滋肾温阳汤联合克龄蒙治疗卵巢储备功能下降45例

Treatment of 45 Cases of Diminished Ovarian Reserve with Zishen Wenyang Decoction(滋肾温阳汤)Combined with Climen

目的:观察滋肾温阳汤联合克龄蒙治疗卵巢储备功能下降(DOR)患者的临床疗效,并探讨其对患者血清激素水平、细胞因子Toll样受体1(TLR1)、Toll样受体2(TLR2)的影响。方法:将90例肾虚血瘀型DOR患者按随机数字表法分为对照组和观察组各45例。对照组采用口服克龄蒙治疗,观察组在对照组治疗的基础上加用滋肾温阳汤。比较两组患者治疗前后的中医症状评分、血清性激素水平、卵巢状态及细胞因子TLR1、TLR2表达率,并评价临床疗效。结果:观察组疗效优于对照组(P=0.048)。治疗后,两组中医症状评分较治疗前均降低(P<0.001),且观察组明显低于对照组(P<0.001);两组血清促卵泡激素(FSH)、黄体生成素(LH)水平较治疗前明显降低(P<0.05),雌二醇(E2)水平较治疗前明显升高(P<0.05),且观察组血清FSH、LH、E2水平均低于对照组(P<0.05);两组治疗后卵巢窦卵泡数(AFC)、卵巢动脉收缩期峰值流速(PSV)明显升高(P<0.05),且观察组AFC、PSV高于对照组(P<0.001);两组TLR1、TLR2表达率较治疗前均显著下降(P<0.05),且观察组明显低于对照组(P<0.05)。治疗期间,观察组和对照组患者均未出现明显不良反应。结论:滋肾温阳汤联合克龄蒙治疗DOR疗效显著,可明显改善患者临床症状,降低血清FSH、LH水平,提高血清E2水平,增加AFC,提高PSV,降低TLR1、TLR2表达率。

Objective:To explore the clinical efficacy of Zishen Wenyang Decoction combined with climen on patients with diminished ovarian reserve(DOR)and its effects on serum hormone levels,cytokines Toll like receptor 1(TLR1)and Toll like receptor 2(TLR2).Methods:A total of 90 patients with DOR of kidney deficiency and blood stasis syndrome were divided into control group and observation group according to the random number table method,with 45 cases in each group.The control group was treated with climen orally,and the observation group was treated with Zishen Wenyang Decoction on the basis of the control group.The TCM symptom scores,serum sex hormone levels,ovarian status and the expression rates of TLR1 and TLR2 of the two groups were compared before and after treatment,and the clinical efficacy was evaluated.Results:The total effective rate of the observation group was higher than that of the control group(P=0.048).After treatment,the TCM symptom scores of the two groups were lower than those before treatment(P<0.001),and the TCM symptom score of the observation group was significantly lower than that of the control group(P<0.001).The levels of serum follicle stimulating hormone(FSH)and luteinizing hormone(LH)in the two groups were significantly lower than those before treatment(P<0.05),and the level of estradiol(E2)was significantly higher than that before treatment(P<0.05),and the serum levels of FSH,LH and E2 in the observation group were lower than those in the control group(P<0.05).After treatment,the number of ovarian antrum follicles(AFC)and peak systolic velocity(PSV)of ovarian artery in the two groups were significantly increased(P<0.05),and the AFC and PSV in the observation group were higher than those in the control group(P<0.001).The expression rates of TLR1 and TLR2 in the two groups were significantly lower than those before treatment(P<0.05),and those of the observation group were significantly lower than those of the control group(P<0.05).During the treatment,there were no obvious adverse reactions in the observation group and the control group.Conslusions:Zishen Wenyang Decoction combined with climen is effective in treating DOR.It can significantly improve clinical symptoms,reduce levels of serum FSH and LH,increase E2 level,AFC,and PSV,and reduce the expression rates of TLR1 and TLR2.