温肾养血颗粒联合枸橼酸氯米芬对卵泡发育不良性不孕症抑制素—激活素—卵泡抑素系统的调控

Regulation and Control of Wenshen Yangxue Granule Combined with Clomifene Citrate on INH-ACT-FS System in Patients with Follicular Maldevelopment Infertility

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DOI：

中文关键词: 温肾养血颗粒卵泡发育不良性不孕症抑制素—激活素—卵泡抑素

英文关键词:Wenshen Yangxue Granule follicular maldevelopment infertility inhibin-activin-follistatin

基金项目:北京市卫生局、北京市中医管理局青年科研资助项目(No.N-2008-7)

作者	单位
张莹	首都医科大学附属北京妇产医院中医科
杨维	首都医科大学附属北京妇产医院中医科
辛明蔚	首都医科大学附属北京妇产医院中医科
武颖	首都医科大学附属北京妇产医院中医科
王玉雯	首都医科大学附属北京妇产医院中医科
梁欣韫	首都医科大学附属北京妇产医院中医科
李玛建	首都医科大学附属北京妇产医院中医科
何军琴	首都医科大学附属北京妇产医院中医科
高爱萍	首都医科大学附属北京妇产医院中医科

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中文摘要:

目的观察温肾养血颗粒联合枸橼酸氯米芬对卵泡发育不良性(follicular maldevelopment,FM)不孕症临床疗效,探讨其可能的作用途径。方法选取90例FM肾虚血瘀型患者,随机分为中药组、西药组和中西药联合组,每组30例,分别给予温肾养血颗粒、枸橼酸氯米芬及两药联合治疗,共观察3个月经周期。检测患者治疗前后血清黄体生成素(LH)、卵泡刺激素(FSH)、雌激素(E2)、抑制素B(inhibin B,INHB)、激活素A(activin A,ACTA)、卵泡抑素(follistatin,FS)水平;监测卵泡发育及基础体温。结果各组临床疗效比较,差异均无统计学意义(P>0.05)。中西药联合组和中药组在中医证候疗效、排卵率和排卵日子宫内膜厚度方面明显优于西药组,差异均有统计学意义(P<0.05)。与本组治疗前比较,中西药联合组治疗后第1个月经周期第3天E2水平升高;第10天INHB和FS升高,ACTA下降,差异均有统计学意义(P<0.05)。中西药联合组治疗的第3个月经周期第10天血清LH水平明显低于西药组(P<0.05)。中西药联合组治疗的第3个月经周期第3天INHB与FSH呈显著负相关(r=-0.492,P<0.01);第10天INHB与E2、FS呈显著正相关(r=0.682、0.772,P<0.01),与ACTA呈显著负相关(r=-0.635,P<0.01)。结论温肾养血颗粒联合枸橼酸氯米芬可以改善FM患者的中医证候,调节FM患者卵巢局部因子INHB、ACTA、FS的表达,改善卵巢功能状态,调控卵泡发育。

英文摘要:

Objective To observe the clinical curative effect of Wenshen Yangxue Granule(WSYXG) combined with clomifene citrate(CC) in treating follicular maldevelopment(FM) infertility,and to explore its possible action channels.Methods Ninety patients with FM of Shen-deficiency blood stasis syndrome were randomly assigned to 3 groups,i.e.,the Chinese medicine group(CMG,treated with WXYXG),the Western medicine group(WMG,treated with CC),and the combination group of Chinese medicine and Western medicine(CG,treated with both WSYXG and CC),30 cases in each group.Three menstrual cycles were totally observed.Serum levels of luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E2),inhibin B(INHB),activin A(ACTA),and follistatin(FS) were tested before and after treatment,and the ovulation was monitored and their basic body temperature measured.Results There was no statistical difference in clinical efficacy among the three groups(P>0.05).Better effects on the Chinese medicine syndrome efficacy,the ovulation rate,and the endometrium thickness on the ovulation day were shown in CMG and CG than in WMG,showing statistical difference(P<0.05).The E2 level increased on the third day of the first menstrual cycle in CG when compared with before treatment.On the 10th day of the 1st menstrual cycle,the INHB and FS increased and the ACTA decreased,showing statistical difference(P<0.05).On the 10th day of the 3rd menstrual cycle the serum LH level decreased more obviously in CG than in WMG,showing statistical difference(P<0.05).On the 3rd day of the 3rd menstrual cycle in CG,the INHB was negatively correlated with FSH(r=-0.492,P<0.01),and INHB on the 10th day was positively correlated with E2 and FS(r=0.682,0.772,P<0.01),and negatively correlated with ACTA on the 10th day(r=-0.635,P<0.01).Conclusion WSYXG combined with CC could improve Chinese medicine syndrome,regulate the expressions of FM patients′ ovary local factors INHB,ACTA and FS,improve the condition of ovary functions,and control the follicle development.

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