加味五子衍宗丸治疗肾虚精亏证黄体功能不全所致的女性不孕

发布时间：2018-12-13 10:50

【摘要】：目的:探讨加味五子衍宗丸对黄体功能不全(LPD)所致女性不孕妊娠率的疗效及对激素水平和子宫内膜容受性的影响。方法:将130例患者随机按数字法分为对照组和观察组各65例。对照组采用地屈孕酮片,在阴道B超监测到排卵后当日服用,20 mg·d-1,连续服用10 d;未孕者,下个月经周期继续服用;若已怀孕,怀孕初期可以继续服用,根据孕酮水平调节用量。观察组内服加味五子衍宗丸,1剂/d。两组受孕者均给予维生素E胶囊,0.1 g/次,3次/d。两组疗程均连续观察3个月经周期,疗程结束后随访3个月经周期。记录6个月周期(治疗+随访)内的妊娠情况,并随访观察活胎率;测量基础体温(BBT),并进行黄体功能基础体温氋温相评分(HPS);检测促卵泡刺激素(FSH),黄体生成素(LH),雌二醇(E2)和孕酮(P)水平;采用彩色B超记录优势卵泡情况,并记录子宫内膜螺旋动脉搏动指数(PI)和阻力指数(RI),测量子宫内膜厚度,并进行Salle评分;进行肾虚精亏证评分;以上指标治疗前后各评价1次。结果:对照组临床疗效总有效率为77.42%,观察组为93.65%,观察组高于对照组(χ~2=6.678,P0.01);对照组临床妊娠率为32.26%,观察组为52.38%,观察组临床妊娠率高于对照组(χ~2=5.181,P0.05),两组活胎率比较差异无统计学意义;治疗后观察组FSH,LH,E2和P水平高于对照组(P0.01);治疗后观察组HPS评分高于对照组,优势卵泡直径大于对照组,肾虚精亏证评分低于对照组(P0.01);治疗后观察组Salle评分高于对照组,子宫内膜增厚于对照组,PI和RI均低于对照组,A型子宫内膜比例多于对照组(P0.01);两组治疗期间均无不良反应及严重不良事件的发生。结论:加味五子衍宗丸治疗LPD所致不孕肾虚精亏证患者,能调节HPOA轴,提高了黄体功能,改善激素水平,减轻肾虚精亏证评分,改善了子宫内膜容受性,从而提高妊娠率,临床疗效优于西医治疗。
[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.
【作者单位】：川北医学院附属医院;
【基金】：南充市应用技术研究与开发资金项目(13A0037)
【分类号】：R271.14

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