奥利司他联合益肾化痰方治疗肥胖型多囊卵巢综合征不孕患者临床研究

Effects and changes of ovulatory rate and pregnancy rate in patients with obesity polycystic ovary syndrome after treatment by orlistat combined with Yishenhuatan formula

目的观察奥利司他联合益肾化痰方对肥胖型多囊卵巢综合征(PCOS)不孕患者排卵率及妊娠率影响及变化。方法将90例诊断为PCOS不孕患者患者随机分为对照组、中药组、治疗组,每组30例。对照组给予炔雌醇环丙孕酮联合调整生活方式的指导治疗,中药组在对照组治疗基础上给予益肾化痰方治疗,治疗组在中药组基础上加用奥利司他治疗,3组治疗时间均为6个月。观察3组治疗前后腰臂比(WHR)、体重指数(BMI)、卵巢体积、血清性激素水平[黄体生成激素(LH)、促卵泡成熟激素(FSH)、LH/FSH、雌二醇(E2)、睾酮(T)]、抗菌勒氏管激素(AMH)、抑制素B(IHNB)、排卵率、妊娠率和临床疗效。结果 3组相比,PCOS患者的腰臀比(WHR)、体重指数(BMI)均有所下降;治疗后中药组和治疗组的AMH水平明显下降,其中治疗组的AMH水平抑制作用高于对照组,IHNB治疗前后无明显差异;3组排卵率和妊娠率分别为62.3%、77.1%、88.1%和60.0%、66.6%、83.3%;3组总有效率分别为63.3%、76.6%和90.0%;观测指标显示治疗组均优于其他2组(P<0.05)。结论奥利司他联合益肾化痰方对肥胖型PCOS不孕患者备孕前预处理效果明显,可有效提高临床排卵率和妊娠率,临床值得推广。

Objective To observe the effects and changes of ovulatory rate and pregnancy rate in patients with obesity polycystic ovary syndrome（PCOS） after treatment by orlistat combined with Yishenhuatan formula. Methods Ninety patients with PCOS infertility were randomly assigned to three groups： control group（n = 30）,TCM group（n = 30） and combination treatment group（n = 30）. The patients in control group were treated by Diane 35 combined with adjusting life style,and the patients in TCM group,on the basi of control group,were treated by Yishenhuatan formula,and the patients in combination treatment group,on the basis of TCM group,were treated by orlistat,with a treatment course of 6 months for the three groups.The waist vs hip ratio（WHR）,body mass index（BMI） WHR,ovary size,the serum levels of sex hormone including LH,FSH,LH/FSH,E2,T as well as AMH,IHNB,ovulatory rate,pregnancy rate,clinical curatiive effects were observed and compared among the three groups. Results After treatment the levels of WHR and BMI in patients with PCOS were significantly decreased（P〈0. 05）,and the levels of AMH were significantly decreased in TCM group and combination treatment group（P〈0. 05）,moreover,the levels of AMH in combination treatment group were significantly higher than those in control group（P〈0. 05）,however,there were no significant differences in the levels of IHNB before and after treatment（P〈0. 05）. In addition the ovulation rate,pregnancy rate and total effective rate in combination treatment group were superior to those in control group and TCM group（P〈0. 05）. Conclusion The pretreatment effects of orlistat combined with Yishenhuatan formula in treating obesity PCOS infertility are obvious,which can effectively improve the ovulation rate and pregnancy rate,therefor,it is worthy of promotion in clinical practice.