自拟增膜助孕方联合地屈孕酮对肾虚血瘀型薄型子宫内膜不孕患者的临床疗效观察

Clinical Observation on Self-prescribed Zengmo Zhuyun Recipe Combined with Dydrogesterone for the Treatment of Infertility Patients with Thin-type Endometrium Differentiated as Kidney Deficiency and Blood Stasis Type

【目的】探究自拟增膜助孕方联合地屈孕酮对肾虚血瘀型薄型子宫内膜不孕患者的疗效。【方法】将60例肾虚血瘀型薄型子宫内膜不孕患者随机分成研究组和对照组,每组各30例。2组患者均于月经第5天给予口服戊酸雌二醇治疗,对照组患者于阴道B超监测排卵后给予口服地屈孕酮治疗,研究组患者在对照组的基础上给予自拟增膜助孕方治疗,1个月经周期为1个疗程,共治疗3个月经周期并随访1年。观察2组患者治疗前后子宫内膜厚度、A型子宫内膜形态占比及黄体期雌激素(E2)、孕酮(P)和促卵泡生成素(FSH)水平的变化情况,比较2组患者1年内妊娠率及足月分娩率。【结果】(1)治疗后,2组患者的子宫内膜厚度均较治疗前显著增厚(P<0.01),且研究组患者的子宫内膜厚度明显厚于对照组,差异有统计学意义(P<0.01)。(2)治疗后,2组患者的A型子宫内膜形态占比均较治疗前明显升高(P<0.01),且研究组患者的A型子宫内膜形态占比明显高于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者血清E2、P水平均较治疗前明显升高,FSH水平均较治疗前明显降低,差异均有统计学意义(P<0.05),且研究组患者血清E2、P水平明显高于对照组,FSH水平明显低于对照组,差异均有统计学意义(P<0.01)。(4)治疗后,研究组患者的1年内妊娠率和足月分娩率分别为56.67%(17/30)和88.24%(15/17),明显高于对照组的30.00%(5/30)和55.56%(5/9),其中,2组1年内妊娠率比较,差异均有统计学意义(P<0.05),而2组足月分娩率比较,差异无统计学意义(P>0.05)。【结论】自拟增膜助孕方联合地屈孕酮治疗肾虚血瘀型薄型子宫内膜不孕的疗效显著,可有效改善患者子宫内膜状态,提高患者妊娠率。

Objective To investigate the clinical effect of self-prescribed Zengmo Zhuyun Recipe combined with dydrogesterone for the treatment of infertility patients with thin-type endometrium differentiated as kidney deficiency and blood stasis type.Methods Sixty cases of thin-type endometrium infertility patients with kidney deficiency and blood stasis type were randomly divided into study group and control group,30 cases in each group.Patients in both groups were treated with oral use of Estradiol Valerate Tablets on the 5th day of menstruation,and then the control group was treated with oral use of dydrogesterone after ovulation monitored by vaginal ultrasound,and the study group was additionally given self-prescribed Zengmo Zhuyun Recipe,a Chinese medicine prescription with the actions of enhancing the proliferation and promoting pregnancy,on the basis of treatment for the control group.One menstrual cycle constituted a course of treatment,the treatment lasted 3 menstrual cycles and then one-year follow-up was performed.The changes of endometrial thickness,the proportion of type A endometrium morphology and the levels of estrogen(E2),progesterone(P)and follicle-stimulating hormone(FSH)in luteal phase were observed in the two groups before and after treatment.The pregnancy rate within one year and the rate of full-term delivery in the two groups were compared.Results(1)After treatment,the endometrial thickness in both groups was significantly thicker than that before treatment(P<0.01),and the endometrial thickness in the study group was significantly thicker than that in the control group,the difference being statistically significant(P<0.01).(2)After treatment,the proportion of type A endometrium morphology in the two groups was significantly higher than that before treatment(P<0.01),and the proportion of type A endometrial morphology in the study group was significantly higher than that in the control group,the difference being statistically significant(P<0.05).(3)After treatment,serum E2 and P levels in the two groups were significantly elevated,the FSH level was significantly reduced,and the differences were statistically significant(P<0.05).The intergroup comparison showed that serum E2 and P levels in the study group were significantly higher than those in the control group,FSH level was significantly lower than that in the control group,and the differences were statistically significant(P<0.01).(4)After treatment,the pregnancy rate and full-term delivery rate in the study group were 56.67%(17/30)and 88.24%(15/17)respectively,which were significantly higher than those in the control group[30.00%(5/30),55.56%(5/9)respectively],and the difference of one-year pregnancy rate was statistically significant(P<0.05),but the difference of full-term delivery rate was insignificant(P>0.05).Conclusion The self-prescribed Zengmo Zhuyun Recipe combined with dydrogesterone has significant efficacy in treating thin-type endometrium infertility with kidney deficiency and blood stasis type,which can effectively improve the endometrial status and the pregnancy rate of patients.