葛根黑苏汤改善克罗米芬促排卵后子宫内膜容受性低下的疗效观察

Clinical Efficacy of Gegen Heisu Decoction in Improving Poor Endometrial Receptivity after Ovulation Induction by Clomiphene Citrate

目的探讨葛根黑苏汤改善克罗米芬促排卵后子宫内膜容受性低下的临床疗效及其可能机制。方法将90例排卵障碍性不孕症患者,应用随机数字表法分为阴性对照组、阿司匹林治疗组(简称阿司匹林组)、联合治疗组,每组30例。各组均采用克罗米芬+人绒毛膜促性腺激素促排卵治疗;阿司匹林组于月经第5天开始加服阿司匹林肠溶片100mg/d;联合治疗组月经第3天开始加服葛根黑苏汤(药物组成:葛根、紫苏梗、菟丝子、巴戟天、当归、黑豆等),每日1剂,早、晚口服,月经第5天开始加服阿司匹林肠溶片;各组均连续用药至排卵后第14天。比较各组排卵日子宫内膜厚度、回声类型、子宫动脉阻力指数、宫颈黏液评分及周期排卵率、临床妊娠率。结果 (1)联合治疗组的周期排卵率82.54%(52/63)和妊娠率36.51%(23/63)高于阴性对照组65.67%(44/67)、20.90%(14/67)及阿司匹林组66.67%(48/72)、20.83%(15/72),差异均有统计学意义(P<0.05);(2)阿司匹林组及联合治疗组的排卵日子宫内膜厚度高于阴性对照组(P<0.05,P<0.01);联合治疗组子宫内膜厚度高于阿司匹林组(P<0.01);(3)联合治疗组排卵日A+B型子宫内膜率高于阴性对照组(P<0.05);(4)联合治疗组的宫颈黏液评分高于阴性对照组及阿司匹林组(P<0.05);(5)联合治疗组、阿司匹林组的子宫动脉阻力指数低于阴性对照组(P<0.01,P<0.05);联合治疗组子宫动脉阻力低于阿司匹林组(P<0.05)。结论以温肾暖宫、养血活血为主要功效的葛根黑苏汤能辅助改善子宫内膜厚度、类型及血流阻力,提高宫颈黏液评分,改善子宫内膜容受性,提高周期排卵率及临床妊娠率。

Objective To study clinical effects and possible mechanism of Gegen Heisu Decoction （GHD） in improving poor endometrial receptivity after ovulation induction by clomiphene citrate. Methods Ninety infertility patients with ovulation failure were assigned to the negative control group, the aspirin treat- ment group, the combined treatment group according to random digit table, 30 in each group. All patients received clomiphene citrate （CC） plus human chorionic gonadotropin （HCG） for inducting ovulation. Those in the aspirin treatment group took aspirin （100 mg/d） from the 5th day of menstruation in addition. Those in the combined treatment group took GHD （consisting of Pueraria Lobata, Caulis Perillae, dodders, Morinda Officinalis, Angelica sinensis, black beans, etc.; one dose per day; once in the morning and once in the evening） from the 3rd day of menstruation in addition until the 14th day after ovulation and aspirin （100 mg/d） from the 5th day of menstruation. All medication lasted to the 14th day of menstruation. The en- dometrial thickness on the day of ovulation, the type of endometrial echo, resistance index of uterine arter- y, score of cervical mucus, the rate of ovulation cycle and the rate of clinical pregnancy were compared a- mong the 3 groups. Results （1）The rate of ovulation cycle was 82.54% （52/63）and the clinical pregnancy was 36.51% （23/63）in the combined treatment group, higher than those of the negative control group[65.67% （44/67） and 20.90% （14/67） ] and the aspirin treatment group [66.67% （48/72） and 20.83%（15/ 72） ] （P 〈0.05）. （2）The endometrial thickness in the aspirin treatment group and the combined treatment group were thicker, as compared with the negative control group （P 〈0.05, P 〈0.01 ）. The endometrial thickness were thicker in the combined treatment group than in the aspirin treatment group （P 〈0.01 ）. （3） Type A ＋B endometrial echo was higher in the combined treatment group than in the negative control group （P 〈0.05）.（4）The score of cervical mucus on the day of ovulation was higher in the combined treatment group than in the negative control group and the aspirin treatment group （P 〈0.05）. （5）The resistance in- dex（RI） of uterine artery were lower in the combined treatment treatment group and the aspirin treatment group than in the negative control group （P 〈0.01, P 〈0.05）. The RI of uterine artery were lower in the com- bined treatment group than in the aspirin treatment group （P 〈0.05）. Conclusion GHD, with the action of warming Shen and uterus, nourishing blood and promoting blood circulation, could assistantly improve en- dometrial thickness, types of endometrium, and resistance of blood flow, elevate scores of cervical mu- cus, improve endometrial receptivity, elevate the rate of ovulation cycle and clinical pregnancy.