健脾补肾方联合促排卵方案提高多囊卵巢综合征合并胰岛素抵抗患者妊娠成功率的临床研究

Clinical Effect of Spleen-strengthening and Kidney-tonifying Prescription Combined with Ovulation Induction in Improving Pregnancy Success Rate of Patients with Polycystic Ovary Syndrome and Insulin Resistance

目的观察健脾补肾方联合促排卵方案对多囊卵巢综合征(polycystic ovarian syndrome,PCOS)合并胰岛素抵抗(insulin resistance,IR)患者早期妊娠成功率的疗效及其对糖脂代谢的影响。方法纳入105例脾肾气虚型PCOS合并IR的患者,其中对照组52例,治疗组53例。对照组患者给予促排卵方案(二甲双胍+来曲唑),成功妊娠后口服地屈孕酮片治疗。治疗组患者在对照组治疗基础上予健脾补肾方口服。两组均治疗6个月,妊娠后继续观察13周。评价两组患者的受孕率及早期妊娠成功率,检测并比较两组患者空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,FINS)、血清尿酸(uric acid,UA)水平,计算稳态评估模型-胰岛素抵抗(homeostasis model assessment-insulin resistance,HOMA-IR)指数;妊娠后比较两组患者妊娠第5周、第8周孕酮(progesterone,P)、雌二醇(estradiol,E2)水平和子宫动脉阻力指数(resistance index,RI)。结果①治疗3个月及治疗6个月后,治疗组的受孕率分别为30.2%、52.8%,均显著高于对照组(P<0.05);治疗组早期妊娠成功率为96.4%,高于对照组的70.6%(P<0.05)。②治疗后两组患者FINS、HOMA-IR均显著降低(P<0.05),且治疗组UA较治疗前亦显著降低(P<0.05);妊娠8周时,两组E2、P水平均较妊娠5周时显著提高(P<0.05),治疗组显著优于对照组(P<0.05),且治疗组治疗后RI亦显著降低(P<0.05)。结论健脾补肾方联合促排卵方案较单纯促排卵方案治疗PCOS合并IR患者可以有效提高妊娠成功率,其机制可能与改善体内糖代谢水平,降低体内UA、RI水平相关。

Objective To investigate the clinical effect of spleen-strengthening and kidney-tonifying prescription combined with ovulation induction in improving the success rate of early pregnancy in patients with polycystic ovary syndrome(PCOS)and insulin resistance(IR)and its effect on glucose and lipid metabolism.Methods A total of 105 PCOS patients with spleen-kidney Qi deficiency were enrolled,with 52 patients in the control group and 53 patients in the treatment group.The patients in the control group were given an ovulation induction regimen(metformin+letrozole)and oral administration of dydrogesterone tablets after successful pregnancy,and those in the treatment group were given oral spleen-strengthening and kidney-tonifying prescription in addition to the treatment in the control group.Both groups were treated for 6 months and were observed for 13 weeks after pregnancy.Pregnancy rate and the success rate of early pregnancy were evaluated for both groups,and the two groups were compared in terms of the changes in fasting plasma glucose,fasting insulin(FINS),serum uric acid(UA);homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.After pregnancy,the two groups were compared in terms of progesterone(P),estradiol(E2),and uterine artery resistance index(RI)at weeks 5 and 8 of pregnancy.Results After 3 and 6 months of treatment,the treatment group had pregnancy rates of 30.2%and 52.8%,respectively,which were significantly higher than those in the control group(P<0.05),and the treatment group also had a significantly higher success rate of early pregnancy than the control group(96.4%vs 70.6%,P<0.05).After treatment,both groups had significant reductions in FINS and HOMA-IR(P<0.05),and the treatment group had a significant reduction in UA(P<0.05).Both groups had significant increases in E2 and P from week 5 to week 8 of pregnancy,and the treatment group had significantly better levels of E2 and P than the control group at week 8 of pregnancy(P<0.05).The treatment group had a significant reduction in RI after treatment(P<0.05).Conclusion Compared with the ovulation induction regimen alone,spleen-strengthening and kidney-tonifying prescription combined with ovulation induction can effectively improve the success rate of pregnancy in patients with PCOS and IR,possibly by improving glucose metabolism and reducing UA and RI in the body.