补肾中药对子宫内膜容受性影响的临床观察

Clinical observation of kidney tonic herbal medicine on endometrial receptivity

目的探讨补肾中药对肾阴虚型体外受精-胚胎移植(IVF-ET)患者子宫内膜容受性的影响。方法全部病例选自山东中医药大学附属医院中西医结合生殖与遗传中心行IVF-ET治疗,同时需符合肾阴虚型的患者80例(分为观察组和对照组,每组40例)建立病例档案,并作必要的准备工作。80例患者均按本中心常规方案进行超促排卵,观察组于降调节当月月经周期第3~14天服用二至天癸颗粒;并于降调节后月经周期第3天继续服用至取卵日,对照组不服中药,仅于降调节周期月经的第21天左右(即经超声检测排卵后第7天),患者知情同意后常规微创搔刮内膜,两组在人绒毛膜促性腺激素(HCG)日经B超测量子宫内膜厚度、分型、容积,子宫内膜下血流,子宫动脉搏动指数(PI)和阻力指数(RI),内膜下血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)。结果临床发现观察组治疗后子宫内膜厚度、内膜分型,容积,内膜下血流,PI和RI,VI、FI、VFI均比服药前有明显改善,差异有统计学意义(P<0.05)。结论补肾中药可改善子宫内膜厚度、分型及子宫内膜下血流,降低PI、RI,提升VI、FI及VFI,继而有助于改善子宫内膜容受性,在胚胎成功着床方面起到一定积极影响。

Objective To explore the effects on endometrial receptivity with kidney tonic herbal medicine in the IVF-ET patients of kidney yin deficiency.Methods All of the subjects,treated with IVF-ET,were collected from the Reproduction and Inheritance Center of Integrative Chinese and Western Medicine in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine and 80 eligible cases of kidney yin deficiency were divided into an observation group and a control group,40 cases in each one.The medical data of the eligible cases were prepared.According to the routine protocol of the Center,all of 80 cases received the ovarian hyperstimulation.From the 3rd to 14th day of the menstrual cycle of downregulation month,erzhi tiankui granules were prescribed for oral administration.The granules were taken continuously from the 3rd day of the menstrual cycle after downregulation month to the day of egg collection.In the control group,the patients did not take Chinese herbal medicine,but received the routine minimally invasive endometrial scratching with the informed consent around the 21st day of menstrual cycle of downregulation(the 7 th day after ovulation determined with the ultrasound).Using the ultrasound B on the day of HCG,uterine endometrial thickness,type and volume,endometrial bleeding,uterine arterial pulsatility index(PI)and resistance index(RI),endometrial vascularization index(VI),blood flow index(FI)and vascularization flow index(VFI)were determined in the two groups.Results It was found in clinic that uterine endometrial thickness,type and volume,endometrial bleeding,PI and RI,VI,FI and VFI were improved obviously as compared with the levels before medication in the treatment group,indicating the significant differences( P <0.05).Conclusion The kidney tonic herbal medicine improves in uterine endometrial thickness,type and endometrial bleeding,reduces PI and RI,raises VI,FI and VFI.Consequently,it improves the endometrial receptivity and plays the active effects on the successful embryo implantation.