摘要
目的通过观察朱氏调经促孕方加减干预肾虚型排卵障碍性不孕症的临床疗效,探讨其可能促排卵的分子生物学机制。方法将80例患者采用区组随机化方法分为治疗组(40例)和对照组(40例),月经周期规律患者于周期第5天开始用药,若月经周期不规律者可使用黄体酮撤退性出血后,从阴道出血第5天开始用药。治疗组给予朱氏调经促孕方,每日1剂,对照组给予枸橼酸氯米芬片(clomifene citrate,CC)50 mg/d口服进行治疗,3个月经周期为1个疗程,治疗2个疗程。观察临床疗效(妊娠率、流产率)、监测排卵(成熟卵泡、黄素化卵泡、排卵前卵泡最大直径及排卵日子宫内膜厚度)及治疗前后中医肾虚证候、月经症状积分;治疗前及治疗1个疗程后采用化学发光免疫分析法测定卵泡刺激素(follicIe stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E_2),采用双抗体夹心酶联免疫吸附技术(sandwich ELISA)同批进行检测激活素A(activin A,ACTA)、抑制素B(inhibin B,INHB)、卵泡抑素(follistatin,FS)。结果与对照组比较,治疗组妊娠率明显升高,流产率明显降低,治疗组周期成熟卵泡排卵率与黄素化卵泡率降低,差异有统计学意义(P<0.05)。与治疗前比较,两组治疗后中医肾虚证候积分降低,排卵前卵泡最大直径增加,未妊娠患者月经症状积分明显降低,同时治疗组排卵日子宫内膜厚度较治疗前增加而对照组减少,差异均有统计学意义(P<O.05,P<0.01)。与对照组比较,治疗组治疗后中医肾虚证候积分降低,排卵前卵泡最大直径降低(P<0.05,P<O.01);治疗组中医肾虚证候积分及排卵日子宫内膜厚度差值增多,排卵前卵泡最大直径差值减少,差异亦有统计学意义(P<0.05,P<0.01)。治疗1个疗程后,与治疗前比较,治疗组E_2、ACTA水平增加(P<0.01),INHB及FS水平降低(P<0.05),对照组FSH及ACTA水平升高,FS水平降低(P<0.05,P<O.01);与对照组比较,治疗组治疗1个疗程后E_2、ACTA水平增加,INHB水平降低(P<0.05,P<0.01)。结论朱氏调经促孕方能够改善排卵障碍性不孕症患者中医证候、调控卵泡发育、提高妊娠率,其作用可能与调节患者性激素及卵巢局部因子INHB、ACTA、FS的表达有关。
Objective To explore the molecular biological mechanism of ZHU＇s Tiaojing Cuyun Recipe（TCR） for treating anovulatory infertility patients with Shen deficiency syndrome（SDS） by observing its clinical efficacy.Methods Using randomized blocking methods,80 patients were assigned to the treatment group（40 cases） and the control group（40 cases）.Patients with regular menstrual cycle started medication from the 5th day of menstruation.Those with irregular menstrual cycle first took progesterone till withdrawal bleeding,and then started medication from the 5th day of vaginal bleeding.Patients in the treatment group took ZHU＇s TCR,one dose per day,while those in the control group took Clomifene Citrate（CC）,50 mg per day.Three menstrual cycles consisted of one therapeutic course,a total of 2 courses.Clinical efficacy such as pregnancy rates and abortion rates were observed.Ovulation indices（the maximal diameter of mature follicles,luteinized follicles,ovulational follicles,and the endometrial thickness on the ovulation day）,SDS,and integrals of menstrual symptoms were monitored before and after treatment.Serum levels of follicle stimulating hormone（FSH）,luteinizing hormone（LH）,and estradiol（E_2） were determined using chemiluminescent immunoassay before treatment and after on therapeutic course.Serum levels of activin A（ACTA）,inhibin B（INHB）,and follistatin（FS） were detected using double antibody sandwich ELISA.Results Compared with the control group,the pregnancy rate was obviously elevated and the abortion rate was obviously lowered in the treatment group（P〈0.05）.Ovulation rates of mature follicles and luteinizing follicles decreased more in the treatment group（P〈0.05）.Compared with before treatment,integrals for SDS were lower,the maximal diameter of pre-ovulational follicles was increased,and integrals for menstrual symptoms in non-pregnant patients of the two groups were obviously lowered.Meanwhile,the endometrial thickness on the ovulation day was increased in the treatment group after treatment,but reduced in the control group（P〈0.05,P〈0.01）.Compared with the control group,integrals for SDS were decreased,and the maximal diameter of pre-ovulational follicles was lowered in the treatment group after treatment（P〈0.05,P〈0.01）.Integrals for SDS and the difference in the endometrial thickness on the ovulation day were increased,but the difference in the maximal diameter of pre-ovulational follicles were reduced（P〈0.05,P〈0.01）.In the treatment group serum levels of E_2 and ACTA increased more after one therapeutic course than before treatment（P〈0.01）,but serum levels of INHB and FS decreased more after one therapeutic course than before treatment（P〈0.05）.In the control group serum levels of FSH and ACTA increased more,and the serum level of FS decreased more after one therapeutic course than before treatment（P〈0.05,P〈0.01）.Compared with the control group,serum levels of FSH and ACTA increased more,and serum levels of INHB decreased more in the treatment group after one therapeutic course than before treatment（P〈0.05,P〈0.01）.Conclusions ZHU＇sTCR could improve SDS of anovulatory infertility patients,regulate the follicular development,and elevate the pregnancy rate.Its actions might be associated with regulating their sex hormones,expressions of ovary local factors such as INHB,ACTA,and FS.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2015年第10期1181-1185,共5页
Chinese Journal of Integrated Traditional and Western Medicine
基金
上海市中医药事业发展三年行动计划项目(海派中医流派传承研究基地)(No.AYSNXD-CC-HPGC-JD-008)
上海市高级中西医结合人才培养项目(No.ZYSNXD012-RC-ZXY011)
上海市科委科研计划项目(No.12401903303)
上海市科委自然基金资助项目(No.12ZR1432700)
上海市科委课题(No.074119624)
国家中医药管理局朱氏妇科传承工作室项目(No.2011)
关键词
排卵障碍性不孕
朱氏调经促孕方
肾虚证
anovulatory infertility
ZHU＇s Tiaojing Cuyun Recipe
Shen deficiency syndrome
