葛根黑苏汤联合温针灸应用于子宫内膜薄性不孕症的临床研究

Clinical Study of Gegen Heisu Decoction Combined with Warm Needling to Treat the Sterility Caused by Thin Endometrium

[目的]探讨葛根黑苏汤联合温针灸治疗子宫内膜薄性不孕症的临床疗效。[方法]将120例子宫内膜薄性不孕症患者采用随机数字表法分西药组(Ⅰ组)、中药+温针灸组(Ⅱ组)、中药+温针灸+西药组(Ⅲ组),每组各40例。Ⅰ组采用戊酸雌二醇片治疗,Ⅱ组采用葛根黑苏汤+温针灸治疗,Ⅲ组在Ⅱ组的基础上加戊酸雌二醇片。观察3组患者排卵日子宫内膜厚度、子宫内膜类型、子宫内膜螺旋动脉血流搏动指数(pulsation index,PI)及子宫内膜螺旋动脉血流阻力指数(resistance index,RI)、黄体期血清雌二醇、孕酮水平。[结果]Ⅱ、Ⅲ组患者排卵日子宫内膜螺旋动脉RI、PI显著低于Ⅰ组,差异有统计学意义(均P<0.05)。Ⅲ组患者子宫内膜厚度厚于Ⅰ组和Ⅱ组,差异均有统计学意义(P<0.01,P<0.05),Ⅱ组与Ⅰ组子宫内膜厚度差异无统计学意义(P>0.05)。Ⅱ、Ⅲ组患者子宫内膜A型率明显高于Ⅰ组(P<0.05)。Ⅲ组患者黄体期血清雌二醇水平明显高于Ⅰ组和Ⅱ组(P<0.05),Ⅱ组与Ⅰ组差异无统计学意义(P>0.05);Ⅱ、Ⅲ组患者孕酮水平高于Ⅰ组,差异有统计学意义(P<0.05)。Ⅰ、Ⅱ、Ⅲ组患者的临床妊娠率分别为10%、27.5%、32.5%,Ⅱ、Ⅲ组的妊娠率明显高于Ⅰ组,差异有统计学意义(P<0.05),Ⅱ、Ⅲ两组患者的临床妊娠率差异无统计学意义(P>0.05)。[结论]采用葛根黑苏汤联合温针灸治疗子宫内膜薄性不孕症,能使子宫内膜增厚,A型子宫内膜比例升高,增加子宫内膜血供,提高黄体期孕酮及雌激素水平,从而提高妊娠率。在增加子宫内膜厚度方面与戊酸雌二醇片效果相似,而在改善子宫内膜血流状态及提高妊娠率方面优于戊酸雌二醇片。

[Objective] To evaluate the effectiveness of Gegen Heisu decoction combined with warm needling on the sterility due to thin endometrium.[Methods] 120 sterility patients with thin endometrium were randomly divided into 3 groups： western medicine group（group Ⅰ）, traditional Chinese medicine combined with warm needling group（groupⅡ）, traditional Chinese medicine and warm needling combined with western medicine group（group Ⅲ）.Observe three groups of patients with ovulation days intrauterine membrane thickness, type, endometrial spiral artery blood flow pulsation index（PI） and endometrial spiral artery blood flow resistance index（RI）,luteal phase serum estradiol（E2） and progesterone（P） after ovulation.[Results]The PI and RI in the groupⅡand Ⅲwere obviously lower than groupⅠin ovulation day of patients（all P〈0.05）;The endometrial thickness, groupⅢand groupsⅡ,Ⅰof comparison difference was statistically significant（P〈0.05, P〈0.01）, groupⅡcompared with group Ⅰhas no statistical significance（P〈0.05）, but in terms of improving rate of endometrial type A, groupⅡand groupⅢwas better than groupⅠ（P〈0.05）; The luteal phase serum E2 is obviously enhanced GroupⅢcompared with groupⅠ（P〈0.05）. GroupⅡcompared with groupⅠof no statistical significance（P〈0.05）, The progesterone difference was statistically significant group Ⅱand Ⅲcompared with groupⅠ（P〈0.05）; three groups of clinical pregnancy rate was 10%, 27.5% and 32.5%. The pregnancy rate of groups ⅡandⅢwas obviously higher than that in groupⅠ, by comparision the difference was statistically significant（P〈0.05）. [Conclusion] Gegen Heisu decoction combined with warm needling may make endometrial thickening, Increase A type ratio of endometrial, with estradiol valerate on improve the endometrial thickness has a similar effect, can improve the endometrial blood flow state, improve the luteal phase progesterone and estrogen levels, improve the function of corpus luteum, so as to improve the success rate of pregnancy, the study also found Gegen Heisu decoction combined with warm needling in improving the endometrial blood flow state and increase pregnancy rate is better than that of estradiol valerate.