调周法治疗肾虚型排卵障碍性不孕症的临床研究

Clinical Study on Treating Kidney Deficiency Type Sterility of Ovulation Disturbance with Menstrual Regulation Methods

目的基于科学疗效评价体系,运用中药调周法、辨证论治法、调周联合辨证论治法治疗肾阳虚、肾阴虚型排卵障碍性不孕症,通过大样本队列比较,总结不孕症疗效,证实中药调整月经周期节律是治疗肾虚(包括肾阴虚、肾阳虚型)排卵障碍性不孕症有效方法。方法排卵障碍性不孕症女性分别予中药调周、辨证、调周联合辨证治疗,其中调周组115例(肾阳虚证75例、肾阴虚证40例),辨证组106例(肾阳虚证54例、肾阴虚证52例),调周联合辨证组108例(肾阳虚证60例、肾阴虚48例)。观察3个周期为1个疗程,连续4个疗程,比较3组临床妊娠率、周期排卵率、月经症状积分、证候积分的差异。结果肾阳虚型排卵障碍性不孕症患者,调周组、辨证组、调周联合辨证组临床妊娠率分别为62.67%、59.26%、63.33%,周期排卵率67.43%、53.21%、65.31%,调周组、调周联合辨证组周期排卵率显著高于辨证组(P<0.01);治疗4个疗程后3组证候积分无显著差异,但辨证组、调周联合辨证组月经症状积分均显著低于调周组(P<0.05)。肾阴虚型排卵障碍性不孕症患者,调周组、辨证组、调周联合辨证组临床妊娠率分别为65.00%、53.85%、62.50%,周期排卵率79.70%、51.03%、77.97%,调周组、调周联合辨证组周期排卵率显著高于辨证组(P<0.01);治疗4个疗程后3组月经症状积分无显著性差异,调周组、调周联合辨证组证候积分显著低于调周组(P<0.01)。结论中医生殖节律调节理论指导下的调周法对排卵障碍性不孕症具有积极的治疗作用,可促进排卵,提高妊娠。

OBJECTIVE To treat sterility of ovulation disturbance due to deficiency of kidney yin or kidney yang,this paper applied menstrual cycle regulation with Chinese medicine methods,syndrome differentiation and treatment methods and combination methods according to scientific efficacy evaluation system.Based on the comparison of large sample cohort and summary of efficacy,it has been proposed that regulating menstrual cycle with Chinese medicine to treat kidney deficiency type(including kidney yin or kidney yang)sterility of ovulation disturbance was effective.METHODS Female patients with sterility of ovulation disturbance were divided into three groups and given different treating methods respectively:menstrual cycle regulation with Chinese medicine group(115 cases,including 75 cases of kidney yang deficiency and 40 cases of kidney yin deficiency),syndrome differentiation and treatment group(106 cases,including 52 cases of kidney yang deficiency and 54 cases of kidney yin deficiency)and combined treatment group(108 cases,including 60 cases of kidney yang deficiency and 48 cases of kidney yin deficiency).One course lasted three menstrual cycles.After four courses,clinical pregnancy rate,ovulation rate,menstrual symptom score,syndrome integral of three groups would be compared.RESULTS For patients with kidney yang deficiency type sterility of ovulation disturbance,clinical pregnancy rates of the three groups were 62.67%,59.26%and 63.33%and ovulation rates were 67.43%,53.21%and 65.31%in turn.Ovulation rates of menstrual regulation group and combined treatment group were significantly higher than that of syndrome differentiation group(P<0.01).After four courses,there were no significant differences among theses three groups in terms of syndrome integral while menstrual symptom scores of syndrome differentiation group and combined treatment group were significantly lower than that of menstrual regulation group(P<0.05).As to patients with kidney yin deficiency type sterility of ovulation disturbance,clinical pregnancy rates of the three groups were 65.00%,53.85%and 62.50%and ovulation rates were 79.70%,51.03%and 77.97%in turn.Ovulation rates of menstrual regulation group and combined treatment group were significantly higher than that of syndrome differentiation group(P<0.01).After four courses,there were no significant differences among theses three groups in terms of menstrual symptom score and syndrome integral while syndrome integrals of menstrual regulation group and combined treatment group were significantly lower than that of syndrome differentiation group(P<0.01).CONCLUSION Under the guidance of regulation of reproduction rhythm theory in traditional Chinese medicine,menstrual regulation methods have a positive therapeutic effect on treating sterility of ovulation disturbance,which can promote ovulation and increase pregnancy rate.