二补助育汤治疗肾虚血瘀型反复胚胎种植失败低子宫内膜容受性患者的临床观察

Clinical observation of Erbuzhuyu Decoction on the low endometrial receptivity in recurrent implantation failure patients with syndrome of kidney deficiency and blood stasis

目的:观察二补助育汤对肾虚血瘀型反复胚胎种植失败(RIF)患者子宫内膜容受性的影响。方法:32例肾虚血瘀型低子宫内膜容受性RIF患者予二补助育汤连续服用1~3个疗程,比较患者治疗前后的中医证候评分、黄体中期的超声学指标及血清中血管生成相关因子水平,并随访患者的妊娠结局。结果:与治疗前比较,患者治疗后中医证候评分显著降低(P<0.01),总有效率为71.88%(23/32);黄体中期子宫内膜厚度与容积显著增加(P<0.01),A型、B型子宫内膜例数呈增多趋势,双侧子宫动脉搏动指数、阻力指数、收缩期峰值/舒张期峰值均显著降低(P<0.01),Salle评分显著增加(P<0.01);黄体中期血清中血管内皮生长因子、血管生成素(Ang)-1水平均较治疗前显著升高(P<0.01),Ang-2较治疗前呈升高趋势;治疗结束后,患者下一周期的胚胎种植率为40.74%(22/54),临床妊娠率为37.50%(12/32)。结论:二补助育汤可显著改善RIF患者肾虚血瘀证候,改善黄体中期子宫内膜超声学指标,提高黄体中期血管生成相关因子表达水平,从而提高子宫内膜容受性,改善妊娠结局。

Objective:To explore the clinical effect of Erbuzhuyu Decoction on endometrial receptivity in recurrent implantation failure(RIF)patients with syndrome of kidney deficiency and blood stasis.Methods:Thirty-two cases of RIF with low endometrial receptivity and syndrome of kidney deficiency and blood stasis were collected.The patients were treated with Erbuzhuyu Decoction for 1-3 consecutive treatment courses.The TCM syndrome scores,as well as the ultrasound parameters in the mid-luteal phase,serum angiogenesis-related factor levels were observed and compared before and after treatment.And the implantation rate and clinical pregnancy rate of the next IVF-ET/ICSI cycle were followed up.Results:After the treatment,the syndrome of kidney deficiency and blood stasis were significantly improved in patients with RIF(P<0.01),the total efficiency rate was 71.88%(23/32).The thickness and volume of endometrium increased significantly(P<0.01),the number of cases of type A and type B endometrium got a tendency to increased.The PI,RI,and S/D values of bilateral uterine arteries were significantly lower(P<0.01).And the Salle scores were significantly higher(P<0.01).The levels of VEGF and Ang-1 in the mid-luteal phase were significantly higher than those before treatment(P<0.01),Ang-2 also got a tendency to increased.The embryo implantation rate of next IVF-ET/ICSI cycle was 40.74%(22/54),and the clinical pregnancy rate was 37.50%(12/32).Conclusion:Erbuzhuyu Decoction can significantly improve the syndrome of kidney deficiency and blood stasis in patients with RIF,increase the thickness and volume of the endometrium in the mid-luteal phase,improve the ultrasound parameters in the mid-luteal phase,increase the serum angiogenesis-related factor levels.Thereby the Erbuzhuyu Decoction can improve the endometrial receptivity and pregnancy outcomes.