加味桂枝茯苓汤对多囊卵巢综合征血清抗苗勒管激素及子宫内膜容受性的影响

Effects of Jiawei Guizhi Fuling Decoction on Serum Anti Miillerian Hormone of Polycystic Ovary Syndrome and Endometrial Receptivity

目的:观察加味桂枝茯苓汤对多囊卵巢综合征(PCOS)血清抗苗勒管激素及子宫内膜容受性的影响。方法:选取2014年1月至2016年6月新乡市中心医院收治的PCOS合并不孕患者60例为研究对象,按照随机数字表随机分为观察组与对照组,每组30例,对照组给予枸橼酸氯米芬胶囊治疗;观察组在对照组基础上给以加味桂枝茯苓汤,5 d为1个疗程,总疗程为3个月经周期。记录一般情况包括月经恢复率、排卵率、妊娠率和流产率。经阴道彩色多普勒超声(TV-CDFI)测量排卵当日子宫内膜厚度和子宫动脉血流频谱,计算阻力指数(RI)和搏动指数(PI);采集患者晨间血检测观察2组治疗前后性激素指标,包括血清睾酮(T)、促黄体生成素(LH)、促卵泡生成素(FSH)以及LH/FSH比值及血清抗苗勒管激素(AMH)。结果:治疗后2组T、LH、FSH及LH/FSH均有不同程度下降,其中观察组下降的趋势更为明显,与对照组比较差异有统计学意义(P <0. 05)。2组治疗后月经均有一定程度的恢复,排卵率及妊娠率上调,流产率下降,观察组上述指标改善明显优于对照组,差异有统计学意义(P <0. 05)。治疗后2组子宫内膜均有增加,RI及PI均有不同程度减少,与治疗前比较差异有统计学意义(P <0. 05),其中观察组下调较对照组明显(P <0. 05)。治疗后2组AMH表达均有不同程度上调,与治疗前比较差异有统计学意义(P <0. 05),其中观察组上调较对照组明显(P <0. 05)。结论:加味桂枝茯苓汤可明显改善PCOS患者子宫容受性,提高了排卵率及妊娠率,其机制可能与通过降低机体AMH水平,增强卵泡对FSH的敏感度而促进排卵有关。

Objective:To observe effects of Jiawei Guizhi Fuling Decoction on serum Anti Miillerian Hormone of polycystic ovary syndrome and endometrial receptivity.Methods:A total of 60 cases of polycystic ovary syndrome(PCOS)with infertility in our hospital from January 2014 to June 2016 were randomly divided into observation group and control group,with 30 cases in each group.The control group was administrated with Clomifene Citrate Capsules,while the observation group was additionally administrated with Jiawei Guizhi Fuling Decoction,with 5 days for a course of treatment.The total course of treatment last for 3 menstrual cycles.The general conditions including the rate of menstruation,the rate of ovulation,the rate of pregnancy,and the rate of abortion were recorded.Transvaginal color Doppler Flow Image(TV-CDFI)was used to measure endometrial thickness and uterine artery blood flow spectrum on the day of ovulation measurement,and the resistance index(RI)and pulsatility index(PI)were calculated.Morning blood were collected to test the sex hormone index of 2 groups before and after the treatment,including serum testosterone(T)and luteinizing hormone(LH),follicle stimulating hormone(FSH)and LH/FSH ratio and serum anti Mullerian hormone(AMH).Results:The levels of T,LH,FSH and LH/FSH in 2 groups decreased to varying degrees,and the trend of the observation group decreased more significantly than that of control group after treatment(P<0.05).Two groups of patients had a certain degree of recovery after treatment.The ovulation rate and pregnancy rate increased,and abortion rate decreased.Statistical analysis showed that the above indicators in the observation group were significantly better than that of control group,and the difference was statistically significant(P<0.05).The endometrium in 2 groups increased,and the levels of RI and PI were reduced to some extent after treatment.The differences between the 2 groups were statistically significant(P<0.05),and the rate of reduction in the observation group was significantly higher than that of control group(P<0.05).The expression levels of AMH in 2 groups increased to varying degrees.Compared with those before treatment,the difference was statistically significant after treatment(P<0.05),and the above indexes in observation group were significantly higher than that of the control group(P<0.05).Conclusion:Jiawei Guizhi Fuling Decoction can significantly improve PCOS in patients with uterine receptivity,improve the ovulation rate and pregnancy rate,and its mechanism may be through decreasing the concentration of AMH,enhance the sensitivity of FSH and promote follicular ovulation related.