二至天癸方对高龄不孕妇女卵巢反应性的影响

作者	单位
连方	山东中医药大学附属医院
王琳	山东中医药大学
张建伟	山东中医药大学附属医院
孙振高	山东中医药大学附属医院
张宁	山东中医药大学附属医院
马凤梅	山东中医药大学附属医院
孟茜	山东中医药大学附属医院
滕依丽	山东中医药大学
刘海萍	山东中医药大学

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中文摘要:

目的探讨补肾益天癸之二至天癸方提高高龄不孕妇女卵巢反应性的临床疗效。方法将66例参加体外受精-胚胎移植(IVFET)周期的高龄不孕妇女随机分为中药组(二至天癸方联合超排卵方案治疗,33例)和对照组(单用超排卵方案治疗,33例),观察临床症状改善情况,促性腺激素(FSH)的用量,不同时期血清激素水平、HCG注射日子宫内膜厚度、子宫和卵巢动脉搏动测定,卵泡数,取卵数,优质卵率,受精率,优质胚胎率,妊娠率,并对治疗后两组患者阴中干涩症状积分与HCG注射日血清E2进行相关性分析。结果中药组患者临床肾气阴两虚症状得到有效改善,与对照组比较差异有显著性(P<0.05);中药组FSH总用量及每天FSH用量明显低于对照组,两组比较,差异有显著性(P<0.05);在HCG注射日血清E2水平、子宫内膜厚度、取卵数、优质卵率、受精率、优质胚胎率,中药组均明显优于对照组,差异有显著性(P<0.05);两组患者治疗后阴中干涩症状积分与HCG注射日血清E2水平均存在弱负相关关系(r=-0.369,r=-0.425),说明HCG注射日血清E2水平是影响阴中干涩症状的因素,但不是唯一因素。中药组治疗后阴中干涩积分低于对照组,差异有显著性(t=2.422,P<0.05)。结论二至天癸方配合超排卵方案可明显减少FSH用量,提高卵巢反应,改善卵子质量,提高妊娠率,提示其机理与补肾益天癸之二至天癸方改善卵巢反应性,提高雌激素水平,协调下丘脑—垂体—卵巢轴有关。

英文摘要:

ObjectiveTo observe the clinical effect of Erzhi Tiangui Recipe （ETR）, a traditional Chinese recipe for strengthening Shen and nourishing Tiangui, in improving the ovarian reactivity in elderly sterile women. MethodsSixty-six elderly sterile women receiving in vitro fertilization pre-embryo transfer （IVF-ET）were randomly divided into two groups: the ETR group treated with ETR plus follicle stimulating hormone （FSH） and the control group treated with FSH alone, 33 cases in each group. Changes of symptoms and the relative parameters were observed, including the dosage of FSH used, the serum hormone levels at different periods, endometrium thickness and arteriopalmus of uterus and ovary on the day of HCG injection, follicle number, follicular oocyte number, mature follicular oocyte rate and fertilization rate, prime embryo rate, and pregnancy rate. Moreover, the correlation of the symptom score of colpoxerosis （CR2） and serum estradiol （E₂） level was analyzed after treatment （on the HCG injection day）. ResultsSymptoms of Shen qi-yin deficiency were improved significantly in the ETR group, with the improvement better than that in the control group （P<0.05）. The total and daily FSH dosage in the ETR group were lower than those in the control group, showing significant difference between the two groups （P<0.05）. The effects were better in the ETR group than those in the control group in increasing serum E₂ and endometrium thickness on the HCG injection day, and also in elevating the follicular oocyte number, the mature oocytes rate, the fertilization rate, and the prime embryo rate （all P<0.05）. CR2 analysis showed low negative correlation in both groups （r=-0.369 in the ETR group and r=-0.425 in the control group）, suggesting E₂ could be one of the factors but not the only factor for influencing colpoxerosis. And the score of colpoxerosis was lower in the ETR group after treatment than that in the control group （t=2.422, P<0.05）. ConclusionETR combined with FSH can obviously reduce the dosage of FSH used, improve ovarian reactivity and pregnancy rate, and improve the quality of oocytes, the mechanism is possibly related with its effects in improving ovarian reactivity elevating blood estrodiol and regulating the hypothalamus-pituitary-ovary axis （HPOA）.

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