补肾养血中药对无排卵性不孕的治疗作用及机理探讨

Treatment of Kidney-reinforcing and Blood-nourishing Herbs for Anovulatory Sterility:Effect and Mechanism

【目的】观察补肾养血中药对无排卵性不孕的治疗作用并探讨其机理。【方法】对 2 76例经血液性腺激素检测证实为垂体功能低下的无排卵性不孕患者分成 3组进行促排卵治疗。中药组以真武汤合生脉散加减 ,在月经周期第 3天开始服用中药 ,每天 1剂 ,直至排卵后停服 ;克罗米酚 (CC) +绒毛膜激素 (HCG)组在月经周期第 5天开始口服CC 5 0mg/d ,并在卵泡成熟日加用HCG 10 0 0 0U肌肉注射 ;人绝经后促性腺激素 (HMG) +HCG组则在月经周期第 8天开始肌注HMG 2 5U/d ,并在卵泡成熟日加用HCG10 0 0 0U肌肉注射。嘱患者连续 3晚同房。从月经周期第 10天开始 ,用B型超声波影象监测排卵情况 ,隔天 1次 ,至卵泡成熟 (1 8cm× 1 8cm) ,并以早孕试纸检测是否排卵妊娠。【结果】中药组共观察了 16 7个促排卵周期 ,其中排卵周期 93个 ,不排卵周期 74个 ,排卵率为 5 5 6 8% ;CC +HCG组观察了促排卵周期 2 30个 ,其中排卵周期 182个 ,不排卵周期 4 8个 ,排卵率为 79 13% ;HMG +HCG组观察了促排卵周期 134个 ,其中排卵周期 88个 ,不排卵周期 4 6个 ,排卵率为 6 5 6 7%。经多个样本率的 χ2 检验 ,显示中药组排卵率均低于CC +HCG组和HMG +HCG组 (χ2 =9 345 ,P <0 0 1)。但中药组的妊娠周期有 5 4个 ,未妊娠周期 113个 。

To observe the effect of kidney reinforcing and blood nourishing herbal medicines in treating anovulatory sterility (AS) and its mechanism. Two hundred and seventy six cases of AS with hypopituitarism confirmed by the examination of blood sexual hormones were divided into three groups to receive the treatment of promoting ovulation. Group A was treated with modified Zhenwu Decoction and Reinforcing Qi and Nourishing Yin Powder (one dose per day) from the third day of menstrual cycle (MC) to the ovulating day; Group B with clomiphene (50mg/d) from the fifth day of MC, with human chorionic gonadotrophin (HCG) added, 10?000?U im in the day of follicle maturity and Group C with human menopausal gonadotrophin (HMG) 25 U/d im from the eighth day of MC and then with HCG added, 10 000 U im in the day of follicle maturity. After treatment, the cases were asked to have sexual intercourse for three nights. Ovulation time was monitored by ultrasound B imaging for one time every other day until follicle became maturity (1 8?cm×1 8?cm).Early pregnancy was detected by HCG test.Ninety three MC were ovulatory among 167 MC in Group A, the ovulation rate being 55 68%; 182 among 230 in Group B , the rate being 79 13% and 88 among 134 in Group C , the rate being 65 67%. Multisample χ 2 test showed that the ovulation rate in Group A was lower than that in Group B and Group C (χ 2=9 345, P<0 01). As for early pregnancy, 54 (32 33%) MC were positive in Group A, 50 (21 73%) in Group B and 48 (35 82%) in Group C. The pregnancy rate in Group A was higher than that in Group B and similar to that in Group C (χ 2=9 7173,P<0 01). Classification of endometrium showed that the percentage of endometrium type A was 80 80%, 82 80% and 40 86% in Group A, Group B and Group C respectively. This indicates that the endometria of Group A and Group B are apt for implantation of ovum.[Conclusion]Ovulation promoting action of kidney reinforcing and blood nourishing herbal medicines is coordinated with the conception of endometrium and lead a high pregnancy rate, which may be credited to the holistic regulation of kidney tiangui chongren uterus axis function.