补肾活血方对多囊卵巢综合征不孕症患者子宫内膜容受性及雌二醇、孕酮影响

Effect of reinforcing kidney and activating blood decoction on endometrial receptivity and estrogen,progesterone of infertility patients with polycystic ovary syndrome

目的探讨补肾活血方对PCOS不孕症患者子宫内膜容受性及雌二醇（estrogen,E2）、孕酮（progesterone,P）的影响。方法选取符合PCOS肾虚血瘀证的不孕症患者90例,按随机数字表法将病人分为三组,中药组：补肾活血方;西药组：克罗米芬;中西药组：补肾活血方＋克罗米芬;空白对照组选取30例因男方因素就诊的不孕患者。服药方法：中药组自月经周期（或撤退性出血）第1天开始口服补肾活血方,连服21天;西药组自月经周期（或撤退性出血）第5天起每晚口服克罗米芬50 mg,连服5天;中西药组自月经周期（或撤退性出血）第1天开始口服补肾活血方,第5天起每晚加克罗米芬50 mg,连服5天后停服西药,继服中药至21天;均连续治疗3个周期。空白对照组不服任何相关药物。以上三组均于月经第9天开始用阴道B型超声连续监测卵泡发育,当B型超声显示双侧卵巢内至少有一个成熟卵泡平均直径≥18~20 mm时定为排卵日,于排卵后第7~9天阴道超声测定子宫内膜厚度、分型及子宫动脉搏动指数（pulse index,PI）和子宫动脉阻力指数（resistance index,RI）,放射免疫法测定血清E2和P含量。结果中药组与中西药组A型子宫内膜百分比均大于西药组（P〈0.05）;中药组与中西药组子宫内膜厚度均大于西药组（P〈0.01）;西药组A型子宫内膜百分比及子宫内膜厚度均低于空白对照组（P〈0.05）;中西药组PI高于西药组与中药组（P〈0.05）;治疗组PI均高于空白对照组（P〈0.01）;西药组RI高于中药组、中西药组与空白对照组（P〈0.05）;西药组E2低于空白对照组（P〈0.05）;中西药组P高于西药组与中药组（P〈0.05）;西药组P低于空白对照组（P〈0.05）。结论补肾活血方可以增加PCOS不孕症患者的子宫内膜容受性,补肾活血方联合克罗米芬可以增加PCOS不孕症患者排卵后的P含量。

Objective The subject is to observe the effect of reinforcing kidney and activating blood decoction on endometrial receptivity and estrogen（ E2）,progesterone（ P） of infertility patients with polycystic ovary syndrome（ PCOS）. Methods 90 cases diagnosed with infertility and PCOS were collected,and randomly divided into 3 groups： Chinese medicine group,CC group,Chinese medicine and CC group. There is also a blank control group including 30 cases diagnosed with infertility because of male problem. After the treatment,the follicle from the 9thday of the menstruation was monitored and the date of the ovulation was confirmed using the ultrasound. Thickness of endometrium,pulse index（ PI） and resistance index（ RI） were measured and the serum expression of E2 and P were tested at the time of 7 to 9 days after the ovulation. Results The rate of the type A endometrium： the Chinese medicine group and the combined group were significantly higher than the CC group（ P〈0. 05）. The thickness of the endometrium： the Chinese medicine group and the combined group were significantly larger than the CC group（ P〈0. 01）. PI： the combined group were significantly higher than the Chinese medicine group and the CC group（ P〈0. 05）. RI： the CC group were significantly higher than the Chinese medicine group and thecombined group（ P〈0. 05）. E2： the CC group were significantly lower than the blank control group（ P〈0. 05）. P： the combined group were significantly higher than the Chinese medicine group and the CC group（ P〈0. 05）. the CC group were significantly lower than the blank control group（ P〈0. 05）. Conclution Reinforcing kidney and activating blood decoction can increase the endometrial receptivity. Reinforcing kidney and activating blood decoction combined with CC can increase the level of P after ovulation.