固阴煎加减对育龄期卵巢低反应肾阴虚型患者卵巢储备功能的影响

Influence of Addition and Subtraction Therapy of Guyinjian to Ovarian Reserve Function for Patients with Poor Ovarian Response with Kidney Yin Deficiency Syndrome

目的:观察固阴煎加减对育龄期卵巢低反应(POR)肾阴虚证患者卵细胞质量、妊娠结局和卵巢储备功能的影响。方法:将90例符合要求的患者,随机按数字表法分为对照组和观察组各45例。两组均采用拮抗剂方案进行治疗,观察组在此基础上加用固阴煎加减内服。记录促性腺激素(Gn)使用时间和使用量、取卵周期;检测扳机日促卵泡激素(FSH),促黄体生成激素(LH),血清雌二醇(E_2)水平和子宫内膜厚度;记录取消周期率、受精率、可利用胚胎率、优质胚胎率、取卵周期临床妊娠率;检测治疗前后抗苗勒管激素(AMH)水平;采用B超检测治疗后卵巢动脉血流指标,记录阻力指数(RI),搏动指数(PI),舒张末期流速(EDV)和收缩期峰值流速(PSV) 4个指标,计算PSV/EDV(S/D);进行治疗前后肾阴虚证评分。结果:观察组Gn使用总量少于对照组(P <0. 01),两组患者Gn使用天数和取卵周期数组间比较差异无统计学意义;在扳机日,观察组患者FSH水平低于对照组(P <0. 01),LH,E_2水平均高于对照组(P <0. 01),子宫内膜厚度优于对照组(P <0. 01),获卵数多于对照组(P <0. 01);观察组患者取消周期率为13. 33%,低于对照组的17. 91%,观察组患者优质胚胎率为41. 86%,高于对照组的31. 43%,观察组患者取卵周期临床妊娠率为25%,高于对照组的11. 94%,但组间比较差异均无统计学意义;观察组患者受精率为82. 12%,高于对照组的72. 96%(χ~2=5. 124,P <0. 05);观察组患者可利用胚胎率为73. 71%,高于对照组的60. 34%(χ~2=5. 767,P <0. 05);治疗后观察组患者AMH水平高于对照组(P <0. 01);治疗后观察组患者的肾阴虚证评分低于对照组(P <0. 01);治疗后观察组患者RI,PI和S/D均低于对照组,PSV和EDV均快于对照组(P <0. 01)。结论:固阴煎加减治疗肾阴虚型POR患者能增加卵巢血供,提高卵巢储备功能,能减少Gn用量,增加获卵数,提高受精率,减轻肾阴虚症状,起到改善卵巢反应性和改善妊娠结局的效果。

Objective:To observe the effect of addition and subtraction therapy of Guyinjian on oocyte quality,pregnancy outcome and ovarian reserve function in patients with poor ovarian response(POR)with kidney Yin deficiency syndrome.Method:Ninety patients were randomly divided into control group(45 cases)and observation group(45 cases)by random number table.The patients in both groups got antagonist.Based on such treatment,the patients in observation received additional addition and subtraction therapy of Guyinjian.The using time and amount of gonadotropin(Gn),ovum taking cycle,cycle canceling rate,fertilization rate,available embryo rate,quality embryo rate,ovulation cycle clinical pregnancy rate were recorded.Levels of follicle stimulating hormone(FSH),luteinizing hormone(LH),serum estradiol(E2)and endometrial thickness,anti mullerian hormone(AMH),resistance index(RI),pulsation index(PI),end diastolic velocity(EDV)and peak systolic velocity(PSV)were detected.Ratio of PSV/EDV(S/D)was calculated,and scores of kidney yin deficiency syndrome were graded before and after treatment.Result:Total amount of Gn in observation group was less than that in control group(P<0.01),but there was no statistically significant difference in Gn using days and ovum taking cycle between two groups.On the trigger day,level of FSH in observation group was lower than that in control group(P<0.01),while levels of LH and E2 were higher than those in control group(P<0.01).Endometrial thickness was superior to that in control group(P<0.01),and number of acquired eggs was larger than that in control group(P<0.01).Cycle canceling rate in observation group was 13.33%,lower than17.91%in control group,and the quality embryo rate was 41.86%in observation group,higher than 31.43%in control group;ovulation cycle clinical pregnancy rate was 25%in observation group,higher than 11.94%in control group,but with no statistically significant differences.The fertilization rate was 82.12%in observation group,higher than 72.96%in control group(χ2=5.124,P<0.05).Available embryo rate was 73.71%in observation group,higher than 60.34%in control group(χ2=5.767,P<0.05).After treatment,level of AMH in observation group was higher than that in control group(P<0.01).Score of kidney Yin deficiency syndrome in observation group was lower than that in control group(P<0.01).And levels of RI,PI and S/D were lower than those in control group(P<0.01),while levels of PSV and EDV were lower than those in control group(P<0.01).Conclusion:Addition and subtraction therapy of Guyinjian can increase ovarian blood supply,improve high ovarian reserve function,reduce Gn consumption,increase number of acquired eggs,alleviate symptoms of kidney yin deficiency,and can ameliorate ovarian responsiveness and pregnancy outcome.