补肾活血散瘀汤联合地诺孕素对肾虚血瘀型子宫腺肌病不孕患者子宫内膜容受性的影响

Influence of Decoction for tonifying kidney,activating blood and resolving stasis combined with dienogest on end-ometrial receptivity of patients with adenomyosis associated infertility of type of Shen deficiency and blood stasis

目的观察补肾活血散瘀汤联合地诺孕素对肾虚血瘀型子宫腺肌病相关性不孕患者子宫内膜容受性、妊娠率的影响。方法选取2022年1月—2023年4月在江苏省中西医结合医院妇科门诊治疗的子宫腺肌病相关性不孕且证属肾虚血瘀型患者48例,按随机数字表分为2组,每组24例。对照组给予地诺孕素口服,联合组给予地诺孕素联合补肾活血散瘀汤治疗,2组均治疗3个月经周期。比较2组患者治疗前后子宫内膜容受性超声学指标、中医证候总积分以及不良反应发生率、停药后6个月内自然妊娠率。结果2组治疗后子宫内膜厚度、A+B型子宫内膜患者占比以及Ⅲ型子宫内膜血流分型患者占比均明显高于治疗前(P均<0.05),且联合组均明显高于对照组(P均<0.05);2组治疗后双侧子宫动脉血流参数及中医证候总积分均明显低于治疗前(P均<0.05),且联合组均明显低于对照组(P均<0.05);联合组不良反应发生率明显低于对照组[17.4%(2/23)比45.5%(10/22),P<0.05],停药后6个月内自然妊娠率明显高于对照组[56.5%(12/23)比27.3%(6/22),P<0.05]。结论补肾活血散瘀汤联合诺孕素治疗较地诺孕素单独治疗可进一步改善肾虚血瘀型子宫腺肌病相关性不孕患者的子宫内膜容受性,提高妊娠率,且可明显减轻患者症状,减少不良反应。

Objective It is to observe the influence of Decoction for tonifying kidney,activating blood and resolving stasis combined with dienogest on endometrial receptivity and pregnancy rate of patients with adenomyosis associated infertility of type of Shen deficiency and blood stasis.Methods Forty-eight patients with adenomyosis associated infertility of type of Shen deficiency and blood stasis treated at the gynecology outpatient clinic of Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to July 2023 were selected and randomly divided into two groups,with 24 cases in each group.The control group was treated with oral administration of dienogest,while the combination group was treated with Decoction for tonifying kidney,activating blood and resolving stasis combined with dienoges,both groups were treated for 3 menstrual cycles.The endometrial receptivity ultrasonic indexes,Chinese medicine syndrome scores before and after treatment,the incidence of adverse reactions,and the natural pregnancy rate within 6 months after drug withdrawal were compared between the two groups.Results After treatment,the endometrial thickness,proportion of patients with type A+B endometrium,and proportion of patients with typeⅢendometrial blood flow in both groups were significantly higher than those before treatment(all P<0.05),and the combination group was higher than the control group(P<0.05);additionally,the blood flow parameters of bilateral uterine arteries,scores of Chinese medicine syndrome were significantly lower than those before treatment(all P<0.05),and the combination group was lower than the control group(P<0.05).The incidence of adverse reactions of the combination group was significantly lower than that of the control group[17.4%(2/23)VS.45.5%(10/22),P<0.05],and the natural pregnancy rate within 6 months after drug withdrawal was significantly higher than that of the control group[56.5%(12/23)VS.27.3%(6/22),P<0.05].Conclusion Decoction for tonifying kidney,activating blood and resolving stasis combined with dienogest can more effectively improve endometrial receptivity and increase pregnancy rates in patients with adenomyosis associated infertility of type of Shen deficiency and blood stasis,and obviously alleviate their symptoms with less side effects.