二甲地黄汤加减联合来曲唑片治疗肾虚痰湿型多囊卵巢综合征不孕症临床研究

Clinical Study on Modified Erjia Dihuang Tang Combined with Letrozole Tablets for Infertility Resulting from Polycystic Ovary Syndrome of Kidney Deficiency with Phlegm-Dampness Type

目的:观察二甲地黄汤加减联合来曲唑片治疗肾虚痰湿型多囊卵巢综合征(PCOS)不孕症的临床疗效。方法:将80例肾虚痰湿型PCOS不孕症患者随机分成观察组与对照组各40例。对照组给予来曲唑片治疗,观察组在对照组基础上给予二甲地黄汤加减治疗。比较2组治疗前后血清性激素指标、子宫内膜容受性指标及胰岛素抵抗指标;随访1年,统计2组排卵率与妊娠率。结果:与同组治疗前比较,治疗后2组血清促黄体生成素(LH)、空腹血糖(FBG)、空腹胰岛素(FINS)水平、胰岛素抵抗指数(HOMA-IR)及子宫螺旋动脉搏动指数(PI)、阻力指数(RI)均下降(P<0.05),子宫内膜厚度均增加(P<0.05),血清雌二醇(E_(2))水平均升高(P<0.05);与对照组治疗后比较,观察组治疗后血清LH、FBG、FINS水平、HOMA-IR及子宫螺旋动脉PI、RI较低,子宫内膜厚度增加(P<0.05),E_(2)水平较高(P<0.05)。2组排卵率比较,差异无统计学意义(P>0.05)。观察组妊娠率47.50%,高于对照组25.00%(P<0.05)。结论:二甲地黄汤加减联合来曲唑片能显著改善肾虚痰湿型PCOS不孕症患者子宫内膜容受性,纠正生殖内分泌紊乱,减轻胰岛素抵抗,提高妊娠率。

Objective: To observe the clinical effect of modified Erjia Dihuang tang combined with letrozole tablets for infertility resulting from polycystic ovary syndrome(PCOS) of the kidney deficiency with phlegm-dampness type. Methods:A total of 80 cases of patients with infertility resulting from PCOS of the kidney deficiency with phlegm-dampness type were randomly divided into the observation group and the control group,with 40 cases in each group. The control group was treated with letrozole tablets,and the observation group was additionally treated with modified Erjia Dihuang tang based on the treatment of the control group. The indexes of serum sex hormones, endometrial receptivity and insulin resistance were compared between the two groups before and after treatment;the ovulation rate and pregnancy rate in the two groups were counted after one-year follow-up. Results: The levels of luteinizing hormone(LH),fasting blood glucose(FBG) and fasting insulin(FINS) in serum, homeostatic model assessment of insulin resistance(HOMA-IR), and pulsation index(PI) and resistance index(RI) in uterine spiral arteries were decreased when compared with those before treatment(P<0.05),and endometrial thickness was increased(P<0.05),and levels of serum estradiol(E_(2)) were increased(P<0.05). After treatment,levels of LH,FBG and FINS in serum,HOMA-IR and PI and RI in uterine spiral arteries in the observation group were lower than those in the control group, and endometrial thickness was increased(P<0.05);level of E_(2) in the observation group was higher(P<0.05). There was no significant difference being found in the comparison of ovulation rates between the two groups(P>0.05). The pregnancy rate was 47.50% in the observation group,higher than that of 25.00% in the control group(P<0.05). Conclusion:Modified Erjia Dihuang tang combined with letrozole tablets can significantly improve endometrial receptivity of patients with infertility resulting from PCOS of the kidney deficiency with phlegm-dampness type,correct reproductive endocrine disorders,reduce insulin resistance,and improve pregnancy rate.