隔药脐灸疗法对肾阳虚宫寒不孕症患者子宫内膜容受性的影响

Effect of medication-separated umbilical moxibustion therapy on endometrial receptivity in infertility patients with kidney-Yang deficiency and cold uterine

目的探讨隔药脐灸疗法对肾阳虚宫寒不孕患者冻融胚胎移植周期子宫内膜容受性的影响。方法采用前瞻性随机对照临床研究,选取2019年6月至2021年6月于烟台市烟台山医院生殖医学中心行降调节激素替代周期冻胚移植,经中医辨证为肾阳虚宫寒不孕症患者200例,年龄21~35岁。使用计算机软件进行随机抽样,分为治疗组和对照组,每组100例。治疗组在冻胚移植周期给予降调节激素替代+隔药脐灸(从降调日隔日给予隔药脐灸直到移植日)治疗,对照组行降调节激素替代,不给予隔药脐灸。观察治疗前后肾阳虚宫寒不孕患者的症候评分变化,子宫内膜厚度和分型、子宫内膜血流、子宫动脉血流变化[搏动指数(PI)、阻力指数(RI)]及临床妊娠率。采用独立样本t检验、χ^(2)检验进行统计分析。结果治疗前,治疗组与对照组肾阳虚宫寒症证候积分比较,差异无统计学意义(P=0.805);治疗后,治疗组与对照组肾阳虚宫寒症证候积分[(4.36±1.54)分比(11.69±2.36)分]比较,差异有统计学意义(P<0.001)。治疗组与对照组子宫内膜转化日子宫内膜厚度[(9.82±1.01)mm比(9.84±0.96)mm]比较,差异无统计学意义(P=0.909);治疗组A型内膜[73.03%(65/89)]与对照组[51.09%(47/92)]比较,差异有统计学意义(P<0.001);子宫内膜下血流分型Ⅲ型比例治疗组[58.43%(52/89)]高于对照组[21.74%(20/92)],差异有统计学意义(P<0.001);治疗组子宫内膜转化日的PI为(1.54±0.22)、RI为(0.53±0.19),均低于对照组[PI为(1.90±0.31)和RI为(0.71±0.25)],差异均有统计学意义(均P<0.001);治疗组临床妊娠率为51.69%(46/89),高于对照组30.43%(28/92),差异有统计学意义(χ^(2)=8.452,P=0.004)。结论隔药艾灸可通过增加子宫A型内膜和Ⅲ型子宫内膜血流比例,改善子宫内膜容受性,从而提高冻胚移植的临床妊娠率。

Objective To investigate the effect of medication-separated umbilical moxibustion therapy on endometrial receptivity during frozen thawed embryo transplantation cycle in infertility patients with kidney-Yang deficiency and cold uterine.Methods Two hundred infertility patients with kidney-Yang deficiency and cold uterine who were going to undergo frozen embryo transplantation in down-regulated hormone replacement cycle at Center of Reproductive Medicine,Yantai Yantaishan Hospital were selected for the randomized controlled trial,age 20-35 years old,and were randomly divided into a treatment group and a control group,with 100 cases in each group.The treatment group took medication-separated umbilical moxibustion treatment during the frozen embryo transplantation cycle from the down-regulation day to the transplantation day.The control group took down-regulated hormone replacement therapy,without moxibustion.The symptom scores,endometrial thicknesses and subtypes before and after the treatment,endometrial blood flow,uterine arterial blood flow[pulsation index(PI),resistance Index(RI)],and clinical pregnancy rates were compared between the two groups.The independent samplet test and χ^(2) test were applied.Results There was no statistical difference in the symptom score of kidney-Yang deficiency and cold uterine between the two groups before the treatment(P=0.805).After the treatment,the symptom score of kidney-Yang deficiency and cold uterine in the treatment group was lower than that in the control group[(4.36±1.54)vs.(11.69±2.36)],with a statistical difference(P<0.001).There was no statistical difference in the endometrial thickness on the endometrial transformation day between the treatment group and the control group[(9.82±1.01)mm vs.(9.84±0.96)mm;P=0.909].More patients had type A endometrium in the treatment group than in the control group[73.03%(65/89)vs.51.09%(47/92)],with a statistical difference(P<0.001).The proportion of the patients with type Ⅲ endometrial blood flow in the treatment group was higher than that in the control group[58.43%(52/89)vs.21.74%(20/92)],with a statistical difference(P<0.001).The PI and RI on the endometrial transformation day in the treatment group were lower than those in the control group[(1.54±0.22)vs.(1.90±0.31)and(0.53±0.19)vs.(0.71±0.25)],with statistical differences(both P<0.001).The clinical pregnancy rate in the treatment group was higher than that in the control group[51.69%(46/89)vs.30.43%(28/92)],with a statistical difference(χ^(2)=8.452;P=0.004).Conclusion Medication-separated umbilical moxibustion therapy can improve the proportions of type A endometrium and typeⅢendometrial blood flow and endometrial receptivity and implantation,and increase the clinical pregnancy rate of frozen embryo transplantation.