cycles, LUFS recurred 26 cycles, the recurrence rate of LUFS was 14.69%, B group had 162 observation cycles, LUFS recurred 21 cycles, and LUFS recurrence rate was 12.96%; C group had 150 observation cycles, LUFS recurred 24 cycles, and the recurrence rate of LUFS was 16%; D group was 211 cycle, LUFS recurred 54 cycles, LUFS recurrence rate was group, LUFS Compared with the D group, there were significant statistical differences (P0.05), and there was no statistical difference between the remaining groups (P0.05). (3) after 7 days of ovulation induction, the four groups of serum estradiol and progesterone were E2:330.41 + 200.48pg/mL, P:15.34 + 6.04ng/mL in group A, B group E2:490.46 + 381.88pg/mL, P:22.07 14.35. 17.64 + 7.95ng/mL, group D E2:462.39 + 291.35 pg/mL, P:24.79 + 13.61ng/mL.B group, D group compared with A group and C group, there was statistical difference (P0.05), while A group and C group, there was no statistical significance. (4) four groups of pregnancy outcomes: 19 cases (42.22%); 15 cases of clinical pregnancy (46.86%); clinical pregnancy 20 Cases (42.55%); in group D, 23 cases (30.26%) of clinical pregnancy (30.26%), group.A, group B, and group C were compared with D group, respectively, and there were statistical differences (P0.05), and there was no significant difference in clinical pregnancy rate between the other groups (P0.05). (5) comparison of the related factors of LUFS patients: from occupational and cultural level analysis, the incidence of mental labor (87.01%). The rate was significantly higher than that of the manual workers (12.99%). Among the cultural level, the university culture accounted for 85.50%, the high school culture accounted for 10%, the junior high school culture accounted for 4.50%, the higher the cultural degree, the higher the incidence of the disease. From the related history of disease analysis, the endocrine disorder of the hypothalamus pituitary ovarian gonadal axis was the majority (54.15%), of which polycystic ovary was polycystic. Syndrome (PCOS) accounted for 35.34%, followed by pelvic factors (37.44%), of which EMS accounted for 24.74%. from psycho psychological factors, 30.50% in LUFS, 30% in depression, in 21.00%. (6) in four groups of PCOS, O1D, EMS, in LUFS infertility patients: PCOS infertile patients, B group, and D group ovulation rate points. Compared with group A and group C, there were statistical differences (P0.05), but there was no statistical significance between group A and C group, B group and D group, and the clinical pregnancy rate of A group, C group and B group was significantly different from that of D group. There were statistical differences (P0.05), group C, group B and group A, compared with group A, D group, there was statistical difference (P0.05) in.EMS infertility patients, the ovulation rate of C group was compared with A group, B group, D group, there was statistical difference (P0.05). The treatment of infertility caused by unruptured follicular yellowing syndrome by different traditional Chinese medicine technology can improve the cycle ovulation rate (40-60%) and the clinical pregnancy rate (42-46%), reduce the incidence of LUFS, and the use of traditional Chinese medicine has highlighted the safety, effectiveness, simple and simple features and advantages, and has certain clinical application and promotion value.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R271.14
本文編號：2127008
[Abstract]:Objective: luteinizedunrupturedfolliclesyndrome (LUFS) [1] has become one of the important causes of the current infertility. This study was conducted by acupuncture at acupoint, oral Chinese medicine decoction, external application of traditional Chinese medicine, and HCG intramuscular injection of Western medicine in the treatment of unruptured follicle yellow syndrome (LUFS) infertile patients. The treatment of four groups was observed and compared. A new effective, safe and simple way of thinking for the prevention and treatment of LUFS was added to the clinical effect of LUFS. Methods: 200 cases of LUFS infertile patients were selected in accordance with the diagnosis and included in the standard. The follicular phase was taken orally with the decoction of oocyte, CC, LE, bromocriptine, dexamethasone, HMG and so on. When the B-ultrasonic monitoring of the follicle diameter reached more than 18mm, it was randomly divided into four groups to treat.A group (Chinese medicine oral Decoction group), 45 cases, 177 menstrual cycles, 32 cases in group B (acupoint acupuncture group), 162 