养精种玉汤加味治疗肾虚肝郁型多囊卵巢综合征不孕症的临床疗效及对患者下丘脑-垂体-肾上腺轴功能和卵巢动脉血流动力学的影响

Clinical efficacy of modified Yangjing Zhongyu Decoction for polycystic ovarian syndrome patients with infertility(kidney liver depression type)and how to impact on hypothalamic-pituitary-adrenal axis function and hemodynamics of ovarian artery

目的观察养精种玉汤加味治疗肾虚肝郁型多囊卵巢综合征(PCOS)不孕症的临床疗效及对患者下丘脑-垂体-肾上腺轴功能和卵巢动脉血流动力学的影响。方法选择安徽省铜陵市妇幼保健院生殖科门诊肾虚肝郁型PCOS不孕症患者95例,按照随机数字表法分为治疗组48例和对照组47例,对照组给予西医常规治疗,治疗组在对照组基础上联合养精种玉汤加味治疗,治疗6个月经周期。比较2组临床疗效、排卵率和妊娠率、中医证候积分、下丘脑-垂体-肾上腺轴相关指标[血清卵泡刺激素(FSH)、黄体生成激素(LH)、生长激素(GH)、促肾上腺皮质激素(ACTH)]、卵巢动脉血流动力学指标[卵巢动脉收缩期峰值流速(PSV)、搏动指数(PI)、阻力指数(RI)]。结果治疗组总有效率89.58%(43/48),对照组72.34%(34/47),治疗组疗效优于对照组(χ^(2)=4.598,P<0.05)。治疗组排卵率(89.58%)、妊娠率(45.83%)高于对照组72.34%、21.28%(χ^(2)=4.598,6.411,P<0.05)。2组治疗后中医证候各项评分及总分均较本组治疗前降低(P<0.05),且治疗组治疗后月经后期、月经量少或闭经、腰骶痠痛、精神抑郁、胸胁胀满、经前乳胀评分及总分低于对照组(P<0.05)。2组治疗后血清FSH、LH、ACTH含量均较本组治疗前降低(P<0.05),GH含量较本组治疗前升高(P<0.05),且治疗组治疗后血清FSH、LH、ACTH含量低于对照组(P<0.05),GH含量高于对照组(P<0.05)。2组治疗后PSV较本组治疗前升高(P<0.05),PI、RI较本组治疗前降低(P<0.05),且治疗组治疗后PSV高于对照组(P<0.05),PI、RI低于对照组(P<0.05)。结论养精种玉汤加味治疗能够改善肾虚肝郁型PCOS不孕症患者临床症状,提高排卵率及妊娠率,可能与调节下丘脑-垂体-肾上腺轴功能紊乱、改善卵巢动脉血流动力学等因素有关。

Objective To observe the clinical efficacy of modified Yangjing Zhongyu Decoction for polycystic ovarian syndrome(PCOS)patients with infertility(kidney liver depression type)and how to impact on hypothalamic-pituitary-adrenal axis(HPA-A)function and hemodynamics of ovarian artery.Methods Totally 95 PCOS patients with infertility(kidney liver depression type)in the Gynecology Clinic,Tongling Maternal and Child Health Hospital were randomly divided into the treatment group(n=48)and the control group(n=47).In addition to conventional Western medicine,and treatment group additionally received modified Yangjing Zhongyu Decoction based on control group.The treatment continued 6 menstrual cycles to compare ovulation rate and pregnancy rate,traditional Chinese medicine(TCM)syndrome score,HPA-A related indicators(serum thyrotropin[TSH],luteinizing hormone[LH],growth hormone[GH],adrenocorticotropic hormone[ACTH]),hemodynamics of ovarian artery(peak systolic velocity[PSV]of ovarian artery,pulsatility index[PI],resist index[RI]);the curative effect was assessed.Results The overall effective rate was 89.58%(43/48)in the treatment group,better than that of 72.34%(34/47)in the control group(χ^(2)=4.598,P<0.05).The ovulation rate and pregnancy rate in the treatment group were higher than those in the control group(89.58%vs 72.34%,45.83%vs 21.28%,[χ^(2)=4.598,6.411,P<0.05],respectively).After treatment,TCM syndromes scores in groups were decreased(P<0.05),TCM syndromes(late menstruation,less menstruation or amenorrhea,lumbosacral pain,mental depression,chest fullness,premenstrual breast distention)scores were decreased in the treatment than in the control group(P<0.05);serum TSH,LH and ACTH in groups were decreased(P<0.05),the reduction in the treatment group was more common(P<0.05);GH in groups was increased(P<0.05),the treatment group was more prevalent(P<0.05);PSV in groups was higher(P<0.05),while PI and RI in groups were lower(P<0.05),increased PSV and decreased PI,RI were detected in the treatment group than those in the control group(all P<0.05).Conclusion For PCOS patients with infertility(kidney liver depression type),modified Yangjing Zhongyu Decoction can improve the clinical symptoms and increase the ovulation rate and pregnancy rate by regulating the dysfunction of HPA-A and improving hemodynamics of ovarian artery.