滋阴疏肝汤干预调控HPO轴改善高龄DOR患者IVF-ET助孕结局临床观察

Clinical Observation of Ziyin Shugan Decoction(滋阴疏肝汤)on Regulating HPO Axis to Improve IVF-ET Pregnancy Outcome in Elderly Patients with DOR

目的观察滋阴疏肝汤对高龄卵巢储备功能低下(DOR)患者HPO轴及IVF-ET助孕结局的影响。方法选择2019年5月—2022年3月于河北省沧州中西医结合医院就诊的DOR患者92例,按照就诊先后顺序随机分为对照组与观察组各46例。对照组常规行体外受精-胚胎移植术(IVF-ET),观察组于IVF-ET术前预处理2个月,给予滋阴疏肝汤口服,每日1剂,早晚各1次,连续服用2个月后常规行IVF-ET。观察评定两组的临床疗效,比较两组治疗前后的卵巢储备功能指标,包括血清基础性激素水平(FSH、LH、E2、P、AMH及FSH/LH比值)和卵巢间质动脉血流信号值(PSV、EDV、PI及RI)。比较两组的促排卵情况(Gn总量、促排天数、获卵率、成熟卵率、受精率、卵裂率及优质胚胎率)和IVF-ET结局指标(胚胎种植率、临床妊娠率)。结果观察组治疗后的总有效率95.45%显著高于对照组80.00%(P<0.05)。两组患者治疗后的FSH、LH、E2水平及FSH/LH比值、PI、RI值,均显著低于治疗前(P<0.05),观察组的FSH、E2水平及FSH/LH比值、PI、RI值均显著低于对照组(P<0.05);两组患者的P、AMH、PSV、EDV值均显著高于治疗前(P<0.05),观察组的P、PSV、EDV值则显著高于对照组(P<0.05),两组间LH和AMH值相比较,差异无统计学意义(P>0.05)。两组间Gn总量、促排天数和卵裂率相比,差异无统计学意义(P>0.05);观察组的获卵数、成熟卵数、受精率、优质胚胎率和胚胎种植率、临床妊娠率,均显著高于对照组(P<0.05)。结论滋阴疏肝汤治疗高龄卵巢储备功能低下(DOR)患者疗效显著,可明显改善患者的卵巢储备功能和IVF-ET助孕结局,该作用可能是通过调控HPO轴实现的。

Objective To observe the effect of Ziyin Shugan Decoction(滋阴疏肝汤)on HPO axis and IVF-ET pregnancy outcomes in elderly patients with DOR.Methods A total of 92 patients with DOR treated in Cangzhou integrated traditional Chinese and Western medicine hospital of Hebei province from May 2019to March 2022 were selected and randomly divided into control group and observation group according to the order of treatment,with 46 cases in each group.The control group received conventional in vitro fertilizationembryo transfer(IVF-ET),while the observation group was pretreated for 2 months before IVF-ET and given Ziyin Shugan Decoction orally,once a day,once in the morning and once in the evening.After 2 months of continuous administration,IVF-ET was routinely performed.The clinical efficacy of the two groups was observed and evaluated.The ovarian reserve function indicators,including serum basal hormone levels(FSH,LH,E2,P,AMH and FSH/LH ratio)and ovarian interstitial artery blood flow signal values(PSV,EDV,PI and RI)before and after treatment were compared between the two groups.The ovulation induction(total consumption of Gn,days of ovulation promotion,oocyte retrieval rate,mature oocyte rate,fertilization rate,cleavage rate and high-quality embryo rate)and IVF-ET outcome indicators(embryo implantation rate and clinical pregnancy rate)were compared between the two groups.Results The total effective rate of the observation group was 95.45%significantly higher than that of the control group(80.00%,P<0.05).After treatment,the levels of FSH,LH,E2,PI and RI,and the values of FSH/LH ratio in the two groups were significantly lower than those before treatment(P<0.05);the levels of FSH,E2,PI and RI,and the values of FSH/LH ratio in the observation group were significantly lower than those in the control group(P<0.05).The P,AMH,PSV and EDV values of the two groups were significantly higher than those before treatment(P<0.05),and the P,PSV and EDV values of the observation group were significantly higher than those of the control group(P<0.05).There was no significant difference in LH and AMH values between the two groups(P>0.05).There was no significant difference in the total consumption of Gn,days of ovulation promotion and cleavage rate between the two groups(P>0.05).The number of oocyte retrieval rate,mature oocyte rate,fertilization rate and high-quality embryo rate,embryo implantation rate and clinical pregnancy rate in the observation group were significantly higher than those in the control group(P<0.05).Conclusion Ziyin Shugan Decoction is effective in the treatment of elderly patients with DOR,and can significantly improve the ovarian reserve function and IVF-ET pregnancy outcome,which may be achieved by regulating HPO axis.