朱氏调经促孕方加味结合克罗米芬对不孕症患者子宫内膜容受性的影响

Influence of Modified Zhu’s Tiaojing Cuyun Decoction combined with clomiphene citrate on endometrial receptivity of patients with infertility

目的:观察朱氏调经促孕方加味联合克罗米芬(CC)对排卵障碍性不孕症患者子宫内膜容受性(ER)的影响。方法:纳入150例排卵障碍性不孕症患者,随机分为A组、B组、C组,每组各50例。A组患者给予CC促排卵治疗,B组患者给予CC促排卵结合朱氏调经促孕方加味口服治疗,C组患者给予CC促排卵结合阿司匹林口服治疗。以3个月经周期为1个疗程,CC至多服用1个疗程,停药后随访3个月经周期。比较3组患者的周期排卵率及未破裂卵泡黄素化综合征(LUFS)的发生率;于人绒毛膜促性腺激素(HCG)注射日进行阴道超声监测,比较3组患者的子宫内膜厚度、内膜类型及子宫动脉搏动指数(PI)与阻力指数(RI);于黄体期中期测定所有患者的血清雌二醇(E2)水平;比较3组患者的妊娠率。结果:①B组患者的周期排卵率明显高于A组和C组(P<0.05),A组患者的LUFS发生率明显高于B组和C组(P<0.05)。②HCG注射日,B组患者的子宫内膜较A组、C组患者明显增厚(P<0.05);B组患者的A型内膜例数多于A组、C组(P<0.05),C组患者的A型内膜例数多于A组(P<0.05)。③HCG注射日,B组患者的子宫动脉PI、RI均低于A组、C组(P<0.05),C组患者的子宫动脉RI亦低于A组(P<0.05)。④黄体期中期,B组患者的血清E2水平高于A组、C组(P<0.05);A组和C组患者的血清E2水平比较,差异无统计学意义(P>0.05)。⑤B组患者的妊娠率高于A组、C组(P<0.05),C组患者的妊娠率高于A组(P<0.05)。结论:朱氏调经促孕方加味能有效提高排卵功能障碍性不孕症患者CC促排卵后的排卵率,降低LUFS的发生率,升高血清雌激素水平,改善患者的子宫内膜容受性,提高临床妊娠率。

Objective:To observe the effects of Modified Zhu’s Tiaojing Cuyun Decoction combined with clomiphene citrate(CC)on the endometrial receptivity(ER)of infertility patients due to ovulatory dysfunction.Methods:One hundred and fifty patients of infertility due to ovulatory dysfunction were enrolled and randomly divided into the group A,group B and group C,50 cases in each group.The patients in group A were treated with CC to promote ovulation,the patients in group B were treated with CC combined with Modified Zhu’s Tiaojing Cuyun Decoction,and the patients in group C were treated with CC combined with aspirin.Three menstrual cycles were taken as one treatment course,and the treatment course of CC was performed at most three menstrual cycles.All patients were followed-up for one treatment course after withdrawal.The ovulation rate of menstrual cycle and the incidence of luteinized unruptured follicle syndrome(LUFS)in the three groups were compared.On the day of human chorionic gonadotropin(HCG)injection,the endometrial thickness,the endometrial type,and the pulsatility index(PI)and resistance index(RI)of uterine artery in the three groups were compared based on transvaginal ultrasound monitoring.The level of serum estradiol(E2)was tested in the middle luteal phase.The rate of pregnancy in the three groups was compared.Results:(1)The ovulation rate in group B was significantly higher than that in groups A and C(P<0.05),and the incidence of LUFS in group A was significantly higher than that in groups B and C(P<0.05).(2)On the day of HCG injection,the endometrium of group B was significantly thicker than that of groups A and C(P<0.05);the number of type A endometrium in group B was more than that in groups A and C(P<0.05),and the number of type A endometrium in group C was more than that in group A(P<0.05).(3)On the day of HCG injection,the levels of PI and RI of uterine artery in group B were lower than those in groups A and C(P<0.05),and the level of RI of uterine artery in group C was lower than that in group A(P<0.05).(4)In the middle luteal phase,the level of serum E2 in group B was higher than that in groups A and C(P<0.05);there was no statistically significant difference on the level of serum E2 between group A and group C(P>0.05).(5)The pregnancy rate of group B was higher than that of groups A and C(P<0.05),and the pregnancy rate of group C was higher than that of group A(P<0.05).Conclusion:Modified Zhu’s Tiaojing Cuyun Decoction can effectively enhance the ovulation rate of patients with infertility due to ovulatory dysfunction after CC promoting ovulation,decrease the incidence of LUFS,increase the level of serum estrogen,improve the ER,and enhance the clinical pregnancy rate.