补肾活血周期疗法辅治薄型子宫内膜患者的冷冻胚胎移植的临床研究

发布时间：2018-05-21 02:37

本文选题：冻融胚胎移植 + 薄型子宫内膜　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:近年来,体外受精-胚胎移植(IVF-ET)已发展成为生殖医学的重要组成部分。虽然IVF-ET技术在不断的改进和更新,目前已获得满意的成功率,但仍然存在一些问题,比如着床率低、周期取消率高等,出现这些问题的原因主要有胚胎质量问题及内膜的容受性等。子宫内膜的容受性影响着受精卵的着床,子宫内膜生长不良是导致胚胎移植失败的重要因素。对于IVF-ET,合适的子宫内膜环境是胚胎移植成功的必备条件。目前越来越多的患者因子宫内膜薄,从而取消移植周期。薄型子宫内膜属中医学无子、月经过少、闭经等范畴,肾虚、血瘀是其基本病机。基于中医学这一基本理论,本研究观察补肾活血周期疗法对薄型子宫内膜患者的冷冻胚胎移植的临床疗效,并探讨补肾活血周期疗法的作用机理,以期改善薄型子宫内膜的血流灌注,改善子宫内膜的容受性,提高薄型子宫内膜患者的冷冻胚胎移植(FET)着床率,或降低冷冻胚胎移植的周期取消率。方法:本研究的研究对象均为在2016年1月至2016年12月就诊于广州中医药大学第一附属医院妇科门诊、广东省第二人民医院生殖中心不孕不育中医门诊,采用人工周期替代方案准备内膜的薄型子宫内膜FET患者共40例,随机分为两组:(中药+补佳乐)治疗组和补佳乐对照组。(中药+补佳乐)治疗组:排卵前,服用理气活血补肾中药方+补佳乐。排卵后至抽血HCG日,服用温肾活血中药方+补佳乐。补佳乐对照组:排卵前至抽血HCG日一直服用补佳乐。两组均治疗一个周期。观察治疗前后两组移植前阴道超声下子宫内膜厚度、子宫血流动力学(RI)、D二聚体的变化,以及两组妊娠率、可移植病例率的情况。成果:1.两组治疗前后的移植前阴道超声下子宫内膜厚度变化进行比较均有显著性差异(P0.05),治疗组在内膜改善方面优于对照组(P0.05)。2.治疗组治疗前后子宫血流动力学(RI)、D二聚体的变化进行比较均有显著性差异(P0.05)。3.两组可移植病例率比较有显著性差异(P0.05)。结论:1.补肾活血周期疗法有助于提高子宫内膜厚度。2.补肾活血周期疗法可改善子宫血流动力学。3.补肾活血周期疗法可降低冷冻胚胎移植的周期取消率。
[Abstract]:Objective: in recent years, IVF-ETS has become an important part of reproductive medicine. Although IVF-ET technology has been continuously improved and updated, it has achieved a satisfactory success rate, but there are still some problems, such as low implantation rate, high cycle cancellation rate, etc. The main causes of these problems are embryo quality and endometrial receptivity. Endometrial receptivity affects the implantation of fertilized eggs. Endometrial malgrowth is an important factor leading to the failure of embryo transfer. For IVF-ETs, an appropriate endometrial environment is a prerequisite for successful embryo transfer. At present, more and more patients cancel the transplant cycle because of the thin endometrium. Thin endometrium belongs to traditional Chinese medicine, menstruation, amenorrhea and other categories, kidney deficiency, blood stasis is its basic pathogenesis. Based on the basic theory of traditional Chinese medicine, this study observed the clinical effect of tonifying kidney and activating blood cycle therapy on frozen embryo transfer in patients with thin endometrium, and discussed the mechanism of cycle therapy of tonifying kidney and activating blood circulation. In order to improve the blood flow perfusion of thin endometrium, improve the receptivity of endometrium, increase the implantation rate of frozen embryo transfer (FET) in patients with thin endometrium, or reduce the rate of cycle cancellation of frozen embryo transfer. Methods: from January 2016 to December 2016, the subjects of this study were the gynecological outpatient clinic of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, and the infertility clinic of the Reproductive Center of the second people's Hospital of Guangdong Province. A total of 40 patients with FET of thin endometrium prepared by artificial cycle replacement were randomly divided into two groups: one was treated with Bu Jia Le and the other was treated with Bujialao. Treatment group: before ovulation, take Qi Huoxue tonifying Kidney prescription Bu Jia Le. After ovulation until HCG day, take warm kidney and blood circulation prescription Bujia Le. Bujialao control group: Bujialao was taken before ovulation until the day of HCG. Both groups were treated for one cycle. The changes of endometrial thickness, uterine hemodynamics, RII-D dimer, pregnancy rate and transplantable cases were observed before and after treatment. Result: 1. There was significant difference in endometrial thickness between the two groups before and after the treatment. The treatment group was better than the control group in improving the endometrium. In the treatment group, there were significant differences in the changes of RII-D dimer in uterine hemodynamics before and after treatment. There was significant difference between the two groups in the rate of transplantable cases (P 0.05). Conclusion 1. The treatment of tonifying kidney and activating blood circulation helps to increase the thickness of endometrium. The treatment of tonifying kidney and activating blood circulation can improve uterine hemodynamics. The cycle therapy of tonifying kidney and activating blood circulation can reduce the cycle canceling rate of frozen embryo transfer.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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