肾虚脾弱型黄体功能不健性不孕症临床研究

Clinical Investigation on Infertility due to Inadequate Luteal Function with Deficiency of Kidney and Spleen

目的 探讨肾虚脾弱型黄体功能不健性不孕症患者子宫内膜的雌、孕激素受体 (ER、PR)及宫腔异常的情况 ,为研究此类不孕症提供实践依据。方法 在子宫内膜增生中晚期进行宫腔镜检查和通过免疫组化法对宫内膜的雌、孕激素受体进行半定量分析 ,并与非黄体功能异常的不孕组进行了比较。结果 15例观察组不孕患者的增生中晚期宫内膜间质细胞、腺上皮细胞的PR明显低于对照组 (P <0 .0 5、P <0 .0 1) ,间质细胞的ER也明显低于对照组 (P <0 .0 5 ) ,腺上皮细胞的ER 2组虽无显著差异 ,但观察组有降低趋势。宫腔镜检发现 ,此类型不孕症患者的宫腔异常改变以宫内膜苍白、肥厚 ,局部呈息肉样增生最多见。结论 增生中晚期子宫内膜的ER、PR含量明显降低 ,宫腔存在明显异常改变 。

OBJECTIVE To investigate into the abnormal conditions in estrogen receptor (ER), progestogen receptor (PR) and the uterine cavity of patients with infertility due to inadequate luteal function with deficiency of kidney and spleen, so as to provide practical basis for the treatment of similar diseases. METHOD Hysteroscopy was performed and immunohistochemical methods were used to carry out semi-quantitative analysis of ER and PR during the middle and late periods of endometrial hyperplasia, compared with patients with infertility without abnormal function of the luteum.RESULT In the observation group of 15 patients, the endometrium interstitial cell and PR of glandular epithelium cells were markedly lower than those in the control group ( P <0.05, P <0.01), ER of the interstitial cell was also markedly lower that that in the control group ( P <0.05), and ER of the glandular epithelium cells in the observation group tended to decrease, though with no marked difference between the two groups. The result of hysteroscopy showed that the abnormal changes in the uterine cavity of this type of patients are characterized by pale and fleshy endometrium with polypoid hyperplasia. CONCLUSION The marked decrease in ER and PR content and abnormal changes in the uterine cavity during the middle and late periods of endometrial hyperplasia are the main reasons for the pathological changes in the patients with infertility due to inadequate luteal function with deficiency of kidney and spleen.