顽固性薄型子宫内膜患者黄体中期内膜容受性、血流动力学特征及马氏补胞汤联合针刺对其影响的研究

Endometrial receptivity and hemodynamics at midluteal phase in patients with persistent thin endometrium and effects of Ma’s Bubao Decoction combined with acupuncture

目的研究薄型子宫内膜患者黄体中期子宫内膜厚度、容积、内膜下血流分型及子宫血流动力学参数等特征,观察马氏补胞汤联合针刺对顽固性薄型子宫内膜患者子宫内膜容受性的影响。方法将90例育龄顽固性薄型子宫内膜患者随机分为治疗组和对照组,每组45例。另外,纳入同期正常育龄妇女30例作为正常对照组。对照组予阿司匹林,治疗组在阿司匹林基础上加用马氏补胞汤及针刺治疗。两组疗程均为2个月(经期暂停治疗),观察各组阴道超声下黄体中期的子宫内膜厚度、容积及子宫血流分型、血流动力学参数,以及中医证候积分的变化情况。结果①试验期间,治疗组脱落3例(因中断治疗),对照组脱落2例(失访),正常对照组无脱落;最终完成试验者115例,治疗组42例,对照组43例,正常对照组30例。②在黄体中期,薄型子宫内膜组的内膜厚度、内膜容积显著低于正常对照组(P<0.05);子宫内膜血流S/D及子宫动脉血流mPI、mRI、mS/D水平显著高于正常对照组(P<0.05);两组子宫内膜血流分型差异有统计学意义(P<0.05)。③在黄体中期,治疗前后组内比较,两组内膜厚度、内膜容积、内膜血流S/D、子宫动脉血流mPI、子宫内膜血流分型差异均有统计学意义(P<0.05);治疗组子宫动脉血流mS/D差异有统计学意义(P<0.05)。组间治疗后比较,内膜厚度、内膜血流S/D、子宫动脉mS/D差异有统计学意义,治疗组对上述指标的改善明显优于对照组(P<0.05)。子宫内膜血流分型差异无统计学意义(P>0.05)。④治疗前后组内比较,两组中医证候积分差异均有统计学意义,均明显降低(P<0.05)。组间治疗后比较,治疗组中医证候积分明显低于对照组(P<0.05)。结论①薄型子宫内膜患者黄体中期子宫血流阻力较正常育龄妇女显著增加,内膜厚度及容积显著下降。②在口服阿司匹林基础上,加用马氏补胞汤联合针刺能更好地改善顽固性薄型子宫内膜患者的临床症状,增加内膜厚度和内膜容积,增强子宫血流灌注,有利于子宫内膜容受性的提高。

Objective To study the endometrial thickness, volume, endometrial blood flow pattern and uterine blood flow parameters at midluteal phase in patients with persistent thin endometrium and the effect of Ma’s Bubao Decoction combined with acupuncture on endometrial receptivity(ER) in them. Methods Ninety cases of persistent thin endometrium of childbearing age were randomly divided into treatment group and control group, 45 cases in each group. In addition, 30 women of normal childbearing age in the same period were included as normal control group.The control group was treated with aspirin, while the treatment group was treated with Ma’s Bubao Decoction and acupuncture on the basis of aspirin. Both groups were treated for 2 months(suspend treatment during menstrual period) and then the changes of endometrial thickness, volume, endometrial blood flow pattern, uterine blood flow hemodynamic parameters and TCM syndrome scores at midluteal phase were observed. Results ①During the experiment, there were 3 cases dropped in the treatment group( due to interruption of treatment),2 cases in the control group,and no drop in the normal control group. Totally 115 cases completed the experiment,42 cases in the treatment group,43 cases in the control group and30 cases in the normal control group.(2)At midluteal phase,the thickness and volume of endometrium in the thin endometrium group were significantly lower than those in the normal control group( P < 0.05);the levels of endometrial blood flow S/D and uterine artery blood flow m PI,mRI and m S/D were significantly higher than those in the normal control group( P < 0.05);the difference of endometrial blood flow pattern between the two groups was significant( P < 0.05).(3)In the midluteal phase,there were significant differences in endometrial thickness,endometrial volume,endometrial blood flow S/D,uterine artery blood flow m PI and endometrial blood flow pattern compared with those before treatment within both groups( P < 0.05),and there were significant differences in the uterine artery blood flow m S/D in the treatment group( P<0.05). There were significant differences in endometrial thickness,endometrial blood flow S/D and uterine artery m S/D between the two groups after treatment. The improvement of the above indexes in the treatment group was significantly better than that in the control group( P<0.05). There was no significant difference in endometrial blood flow pattern( P>0.05).(4) There were significant differences in TCM syndrome scores compared with those before treatment within both groups( P<0.05). All of them were significantly decreased after treatment. After treatment,the TCM syndrome scores in the treatment group were significantly lower than those in the control group( P<0.05). Conclusion(1)The resistance of uterine blood flow at midluteal phase of persistent thin endometrium patients was significantly higher than that of normal women,and the endometrial thickness and volume were significantly decreased.(2) On the basis of oral aspirin,the combination of Ma’s Bubao Decoction and acupuncture can improve the clinical symptoms of patients with persistent thin endometrium,increase the thickness and volume of endometrium and enhance the blood flow perfusion of the uterus,which are conducive to the improvement of endometrial receptivity.