中医药治疗未破裂卵泡黄素化综合征致不孕的临床研究
发布时间：2018-07-16 16:49
【摘要】：目的:未破裂卵泡黄素化综合征(luteinizedunrupturedfolliclesyndrome,LUFS)[1]成为当前不孕症发生的重要原因之一。本研究通过穴位针刺、中药汤剂口服、中药外敷、西药HCG肌注治疗未破裂卵泡黄素化综合征(LUFS)不孕患者,观察比较四组治疗方法的临床疗效,探析LUFS相关发病因素,为预防及治疗LUFS探索增添出一条新的有效、安全、简便的思路。方法:选择符合诊断、纳入标准的LUFS不孕患者200例,卵泡期根据患者不同情况,口服汤剂卵泡方、CC、LE、溴隐亭、地塞米松、肌注HMG等进行预处理,在B超监测卵泡直径达到多18mm时,随机分为四组治疗。A组(中药口服汤剂组)45例,共177个月经周期;B组(穴位针刺组)32例,共162个月经周期;C组(中药方外敷组)47例,共150个月经周期;D组(西药HCG组)76例,共211个月经周期。比较四组治疗后的排卵情况、LUFS复发情况、临床妊娠结局,探析LUFS发病的相关因素。结果:(1)四组排卵情况比较:A组共观察月经周期177个,排卵周期72个,排卵率为40.68%:B组共观察月经周期162个,排卵周期98个,排卵率为60.49%;C组共观察月经周期150个,排卵周期67个,排卵率为44.66%;D组共观察月经周期211个,排卵周期124个,排卵率为58.76%。B组分别与A组、C组比较,有统计学差异(P0.05),D组分别与A组、C组比较,有统计学差异(P0.05),而A组与C组、B组与D组间比较,没有统计学意义(P0.05)。(2)四组LUFS复发情况比较:A组共177个观察周期,LUFS复发26个周期,LUFS复发率为14.69%;B组共162个观察周期,LUFS复发21个周期,LUFS复发率为12.96%;C组共150个观察周期,LUFS复发24个周期,LUFS复发率为16.00%;D组共211个观察周期,LUFS复发54个周期,LUFS复发率为25.59%。A组、B组、C组分别与D组比较,具有显著统计学差异(P0.05);余各组间比较无统计学差异(P0.05)。(3)诱发排卵7天后,经统计,四组血清雌孕激素值为:A 组 E2:330.41 ±200.48pg/mL,P:15.34±6.04ng/mL;B 组 E2:490.46±381.88pg/mL,P:22.07±14.35 ng/mL;C 组 E2:334.55士 190.35 pg/mL,P:17.64±7.95ng/mL;D 组 E2:462.39±291.35 pg/mL,P:24.79± 13.61ng/mL。B组、D组分别与A组、C组比较,有统计学差异(P0.05),而A组与C组、B组与D组间比较,没有统计学意义(P0.05)。(4)四组妊娠结局比较:A组临床妊娠19例(42.22%);B组临床妊娠15例(46.86%);C组临床妊娠20例(42.55%);D组临床妊娠23例(30.26%)。A组、B组、C组临床妊娠率分别与D组比较,存在统计学差异(P0.05),其余各组间临床妊娠率分别比较无统计学意义(P0.05)。(5)LUFS患者发病相关因素比较:从职业与文化程度分析,从事脑力劳动患者(87.01%)的发病率明显要高于体力劳动者(12.99%)。文化程度中,大学文化占85.50%,高中文化占10.00%,初中文化占4.50%,可见文化程度越高,发病率越高。从发病相关病史分析,下丘脑—垂体—卵巢性腺生殖轴的内分泌紊乱性疾病占多数(54.15%),其中多囊卵巢综合征(PCOS)占35.34%;其次为盆腔因素(37.44%),其中内异症(EMS)占24.74%。从精神心理因素分析,LUFS患者中精神紧张者占30.50%,抑郁多虑者占30.00%,急躁易怒者占21.00%。(6)四组PCOS、O1D、EMS所致LUFS不孕患者疗效比较:PCOS不孕患者中,B组、D组排卵率分别与A组、C组比较,有统计学差异(P0.05),而A组与C组、B组与D组间比较,没有统计学意义(P0.05);A组、C组、B组临床妊娠率分别与D组比较,具有显著统计学差异(P0.05);余各组间比较无统计学差异(P0.05)。PID不孕患者中,C组排卵率与A组、B组、D组相比,有统计学差异(P0.05);C组、B组临床妊娠率与A组、D组相比,有统计学差异(P0.05)。EMS不孕患者中,C组排卵率与A组、B组、D组相比,有统计学差异(P0.05);A组、C组临床妊娠率与B组、D组相比,有统计学差异(P0.05)。结论:口服中药汤剂、外敷中药、针刺三种不同的中医药技术治疗未破裂卵泡黄素化综合征致不孕症,可提高周期排卵率(40-60%)及临床妊娠率(42-46%),减少LUFS的发生率;运用中医药治疗凸显出了安全、有效、简便的特色及优势,有一定的临床应用推广价值。
[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.
【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】：2017
【分类号】：R271.14
本文编号：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.
【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】：2017
【分类号】：R271.14
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