中医补肾法对高龄不孕妇女的卵巢储备功能的调控

Regulatory Effect of Kidney-Reinforcing Therapy for Ovarian Reserve in Older Infertile Women

[目的]探讨补肾中药益真Ⅰ、Ⅱ号胶囊对高龄不孕妇女卵巢储备的调控及其机制。[方法]将48例高龄不孕患者随机分为中药组(26例)和西药克罗米芬(CC)对照组(22例),观察两组治疗前后月经周期第3天和克罗米芬兴奋试验(CCT)后月经周期第10天的血卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)及抑制素-B(INH-B)水平,并观察用药期间及用药后的妊娠率。[结果]中药组受孕率的提高优于西药组(P<0.05)。中药组治疗后血中基础FSH(bFSH)水平较治疗前降低,INH-B水平升高(均P<0.05),而血中基础E2(bE2)、基础LH(bLH)含量及FSH/LH比值则无显著性改变(P>0.05);而西药组所有指标治疗前后均无显著性差异(P>0.05)。中药组治疗后的CCT后月经周期第10天FSH较治疗前下降(P<0.05),且其下降作用比西药组明显(P<0.05),而INH-B与治疗前比较无显著性改变(P>0.05);西药组CCT后周期第10天FSH和INH-B均无显著性改变(P>0.05)。相关分析显示,月经周期第3天INH-B水平与FSH呈负相关(r=0.6,P<0.05)。[结论]对部分卵巢储备的预测指标的检测结果提示,补肾中药具有改善卵子质量、提高卵巢储备的作用;应用中药提高高龄不孕妇女的卵巢储备,联合促排卵方案或辅助生育技术,可为高龄不孕的治疗提供一条新的途径。

[Objective] To investigate the regulatory effect of kidney-reinforcing herbal medicine (Yizhen Ⅰ and Yizhen Ⅱ capsule) for ovarian reserve in older infertile women and to explore its mechanism. [Methods] Forty eight cases of older infertile women were randomized to two groups: group A ( n = 26) treated with kidney-reinforcing herbal medicine and group B ( n = 22) with clomiphene. Serum levels of follicle-stimulaing hormone (FSH) , luteinizing hormone (LH) , estrogen (E2) and inhibin-B (INH-B) were detected before treatment, on the third day of menstrual cycle (MC) after treatment and on the 10th day of MC after clomiphene citrate challenge test (CCT) . Pregnancy rate during medication and after treatment was also observed. [Results] The increase of pregnancy rate of group A was superior to that of group B (P < 0.05) . In group A, serum levels of basal FSH was decreased and INH-B increased ( P < 0.05 compared with those before treatment) while no obvious changes were found in serum levels of basal E2, basal LH and the ratio of FSH and LH ( P > 0.05) . The above parameters in group B after treatment did not differ from those after treatment ( P > 0.05). On the 10th day of MC after CCT, FSH level was decreased in group A (P < 0.05 compared with that before treatment and that in group B) and no obvious changes was showed in INH-B level (P > 0.05); no obvious changes were found in FSH and INH-B levels in group B (P > 0.05). A negative correlation was showed in FSH level and INH-B level on the third day of MC ( r = 0.6, P<0.05). [Conclusion] Kidney-reinforcing herbal medicine has an effect in improving the quality of ovum and increasing ovarian reserve. Application of kidney-reinforcing herbal medicine combined with ovulation-promoting therapy or fertility-assistant technology may serve as a new way in the treatment of older infertile women.