归肾丸加减治疗肾虚型卵巢储备功能下降不孕症疗效及对血GDF-9、BMP-10影响

Efficacy of Guishen pill plus or minus for treating infertility women with decreasing ovarian reserve because of kidney deficiency type and its influence on the serum levels of growth differentiation factor-9 and bone morphogenetic protein-10

目的:探讨归肾丸加减治疗肾虚型卵巢储备功能下降(DOR)不孕症疗效及对血清生长分化因子-9(GDF-9)、骨形态发生蛋白-10(BMP-10)影响。方法:选取2016年1月-2017年6月本院DOR伴不孕症(肾虚型)患者140例,随机分为观察组与对照组各70例。对照组予以常规西医人工周期激素治疗,观察组在对照组基础上加用归肾丸加减治疗。治疗前后评价中医症状积分,测定血清激素和细胞因子水平,超声监测窦卵泡数(AFC)、最大卵泡直径及卵巢血流参数。随访12个月统计妊娠情况。结果:治疗后观察组临床总有效率(94.3%)、妊娠率(41.4%)均高于对照组(77.1%、15.7%),中医症状积分低于对照组,雌二醇(E;)、黄体生成素(LH)、卵泡雌激素(FSH)水平低于对照组,抗苗勒激素(AMH)、转化生长因子-β1(TGF-β1)、GDF-9、BMP-10水平高于对照组,AFC、卵泡直径、PSV及EDV均高于对照组,RI、PI低于对照组(均P<0.05)。结论:归肾丸加减治疗肾虚型DOR不孕疗效显著,能够改善临床症状及卵巢功能,提高妊娠率,并可提高血清TGF-β1、GDF-9、BMP-10表达。

Objective:To investigate the efficacy of Guishen pill plus or minus for treating infertility women with decreasing ovarian reserve(DOR)because of kidney deficiency type,and to study its influence on the serum levels of growth differentiation factor-9(GDF-9)and bone morphogenetic protein-10(BMP-10)of the women.Methods:140 infertility women with DOR because of kidney deficiency type were randomly divided into observation group and control group(70 cases in each group).The women in the control group were treated with conventional western medicine,and the women in the observation group were treated with Guishen pill plus or minus except to the western medicine.The traditional Chinese medicine(TCM)symptom scores of the women in the two groups were evaluated before and after treatment,the levels of serum hormone and cytokine of the women in the two groups were determined,the antral follicle number(AFC),maximum follicular diameter,and ovarian blood flow parameters were measured by ultrasound.The pregnancy status of the women in the two groups was analyzed after 12 months of followed up.Results:After treatment,the total clinical effective rate(94.3%)and pregnancy rate(41.4%)of the women in the observation group were significant higher than those(77.1%and 15.7%)of the women in the control group,the TCM symptom scores symptom scores of the women in the observation group were significant lower than those of the women in the control group,and the levels of estradiol(E;),luteinizing hormone(LH),and follicle estrogen(FSH)of the women in the observation group were significant lower than those of the women in the control group.The levels of anti-Mullerin hormone(AMH),transforming growth factor-β1(TGF-β1),GDF-9,and BMP-10 of the women in the observation group were significant higher than those of the women in the control group.The values of AFC,follicular diameter,PSV and EDV of the women in the observation group were significant higher than those of the women in the control group,but the values of RI and PI of the women in the observation group were significant lower(all P<0.05).Conclusion:Guishen pill plus or minus for treating infertility women with decreasing ovarian reserve because of kidney deficiency type has good effect,which can improve the clinical symptoms and ovarian function,improve the pregnancy rate,and increase the expression levels of TGF-β1,GDF-9,and BMP-10 of the women.