从“痰瘀”论治多囊卵巢综合征不孕临床研究

Clinical observation of sterility caused by polycystic ovary syndrome from the 'phlegm and blood stasis' therapy of traditional Chinese medicine

目的:探讨多囊卵巢综合征(PCOS)不孕的中西医结合治疗的临床疗效。方法:将122例PCOS不孕患者随机分为2组,对照组60例,给予克罗米芬治疗。治疗组62例,在对照组治疗基础上联合应用丹黄祛瘀胶囊治疗。观察PCOS患者的中医证候分布规律,生殖内分泌激素变化,组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-Ⅰ(PAI-Ⅰ)、胰岛素样生长因子-Ⅰ(IGF-Ⅰ)的变化,以及阴超监测卵泡发育情况。结果:PCOS中医证候以复合兼夹证为主,122例中肾虚痰阻证31例,肝郁血瘀证25例,脾虚血瘀证20例,肾虚血瘀证19例,脾虚痰阻证19例,肝肾阴虚证8例。治疗组在月经周期第5天雌二醇(E2)显著高于对照组、明显降低黄体生成素(LH),子宫内膜厚度、卵泡直径(FD)、FD≥12mm的卵泡个数较对照组同期显著增加(P<0.01),6个周期后妊娠率治疗组较对照组明显升高(P<0.01)。治疗后治疗组PAI-Ⅰ下降,t-PA、IGF-Ⅰ上升,与对照组比较有显著性差异(P<0.01)。结论:脏腑功能虚弱,痰瘀互结是PCOS的发病机制,从"痰瘀"立论治疗PCOS不孕,可以明显改善患者的排卵功能障碍,增加患者对促排卵药物的敏感性,机制可能与升高t-PA,IGF-Ⅰ,降低PAI-Ⅰ,改善盆腔微循环,缓解血瘀状态,促进卵泡生长发育、卵泡破裂有关。

Objective：To explore the effect of integrated Chinese and western medicines on sterility caused by polycystic ovary syndrome（PCOS）.Methods：One hundred and twenty-two patients were randomly divided into two groups,62 cases in treatment group treated with Danhuang Quyu capsule and clomiphere,60 cases in the control group treated with clomiphere citrate.The level of reproductive endocrine hormone,t-PA,PAI-I,IGF-I and ovulation monitored were observed.Results：At the fifth day of menstrual cycle,the level of estradiol（E2） of the treatment group was higher that of the control group.The luteinizing hormone（LH）,thickness of uterine endometrium,follicle diameter（FD）,follicle count of FD ≥ 12 mm in the treatment group were lower than those in the control group（P〈0.01）.After 6 periods of treatment,the promoting ovulation rate and the pregnancy rate in the treatment group showed better effects than that of control group（P〈0.01）.Compared with control group,the level of PAI-I was decreased and the level of t-PA and IGF-I were increased in the treatment group,with being significant different（P〈0.01）.Conclusion：The therapy,aiming at ’phlegm and blood stasis’ of sterility caused by polycystic ovary syndrome,could significantly improve the ovulation function and enhance the sensitivity to ovulation-inducing drugs,the mechanism of which may be related to the increases of t-PA and IGF-I,a decrease of PAI-I,an improvement of microcirculation in pelvic cavity,and the promote of the growth and rupture of follicle.