滋阴补阳序贯法联合西药促排卵对PCOS患者的临床疗效分析

Effective Analysis of Sequential Method of Nourishing Yin and Tonifying Yang Combined with Controlled Ovarian Induction in Patients with Polycystic Ovary Syndrome

目的:探讨滋阴补阳序贯法联合西药促排卵对PCOS患者的临床疗效。方法:回顾性分析72例多囊卵巢综合征(PCOS)患者122个促排卵周期患者的临床资料,所有患者均于促排卵前后使用滋阴补阳中药进行序贯治疗。根据促排卵方案不同分为4组,A组:克罗米芬(CC)+促性腺激素(Gn)(n=71),B组:来曲唑(LE)+Gn(n=30),C组:CC(n=14),D组:Gn(n=7),比较各组间临床和实验室指标。结果:4组妊娠率比较:C组>A组>B组>D组;Gn用量比较:D组>B组>A组,hCG注射日子宫内膜厚度:A组>D组>B组>C组,但各指标组间比较均无统计学差异(P>0.05),促排天数A组显著高于其它3组(P<0.05)。hCG注射日子宫内膜厚度<7 mm的比例CC组显著高于其它3组(P<0.05)。4组未破裂卵泡黄素化综合征(LUFS)发生率、未启动率均无统计学差异(P>0.05),无OHSS发生。按妊娠结局分组比较:bE2及bLH水平妊娠组>未孕组,差异有统计学意义(P<0.05)。妊娠组子宫内膜厚度显著高于未孕组,各组中A型内膜比例显著高于其它类型内膜。结论:对PCOS患者选择滋阴补阳序贯法联合CC+Gn促排卵能减少Gn用量,降低卵巢过度刺激综合征(OHSS)发生率,增加子宫内膜厚度,改善子宫内膜容受性,提高妊娠率。

Objective： To investigate the effect of different therapies with sequential method of nourishing yin and tonifying yang for polycystic ovary on the outcome. Methods： A retrospective analysis was performed including 72 patients with polycystic ovary syndrome （PCOS）, 122 ovarian inducted cycles in total. According to different controlled ovarian hyperstimulation （COH） protocols, they were divided into 4 groups, group A： domiphene citrate （CC） ＋ gonadotropin （On） （n=71）, group B： letrozole （LE）＋ Gn （n=30）, group C： CC （n=14）, group D： Gn （n=7）. All patients were treated with sepuential method of nourishing yin and tonifying yang during the COH. The clinical and experimental indexes were recorded. Results： The pregnancy rate in group C was the highest, group A remained the second. The requirement of Gn in group A was the least. Thickness of endometrium on hCG injection day was the highest in group A, but there was no significant difference among 4 groups. The incidence ofendometrial thickness less than 7 mm was highest in group C. There were no significant differences in incidence of luteinized unruptured follicle syndrome （LUFS）, cancelled cycle rate in among 4 groups, no ovarian hyperstimulation syndrome （OHSS） accurred in this study. The serum E2, LH level, thickness of endometrium were higher in pregnancy group than in non-pregnancy group, differences of the latter two were significant. Conclusion： Sequential method of nourishing yin and tonifying yang combined with CC ＋ Gn can reduce dosage of Gn, incidence of OHSS, increase thickness of endometrium, improve endometrial receptivity, thus increasing pregnancy rate.