子宫内膜息肉所致不孕症症-因分析及加味生化汤对患者性激素水平的影响

Study on the etiology and causes of infertility caused by endometrial polyp and the effect of Jiawei Shenghua decoction on sex hormone levels of patients

目的探讨子宫内膜息肉(EP)所致不孕症患者术后妊娠的影响因素及加味生化汤对患者性激素水平的影响。方法收集2018年1月至2021年3月于安徽省铜陵市妇幼保健院就诊的348例不孕患者的临床资料,依据助孕情况分为助孕失败组和未助孕组,并依据宫腔镜检查是否有EP将两组分为EP亚组和正常宫腔亚组。助孕失败组136例,其中EP患者44例,正常宫腔患者92例;未助孕组212例,其中EP患者76例,正常宫腔患者136例。将确诊的EP合并不孕患者按照随机数字表法分为对照组(单纯手术,n=60)和观察组(术后加味生化汤治疗,n=60)。评估患者术后妊娠情况;采用Cox比例风险回归筛选影响EP不孕患者术后妊娠的影响因素,纳入并建立Nomogram预测模型,并对模型进行评价。结果助孕失败组中,EP亚组成功妊娠率(40.91%)明显高于正常宫腔亚组(17.39%),差异具有统计学意义(P<0.05)。息肉数目、息肉部位、加味生化汤辅助治疗、息肉大小是影响EP不孕患者术后妊娠的影响因素(P<0.05)。本研究构建的Nomogram模型的区分度、校准度均较好。术后口服加味生化汤治疗,观察组患者雌激素受体(ER)、孕激素受体(PR)均明显高于对照组,雌二醇(E_(2))明显低于对照组,差异具有统计学意义(P<0.05);与治疗前相比,两组患者治疗后的ER、PR均明显增加,E_(2)明显降低,差异具有统计学意义(P<0.05)。结论EP是导致患者不孕的主要原因,EP大小、数目和部位均会影响不孕患者术后妊娠。加味生化汤可能通过上调EP、PR,降低E_(2)改善子宫内膜增殖速度,从而提高治疗效果。

Objective To explore the influencing factors of postoperative pregnancy in infertility patients caused by endometrial polyp(EP)and the effect of Jiawei Shenghua decoction on sex hormone levels of patients.Methods The clinical data of 348 infertile patients treated in Tongling Maternal and Child Health Care Hospital from January 2018 to March 2021 were collected.According to the previous assisted pregnancy situation,they were divided into failed assisted pregnancy group and non-assisted pregnancy group,and according to whether there was EP by hysteroscopy,each group was divided into EP subgroup and normal uterine cavity subgroup.There were 136 patients in failed assisted pregnancy group,including 44 patients with EP and 92 patients with normal uterine cavity.There were 212 patients in non-assisted pregnancy group,including 76 patients with EP and 136 patients with normal uterine cavity.Patients with EP complicated with infertility were randomly divided into control group(operation alone,n=60)and observation group(Jiawei Shenghua decoction after operation,n=60).The postoperative pregnancy was evaluated.Cox proportional hazard regression was used to screen out the influencing factors of postoperative pregnancy in patients with EP infertility,and the Nomogram model was incorporated,established and evaluated.Results In the failed assisted pregnancy group,the successful pregnancy rate of EP subgroup(40.91%)was significantly higher than that of normal uterine subgroup(17.39%)with a statistical significance(P<0.05).The size,location and number of polyps and the adjuvant treatment of Jiawei Shenghua decoction were the influencing factors of postoperative pregnancy in patients with EP infertility(P<0.05).The Nomogram model constructed in this study has good differentiation and calibration.After oral administration of Jiawei Shenghua decoction,estrogen receptor(ER)and progesterone receptor(PR)in the observation group were higher than those in the control group significantly,while estrogen(E_(2))was lower than that in the control group significantly(P<0.05).Compared with those before treatment,ER and PR were significantly increased and E_(2) decreased significantly in the two groups after treatment.Conclusions EP is the main cause of infertility.The size,number and location of EP will affect the postoperative pregnancy of infertile patients.Jiawei Shenghua decoction may improve the proliferation rate of endometrium by up-regulating EP and PR and reducing E_(2),so as to improve the therapeutic effect.