清热祛湿方联合盐酸多西环素片治疗体外受精-胚胎移植中慢性子宫内膜炎临床观察

Clinical observation of Qingre Qushi Formula combined with doxycycline hydrochloride tablets on chronic endometritis of inVitro fertilization-embryo transfer

目的观察清热祛湿方联合盐酸多西环素片治疗体外受精-胚胎移植(IVF-ET)中慢性子宫内膜炎的临床疗效。方法将80例IVF-ET中慢性子宫内膜炎患者按照随机数字表法分为2组,治疗组40例予清热祛湿方联合盐酸多西环素片治疗,对照组40例予盐酸多西环素片治疗,2组均治疗3个疗程。比较2组临床疗效及中医症状疗效;比较2组组间、组内单项中医证候积分变化;比较2组治疗前后中医证候总积分变化;比较2组治疗前后血清炎症因子白细胞介素1β(IL-1β)、IL-2、肿瘤坏死因子α(TNF-α)水平变化;观察2组临床妊娠结局。结果治疗组临床总有效率95.00%(38/40),对照组总有效率80.00%(32/40),治疗组临床疗效优于对照组(P<0.05)。2组治疗前各项中医证候积分比较差异无统计学意义(P>0.05),2组治疗后各项中医证候积分比较差异无统计学意义(P>0.05)。治疗组治疗后下腹部坠胀痛、带下异常、月经不调、痛经评分均较本组治疗前改善(P<0.05),对照组治疗后下腹部坠胀痛、腰骶部疼痛、带下异常评分均较本组治疗前改善(P<0.05)。2组治疗后中医证候总积分较本组治疗前降低(P<0.05);2组中医证候总积分差值比较差异无统计学意义(P>0.05)。2组治疗后血清IL-1β、TNF-α水平均较本组治疗前降低(P<0.05),IL-2水平较本组治疗前升高(P<0.05);治疗后治疗组血清IL-1β、TNF-α水平均低于对照组(P<0.05),血清IL-2水平均高于对照组(P<0.05)。治疗组NT正常率52.50%(21/40),流产率12.50%(5/40);对照组NT正常率25.00%(10/40),流产率27.50%(11/40)。治疗组临床妊娠结局优于对照组(P<0.05)。结论清热祛湿方联合盐酸多西环素片治疗IVF-ET中慢性子宫内膜炎,可提高临床疗效,改善患者炎症状态,减少不良妊娠结局发生,提高临床妊娠率。

Objective To observe the clinical efficacy of Qingre Qushi Formula combined with doxycycline hydrochloride tablets in the treatment of chronic endometritis(CE)of invitro fertilization-embryo transfer(IVF-ET).Methods Eighty patients with CE of IVF-ET were randomized 1∶1 to receive Qingre Qushi Formula combined with doxycycline hydrochloride tablets(treatment group)or doxycycline hydrochloride tablets(control group)for 14 days.The curative effects,the each distance of traditional Chinese medicine(TCM)syndrome scores and total TCM syndrome scores,the levels of serum inflammatory factors interleukin-1β(IL-1β),IL-2 and tumor necrosis factor-α(TNF-α),as well as clinical pregnancy outcomes were included as comparators between groups before and after treatment.Results The total effective rate in the treatment group was better than that in the control group(95.00%[38/40]vs 80.00%[32/40],P<0.05).Before and after treatment,there was no significant difference in the each distance of TCM syndromes scores between groups(all P>0.05).After treatment,the scores of lower abdominal pain,fluor abnormal,irregular menstruation and dysmenorrhea in the treatment group were significantly improved(P<0.05),and the scores of lower abdominal pain,lumbosacral pain and fluor abnormal in the control group were significantly improved(P<0.05).After treatment,the total TCM syndromes scores in the two groups were significantly lower than those before treatment(P<0.05),but there was no significant difference in the total TCM syndromes scores between groups(P>0.05).Significantly lower serum IL-1βand TNF-αand significantly higher IL-2 were detected in the both groups(all P<0.05),there was significant difference in the levels of IL-1β,TNF-αand IL-2 between groups(all P<0.05).The clinical pregnancy outcome in the treatment group was superior to the control group(P<0.05),with the normal rate of nuchal translucency(NT)(52.50%[21/40]vs 25.00%[10/40])and the abortion rate(12.50%[5/40]vs 27.50%[11/40]).Conclusion For patients with CE of IVF-ET,Qingre Qushi Formula combined with doxycycline hydrochloride tablets can improve the clinical efficacy,improve the inflammatory state,reduce adverse pregnancy outcomes rates,and improve the clinical pregnancy rates.