龙鹿丸联合西药治疗多囊卵巢综合征不孕症肾阳虚型的疗效观察

Efficacy Observation of Longlu Pills Combined with Western Medicine in the Treatment of PCOS Infertility with Kidney Yang Deficiency

目的探讨龙鹿丸联合氯米芬治疗多囊卵巢综合征(polycystic ovarian syndrome,PCOS)不孕症肾阳虚型的临床疗效,及对患者性激素、卵泡及子宫情况的影响。方法选取2018年1月—2019年4月期间河南省人口和计划生育科学技术研究所收治的PCOS不孕症且中医辨证属肾阳虚型育龄妇女92例,按随机数字表法分为对照组46例和治疗组46例。对照组给予氯米芬治疗,治疗组在对照组基础上加以龙鹿丸治疗。连续治疗3个月经周期后,观察两组患者临床疗效,治疗前后相关血清性激素水平,卵泡及子宫内膜情况,子宫动脉血流情况及血清血管内皮生长因子(VEGF)水平,治疗后1年随访观察两组患者妊娠情况、排卵率及不良反应发生情况。结果治疗后治疗组总有效率91.30%(32/46)高于对照组69.57%(42/46),两组比较,差异有统计学意义(P<0.05)。治疗后两组患者促卵泡生成激素(FSH)、雌二醇(E2)、黄体酮(P)水平均高于治疗前,差异有统计学意义(P<0.05),且治疗组治疗后FSH、E2、P水平均高于对照组,两组比较,差异有统计学意义(P<0.05);治疗后两组患者LH、T水平均低于治疗前,差异有统计学意义(P<0.05),且治疗组治疗后LH、T水平均低于对照组,两组比较,差异有统计学意义(P<0.05)。治疗后两组患者卵泡数目均低于治疗前(P<0.05),且治疗组治疗后卵泡数目低于对照组,两组比较,差异有统计学意义(P<0.05);治疗后两组患者优势卵泡直径、子宫内膜厚度均大于治疗前,差异有统计学意义(P<0.05),且治疗组治疗后优势卵泡直径、子宫内膜厚度均大于对照组,两组比较,差异有统计学意义(P<0.05)。治疗后两组患者子宫内膜下动脉搏动指数(PI)、阻力指数(RI)、收缩期峰值流速/舒张期流速(S/D),血清VEGF水平均低于治疗前,差异有统计学意义(P<0.05),且治疗组治疗后PI、RI、S/D、VEGF均低于对照组,两组比较,差异有统计学意义(P<0.05)。随访1年,两组患者均未发生不良反应,且排卵率差异无统计学意义(P>0.05);治疗组妊娠率73.91%(34/46)高于对照组43.48%(20/46),两组比较,差异有统计学意义(P<0.05)。结论龙鹿丸联合氯米芬治疗PCOS不孕症肾阳虚型,能提高疗效,改善PCOS症状及VEGF的异常高表达,增加妊娠成功率,同时无明显不良反应。

Objective To investigate the clinical efficacy of Longlu Pills combined with clomiphene in the treatment of polycystic ovarian syndrome(PCOS)infertility with kidney-yang deficiency,and its effect on the sex hormones,follicles and uterus.Methods Ninety-two women of childbearing age with PCOS infertility who were admitted to the Henan Institute of Population and Family Planning Science and Technology from January 2018 to April 2019 and were diagnosed with kidney-yang deficiency in TCM were selected and divided into the control group(n=46)and the treatment group(n=46)according to the random number table.The control group was given clomiphene treatment,and the treatment group was given Longlu pills treatment on the basis of the control group.After continuous treatment for 3 menstrual cycles,the clinical effects of the two groups,related serum sex hormone levels,follicular and endometrial conditions,uterine artery blood flow and serum VEGF levels before and after treatment were observed.Following up for 1 year after treatment,pregnancy and ovulation rate and the occurrence of adverse reactions of the two groups were observed.Results After treatment,the total effective rate of the treatment group was 91.30%(32/46)higher than that of the control group 69.57%(42/46).The difference between the two groups was statistically significant(P<0.05).After treatment,the FSH,E2 and P levels of the two groups of patients were higher than before treatment(P<0.05),and the treatment group was higher than the control group(P<0.05).After treatment,the LH and T levels of the two groups were lower than before treatment(P<0.05),and the treatment group was lower than the control group(P<0.05).After treatment,the number of follicles in the two groups was lower than before treatment(P<0.05),and the treatment group was lower than the control group(P<0.05).After treatment,the diameter of the dominant follicle and the thickness of the endometrium of the two groups were greater than those before treatment(P<0.05),and the treatment group was larger than the control group(P<0.05).After treatment,the PI,RI,S/D and serum VEGF levels of the subendometrial artery in the two groups were lower than before treatment(P<0.05),and the treatment group was lower than the control group(P<0.05).After 1 year of follow-up,there were no adverse reactions in the two groups,and the difference in ovulation rate was not statistically significant(P>0.05).The pregnancy rate of the treatment group was 73.91%(34/46)higher than that of the control group 43.48%(20/46).The difference between the two groups was statistically significant(P<0.05).Conclusion Longlu pills combined with clomiphene in the treatment of kidney-yang deficiency type PCOS infertility can improve the efficacy,improve the abnormally high expression of VEGF and PCOS symptoms,increase the success rate of pregnancy,and have no obvious adverse reactions.It is safe,reliable and worthy of clinical promotion.