补肾活血法联合超声下卵泡抽吸术治疗难治性多囊卵巢综合征的临床观察

Treatment of Refractory Polycystic Ovary Syndrome by Bushen Huoxue Method Combined with Ultrasound-guided Follicle Aspiration

目的观察补肾活血中药联合超声下卵泡抽吸术（MFA）治疗难治性多囊卵巢综合征（PCOS）的临床疗效。方法采用随机数字表方法将44例难治性PCOS患者分为观察组（20例）和对照组（24例）。两组患者均行MFA，观察组同时服用补肾活血中药（菟丝子20g熟地10g桑寄生20g仙灵脾15g补骨脂10g黄精10g皂角刺15g桃仁10g山慈菇10g丹参20g甘草6g），每天1剂，每月连服14剂。接受MFA次月达到疗效标准者行促性腺激素（HMG）促排卵治疗，观察组同时继续服用补肾活血中药。观察两组接受MFA前后促卵泡成熟激素（FSH）、促黄体生成素（LH）、睾酮（T）、窦卵泡数及促排卵治疗HMG用量、成熟卵泡数、卵巢过度刺激综合征（OHSS）、卵泡未破裂黄素化综合征（LUFS）、妊娠率等。结果观察组进行了42周期的MFA治疗，对照组进行了56周期的MFA治疗。两组穿刺后T、LH、LH／FSH水平明显下降，与治疗前比较，差异有统计学意义（P〈0．01），其中观察组LH／FSH与对照组治疗后比较，差异亦有统计学意义（P〈0．01）；窦卵泡数：MFA后降到10个以下者观察组18例（90．0％）；对照组22例（91．7％），与本组治疗前比较，差异均有统计学意义（P〈0．01）；促排卵治疗，两组患者均于月经第5天予以HMG75-150IU／d，用药5天后监测卵泡发育，根据卵泡发育的速度和数量及时调整用药剂量，观察组HMG平均用量（585．04±195．0）IU，对照组HMG平均用量（1470．04±532．5）IU，两组比较，差异有统计学意义（P〈0.01）；注射HCG日成熟卵泡数，观察组平均为（1．14-0．3）个，对照组平均为（3．14-1．4）个，差异有统计学意义（P〈0．01）。观察组中无1例发生OHSS，1例发生LUFS；对照组中1例发生轻度OHSS，2例发生LUFS。连续促排卵治疗并随访3个月，观察组18例中临床妊娠8例，其中1例双胞胎，7例单胎，妊娠率44．4％（8／18例）。对照组22例中临床妊娠7例，其中2例双胞胎，5例单胎，妊娠率31．8％（7／22例）。结论采用补肾活血法联合MFA治疗难治PCOS创伤小、安全、有效；同时应用补肾活血法能明显减少促排卵药HMG用量，减少多个成熟卵泡数发生，降低了OHSS的风险。

Objective To observe the clinical effect of traditional Chinese medicine Bushen Houxue （BSHX） method combined with ultrasound-guided follicle aspiration （MFA） in treating refractory polycystic ovary syndrome （PCOS）. Methods Forty-four patients with PCOS were randomly assigned to two groups by randomizing digital table, 20 in the observation group and 24 in the control group. MFA was performed on both groups, and the decoction of BSHX, which consisted of dodder seed 20 g, prepared rehmannia root 10 g, mulberry mistletoe 20 g, epimedium 15 g, psoralea fruit 10 g, solomonseal rhizome 10 g, honeylocust thorn 15 g, peach kernel 10 g, pleione bulbocodioides 10 g, red sage root 20 g, and licorice root 6 g, was given to the observation group one dose every day for 14 days every menstrual cycle. Changes of follicle stimulating hormone （FSH）, iuteinizing hormone （LH）, and testosterone （T） were determined before and after MFA. The impacts on quantity of HMG used, number of sinus follicle, mature follicle, incidence of ovarian hyperstimulating syndrome （ OHSS）, luteinized unrupture foilicu-lar syndrome （LUFS） and pregnance rate were also observed. Results MFA had been performed for 42 cycles in the observation group and 56 cycles in the control group. Levels of T, LH and LH/FSH ratio markedly reduced after aspiration, showing significant difference as compared with those of before treatment in both groups （P 〈 0. 01 ） , and difference of LH/FSH between groups was of statistical significance （ P 〈 0. 01 ）. In the observation group, 18 patients （90. 0% ） had their sinus follicle decreased to 〈 10 after MFA, while in the control group, it reached to 〈 10 in 22 patients （91.70%）, all were different to those before treatment （P 〈0. 01 ）. In the observation group, the quantity of HMG used for promoting ovulation was （585.0 ± 195.0） IU, number of mature follicle at the day of HCG injection was 1.1 ± 0. 3, while in the control group, the corresponding data were （ 1470. 0 ± 532. 5 ）IU and 3. 1 ± 1.4, all with significant difference between groups （P 〈 0. 01 ）. None of OHSS and 1 case of LUFS occurred in the former group, while 1 mild OHSS and 2 LUFS in the latter. After ovulation promoting therapy and in the 3-month secutive follow-up period, pregnancy was found in 8 out of the 18 patients in the observation group （one twins and 7 single）, with the pregnancy rate of 44.4% ; while in the control group, 7 in 22 （2 twins and 5 single） was found, the pregnancy rate being 31.8%. Conclusion BSHX method combined with MFA is a safe and effective treatment for refractory PCOS, with few trauma. The combined usage of Chinese herbal medicine could significantly reduce dosage of HMG used for promoting follicle and the production of multiple mature follicles, thus to avoid the risk of OHSS.