【摘要】：目的:探討加味五子衍宗丸對(duì)黃體功能不全(LPD)所致女性不孕妊娠率的療效及對(duì)激素水平和子宮內(nèi)膜容受性的影響。方法:將130例患者隨機(jī)按數(shù)字法分為對(duì)照組和觀察組各65例。對(duì)照組采用地屈孕酮片,在陰道B超監(jiān)測(cè)到排卵后當(dāng)日服用,20 mg·d-1,連續(xù)服用10 d;未孕者,下個(gè)月經(jīng)周期繼續(xù)服用;若已懷孕,懷孕初期可以繼續(xù)服用,根據(jù)孕酮水平調(diào)節(jié)用量。觀察組內(nèi)服加味五子衍宗丸,1劑/d。兩組受孕者均給予維生素E膠囊,0.1 g/次,3次/d。兩組療程均連續(xù)觀察3個(gè)月經(jīng)周期,療程結(jié)束后隨訪3個(gè)月經(jīng)周期。記錄6個(gè)月周期(治療+隨訪)內(nèi)的妊娠情況,并隨訪觀察活胎率;測(cè)量基礎(chǔ)體溫(BBT),并進(jìn)行黃體功能基礎(chǔ)體溫氋溫相評(píng)分(HPS);檢測(cè)促卵泡刺激素(FSH),黃體生成素(LH),雌二醇(E2)和孕酮(P)水平;采用彩色B超記錄優(yōu)勢(shì)卵泡情況,并記錄子宮內(nèi)膜螺旋動(dòng)脈搏動(dòng)指數(shù)(PI)和阻力指數(shù)(RI),測(cè)量子宮內(nèi)膜厚度,并進(jìn)行Salle評(píng)分;進(jìn)行腎虛精虧證評(píng)分;以上指標(biāo)治療前后各評(píng)價(jià)1次。結(jié)果:對(duì)照組臨床療效總有效率為77.42%,觀察組為93.65%,觀察組高于對(duì)照組(χ~2=6.678,P0.01);對(duì)照組臨床妊娠率為32.26%,觀察組為52.38%,觀察組臨床妊娠率高于對(duì)照組(χ~2=5.181,P0.05),兩組活胎率比較差異無(wú)統(tǒng)計(jì)學(xué)意義;治療后觀察組FSH,LH,E2和P水平高于對(duì)照組(P0.01);治療后觀察組HPS評(píng)分高于對(duì)照組,優(yōu)勢(shì)卵泡直徑大于對(duì)照組,腎虛精虧證評(píng)分低于對(duì)照組(P0.01);治療后觀察組Salle評(píng)分高于對(duì)照組,子宮內(nèi)膜增厚于對(duì)照組,PI和RI均低于對(duì)照組,A型子宮內(nèi)膜比例多于對(duì)照組(P0.01);兩組治療期間均無(wú)不良反應(yīng)及嚴(yán)重不良事件的發(fā)生。結(jié)論:加味五子衍宗丸治療LPD所致不孕腎虛精虧證患者,能調(diào)節(jié)HPOA軸,提高了黃體功能,改善激素水平,減輕腎虛精虧證評(píng)分,改善了子宮內(nèi)膜容受性,從而提高妊娠率,臨床療效優(yōu)于西醫(yī)治療。
[Abstract]:Objective: to investigate the effect of Jiawei Wuzi Yanzong pill on female infertility induced by luteal insufficiency (LPD) and its effects on hormone level and endometrial receptivity. Methods: 130 patients were randomly divided into control group (n = 65) and observation group (n = 65). The control group was treated with Diproprogesterone tablets on the same day after ovulation was detected by vaginal ultrasound, 20 mg d -1 for 10 days, and those who were not pregnant were continued to take it during the next menstrual cycle. If pregnant, early pregnancy can continue to take, according to the level of progesterone regulation dosage. The observation group was treated with Jiawei Wuzi Yanzong Pill, 1 dose per day. Both groups were given vitamin E capsule, 0.1 g / time, 3 times per day. Three menstrual cycles were observed continuously in both groups, and 3 menstrual cycles were followed up at the end of the course. The pregnancy during the 6-month cycle (follow up) was recorded, and the live fetus rate was observed. The basal body temperature (BBT),) was measured and the luteal function basic body temperature score (HPS);) was performed. The levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone (P) were measured. Color B ultrasound was used to record the dominant follicles and endometrial spiral artery pulsatility index (PI) and resistance index (RI),) were recorded to measure the endometrial thickness and to evaluate the endometrial thickness with Salle score. The above indexes were evaluated once before and after treatment. Results: the total effective rate was 77.42 in the control group and 93.65 in the observation group, which was higher in the observation group than in the control group (蠂 ~ 2 6.678, P0.01). The clinical pregnancy rate was 32.26 in the control group and 52.38 in the observation group. The clinical pregnancy rate in the observation group was higher than that in the control group (蠂 ~ 2 ~ (5.181) P 0.05). After treatment, the levels of FSH,LH,E2 and P in the observation group were higher than those in the control group (P0.01), the HPS score of the observation group was higher than that of the control group, the diameter of dominant follicle was larger than that of the control group, the score of deficiency of kidney essence syndrome was lower than that of the control group (P0.01). After treatment, the Salle score of the observation group was higher than that of the control group, the endometrial thickness was thicker, the PI and RI were lower than that of the control group, and the proportion of type A endometrium was higher than that of the control group (P0.01). There were no adverse reactions and serious adverse events in both groups. Conclusion: modified Wuzi Yanzong pill can regulate HPOA axis, improve luteal function, improve hormone level, reduce the score of deficiency of kidney essence syndrome, improve endometrial receptivity and increase pregnancy rate in patients with infertility caused by LPD. The clinical curative effect is better than western medicine treatment.
【作者單位】： 川北醫(yī)學(xué)院附屬醫(yī)院;
【基金】：南充市應(yīng)用技術(shù)研究與開(kāi)發(fā)資金項(xiàng)目(13A0037)
【分類號(hào)】：R271.14

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