排卵障碍性不孕患者促排卵周期应用滋肾育胎丸联合地屈孕酮的临床研究

发布时间：2018-08-02 21:12

【摘要】：目的：克罗米芬作为排卵障碍性不孕症促排卵治疗的一线用药被广泛应用于临床,然而有很多研究表明在克罗米芬促排卵周期中,药物的作用使得COS周期的内分泌环境发生改变,影响黄体功能、子宫内膜容受性及妊娠率。本研究通过观察排卵障碍性不孕患者COS周期(克罗米芬+HMG)中滋肾育胎丸结合地屈孕酮对周期结局的影响,为滋肾育胎丸改善黄体功能及子宫内膜内环境、增加子宫内膜容受性、提高妊娠率提供循证医学证据。方法：将符和纳入标准与排除标准的排卵障碍性不孕症患者随机分为治疗组(地屈孕酮+滋肾育胎丸组)、对照组(地屈孕酮组)两组。均予CC/HMG/HCG促排卵治疗,治疗组于注射HCG日起予滋肾育胎丸,两组均在HCG注射后48小时经阴道B超检测卵泡排出后(如发生LUFS,则予以剔除)予地屈孕酮。治疗组共30例73周期,对照组共30例77周,期。比较排卵期BBT上升幅度；比较黄体中期血清E2、P水平及P/E2比值,以间接比较两组黄体功能及子宫内膜容受性；妊娠者比较临床妊娠率、流产率及先兆流产症状积分。结果：1.研究结果显示,关于两组排卵期BBT上升幅度,两组第一个刺激周期比较并无显著性差异(F0.05),第二、三刺激周期差异显著,具有统计学意义(P0.05)。2.对两组黄体中期血清E2水平进行比较,差异无统计学意义(P0.05)。3.治疗组黄体中期血清P、P/E2水平均高于对照组。两组第二、三刺激周期比较P及P/E2有明显差异(P0.05)。4.治疗组总临床妊娠率60%,早期流产率5.5%；对照组总临床妊娠率46.6%,早期流产率14.2%,两组间差异无统计学意义(P0.05)。5.对两组先兆流产症状积分进行比较,比较有统计学差别(P0.05)。结论：地屈孕酮联合滋肾育胎丸可以促进黄体形成并分泌更多孕激素,改善黄体功能及子宫内膜容受性,有利于胚胎着床；能够有效改善先兆流产症状,提高临床妊娠率,降低早期流产率。
[Abstract]:Objective: clomiphene is widely used in clinical practice as a first-line therapy for ovulation promotion in ovulatory infertility. However, many studies have shown that clomiphene promotes ovulation in the ovulation cycle. The effect of drugs on the endocrine environment of COS cycle, affecting luteal function, endometrial receptivity and pregnancy rate. In order to improve the luteal function and endometrial environment, the effect of Zishen Yu-Feiwan combined with Diproprogesterone on the outcome of COS cycle (clomiphene HMG) in infertile patients with ovulatory disorder was observed in this study. Increased endometrial receptivity and increased pregnancy rate provide evidence-based medical evidence. Methods: the infertile patients with ovulatory disorder were randomly divided into two groups: treatment group (diflexione group) and control group (diproprogesterone group). Both groups were treated with CC/HMG/HCG to promote ovulation. The treatment group was treated with Zishen Yuet Pill from the day of HCG injection. Both groups were given diproprogesterone 48 hours after HCG injection by vaginal B-ultrasound examination after follicle excretion (if LUFS was removed). There were 73 cycles in 30 cases in treatment group and 77 weeks in control group. The serum E2P level and P/E2 ratio in the middle luteal phase were compared to compare the luteal function and endometrial receptivity between the two groups, and the clinical pregnancy rate, abortion rate and symptom score of threatened abortion were compared between the pregnant women and the pregnant women. The result is 1: 1. The results showed that there was no significant difference in the first stimulation cycle between the two groups (F0. 05), but there was significant difference in the second and third stimulation cycles between the two groups (P0.05). There was no significant difference in serum E 2 levels between the two groups in the middle luteal phase (P0.05). 3. The serum levels of P P / E 2 in the middle luteal phase in the treatment group were higher than those in the control group. P and P/E2 were significantly different between the two groups in the second and third stimulation cycles (P0.05). 4. Treatment group total clinical pregnancy rate 60, early abortion rate 5.5; control group total clinical pregnancy rate 46. 6, early abortion rate 14. 2, there was no significant difference between the two groups (P0.05). 5. The symptoms of threatened abortion were compared between the two groups, the difference was statistically significant (P0.05). Conclusion: Diproprogesterone combined with Zishen Yuet pill can promote luteal formation and secretion of progesterone, improve luteal function and endometrial receptivity, facilitate embryo implantation, improve symptoms of threatened abortion and increase clinical pregnancy rate. Reduce early abortion rate.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.6

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