230例体外受精-胚胎移植高龄女性扳机日中医证型分布及与妊娠结局的关系

Distribution of TCM Syndrome Types and Their Relationship with Pregnancy Outcomes in 230 Cases of in Vitro Fertilization-embryo Transfer Elderly Women with Trigger Days

目的观察体外受精-胚胎移植(IVF-ET)高龄不孕女性扳机日的中医证型分布规律,探析与妊娠结局关系。方法采用流行病学调查方法,对2019年7月-2020年5月西北妇女儿童医院生殖医学中心行IVF-ET长/超长方案的高龄女性患者230例在人绒毛膜促性腺激素(HCG)扳机日开展问卷调查,分析年龄、体质量指数对妊娠结局的影响情况,并观察中医证候及妊娠结局相关因素,研究中医证型分布特征及与妊娠结局关系。结果Logistic回归分析表明,年龄是妊娠结局的危险因素(OR=0.671,95%CI 0.54~0.83,P<0.001);患者高频证候聚类分析显示,证型分布为肾阴亏虚证91例(39.57%)、肝郁气滞证64例(27.83%)、血瘀证43例(18.69%)、肾阳虚兼痰湿证32例(13.91%)。不孕病程与中医证型分布差异无统计学意义(P>0.05),不孕因素与中医证型分布差异存在统计学意义(P<0.05),不同中医证型的妊娠结局差异有统计学意义(P<0.05)。结论接受IVF-ET的高龄女性在HCG扳机日的中医证型以肾阴亏虚证最为常见。IVF-ET高龄患者在HCG扳机日的中医证型与不孕因素、妊娠结局具有一定相关性,临床上应基于患者不同证型预防性辨证施治,以提高临床妊娠率。

Objective To explore the distribution law of TCM syndrome types in elderly female patients who underwent in vitro fertilization-embryo transfer(IVF-ET)on trigger day and their relationship with pregnancy outcomes.Methods With an epidemiological survey method,230 cases of elderly female patients who underwent IVF-ET long/extra-long program at the Reproductive Medicine Center of Northwest Women’s and Children’s Hospital from July 2019 to May 2020 were investigated by questionnaire.The survey was carried out on the trigger day of human chorionic gonadotropin(HCG)to analyze the influence of age and body mass index(BMI)on pregnancy outcome,to observe TCM syndromes and related factors of pregnancy outcome,and to study the distribution characteristics of TCM syndrome types and their relationship with pregnancy outcome.Results Logistic regression analysis showed that age was a risk factor for pregnancy outcome(OR=0.671,95%CI 0.54–0.83,P<0.001).Through clustering analysis of high-frequency syndromes,the results showed that the distribution ratios of syndrome types were 91 cases(39.57%)of kidney-yin deficiency syndrome,64 cases(27.83%)of liver-qi stagnation syndrome,43 cases(18.69%)of blood stasis syndrome,and 32 cases(13.91%)of kidney yang deficiency and phlegm-damp syndrome.There was no significant difference between the course of infertility and the distribution of TCM syndrome types(P>0.05);there was a statistically significant difference between infertility factors and the distribution of TCM syndrome types(P<0.05);there was a statistically significant difference between TCM syndrome types and pregnancy outcomes(P<0.05).Conclusion The most common TCM syndrome of elderly women receiving IVF-ET on HCG trigger day is kidney-yin deficiency syndrome.The TCM syndrome types of elderly patients with IVF-ET on the trigger day of HCG are related to infertility factors and pregnancy outcomes.Clinically,preventive syndrome differentiation and treatment should be based on different syndrome types of patients in order to improve the clinical pregnancy rate.