menstrual cycles, 47 cases in group C (traditional Chinese medicine prescription group), 150 menstrual cycles, and 76 cases in group D (group HCG of Western Medicine), with 211 menstrual cycles. Four groups after treatment were compared. The conditions of ovulation, LUFS recurrence and clinical pregnancy outcome were analyzed. Results: (1) the four groups of ovulation were compared: in group A, 177 menstrual cycles were observed, 72 of ovulation cycle and 40.68% for ovulation were observed: 162 of menstrual cycles were observed in group B, 98 of ovulation cycle, and 60.49% for ovulation; in group C, the period of menstrual cycle was 150, and ovulation cycle 6 was observed in 6 7, the ovulation rate was 44.66%; group D had 211 menstrual cycles, 124 ovulation cycles, ovulation rate in group 58.76%.B, group A, and group C (P0.05), D group compared with group A, C group, and there were statistical differences (P0.05), but there was no statistical significance between the A and C group. (2) four groups were compared with the recurrence rate. A group had 177 observation cycles, LUFS recurred 26 cycles, the recurrence rate of LUFS was 14.69%, B group had 162 observation cycles, LUFS recurred 21 cycles, and LUFS recurrence rate was 12.96%; C group had 150 observation cycles, LUFS recurred 24 cycles, and the recurrence rate of LUFS was 16%; D group was 211 cycle, LUFS recurred 54 cycles, LUFS recurrence rate was group, LUFS Compared with the D group, there were significant statistical differences (P0.05), and there was no statistical difference between the remaining groups (P0.05). (3) after 7 days of ovulation induction, the four groups of serum estradiol and progesterone were E2:330.41 + 200.48pg/mL, P:15.34 + 6.04ng/mL in group A, B group E2:490.46 + 381.88pg/mL, P:22.07 14.35. 17.64 + 7.95ng/mL, group D E2:462.39 + 291.35 pg/mL, P:24.79 + 13.61ng/mL.B group, D group compared with A group and C group, there was statistical difference (P0.05), while A group and C group, there was no statistical significance. (4) four groups of pregnancy outcomes: 19 cases (42.22%); 15 cases of clinical pregnancy (46.86%); clinical pregnancy 20 Cases (42.55%); in group D, 23 cases (30.26%) of clinical pregnancy (30.26%), group.A, group B, and group C were compared with D group, respectively, and there were statistical differences (P0.05), and there was no significant difference in clinical pregnancy rate between the other groups (P0.05). (5) comparison of the related factors of LUFS patients: from occupational and cultural level analysis, the incidence of mental labor (87.01%). The rate was significantly higher than that of the manual workers (12.99%). Among the cultural level, the university culture accounted for 85.50%, the high school culture accounted for 10%, the junior high school culture accounted for 4.50%, the higher the cultural degree, the higher the incidence of the disease. From the related history of disease analysis, the endocrine disorder of the hypothalamus pituitary ovarian gonadal axis was the majority (54.15%), of which polycystic ovary was polycystic. Syndrome (PCOS) accounted for 35.34%, followed by pelvic factors (37.44%), of which EMS accounted for 24.74%. from psycho psychological factors, 30.50% in LUFS, 30% in depression, in 21.00%. (6) in four groups of PCOS, O1D, EMS, in LUFS infertility patients: PCOS infertile patients, B group, and D group ovulation rate points. Compared with group A and group C, there were statistical differences (P0.05), but there was no statistical significance between group A and C group, B group and D group, and the clinical pregnancy rate of A group, C group and B group was significantly different from that of D group. There were statistical differences (P0.05), group C, group B and group A, compared with group A, D group, there was statistical difference (P0.05) in.EMS infertility patients, the ovulation rate of C group was compared with A group, B group, D group, there was statistical difference (P0.05). The treatment of infertility caused by unruptured follicular yellowing syndrome by different traditional Chinese medicine technology can improve the cycle ovulation rate (40-60%) and the clinical pregnancy rate (42-46%), reduce the incidence of LUFS, and the use of traditional Chinese medicine has highlighted the safety, effectiveness, simple and simple features and advantages, and has certain clinical application and promotion value.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R271.14
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