摘要
目的观察来曲唑及二甲双胍配合中药或针灸改善多囊卵巢综合征(PCOS)合并胰岛素抵抗(IR)不孕患者子宫内膜容受性的临床疗效。方法将128例PCOS合并IR的不孕患者分成3组。A组38例,给与达英-35(月经第5天开始,每日1片,连服21天)及二甲双胍(每日0.85 g,1天1次,经期不停药)口服,治疗1个疗程(3个月)后,给予来曲唑(LE)促排卵治疗(月经第5天开始,每日1片,连服5天),并给予注射用绒促性腺激素(HCG)诱导排卵,拟治疗6个月。B组44例,在A组基础上给与补肾活血化痰中药调周治疗。C组46例,在A组基础上于月经第5天开始行针灸治疗,隔2日1次。观察各组治疗前后体重、体重指数(BMI)、血清性激素[促卵泡生成素(FSH)、黄体生成素(LH)、睾酮(T)、LH/FSH]、胰岛素抵抗指数(HOMA-RI)、排卵率、妊娠率及HCG日子宫动脉血流参数值[搏动指数(PI)、阻力指数(RI)]。结果(1)各组体重较治疗前减轻,差异有统计学意义(P<0.05);A组,C组BMI较治疗前下降,差异有统计学意义(P<0.05);C组患者治疗后BMI较A组下降,差异有统计学意义(P<0.05);各组HOMA-RI值较前降低,差异有统计学意义(P<0.05)。(2)各组血清FSH、LH、T、LH/FSH较治疗前均有下降,差异有统计学意义(P<0.05);C组治疗后LH值较B组和A组治疗后LH值下降,差异有统计学意义(P<0.05)。(3)排卵率C组高于A组,B组高于A组,结果有统计学差异(P<0.05);妊娠率C组高于B组,B组高于A组,结果有统计学差异(P<0.05)。(4)HCG日子宫动脉PI值,B组小于A组,C组小于A组,结论有统计学差异(P<0.05);RI值C组小于A组和B组,结论有统计学差异(P<0.05)。结论达英-35及二甲双胍配合针灸可通过降低患者BMI、下调LH水平、改善子宫动脉RI值,起到改善子宫内膜容受性,增加临床妊娠率的作用;针灸较中药能更好提高临床妊娠率。
Objective To observe the clinical efficacy of letrozole and metformin combined with traditional Chinese medicine or acupuncture in improving endometrial receptivity in infertile patients with polycystic ovary syndrome(PCOS)and insulin resistance(IR).Methods 128 infertility patients with PCOS combined with IR were divided into 3 groups.38 cases of group A,were given Diane-35 and metformin orally.After one course of treatment(3 months),they were given letrozole(LE)to induce ovulation for 6 months.Forty-four patients in group B were treated with traditional Chinese medicine for tonifying kidney and and Invigorate the circulation of phlegm,on the basis of group A.Forty-six patients in group C received acupuncture treatment on the 5th day of menstruation,and once every 2 days.Observed between groups before and after treatment of body weight,body mass index(BMI),sex hormone[follicle-stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T),LH/FSH],insulin resistance index(HOMA-RI),the ovulation rate,pregnancy rate and uterine artery blood flow parameter value[pulsation index(PI),resistance index(RI)].Results①Compared with before treatment,Body weight was decreased in each group;BMI of group A and group C was decreased.After treatment,BMI in group C was decreased than that in group A;HOMA-RI value in each group was lower than before,all the differences were statistically significant(P<0.05).②Compared with before treatment,FSH,LH,T and LH/FSH were decreased in all groups,with statistical significance(P<0.05).After treatment,The LH value of group C was lower than that of group B and group A,there is a statistically significant between the deference(P<0.05).③The ovulation rate of group C was higher than that of group A,and that of group B was higher than that of group A,with statistical difference(P<0.05).The pregnancy rate 0f group C was higher than group B,and the data in group B was higher than that in group A,with statistical difference(P<0.05).④The PI value of uterine artery on HCG day was lower in group B than in group A,and lower in group C than in group A,with statistical difference(P<0.05).RI value of group C was lower than that of group A and B,and the conclusion was statistically significant(P<0.05).Conclusion Diane and metformin combined with acupuncture can improve endometrial receptivity and increase clinical pregnancy rate by reducing BMI,lowering LH level,and improving uterine artery RI value.Acupuncture and moxibustion can improve clinical pregnancy rate better than traditional Chinese medicine.
作者
向曦
杨雅琴
高静
田曼
Xiang Xi;Yang Yaqin;Gao Jing;Tian Man(Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,China)
出处
《世界科学技术-中医药现代化》
CSCD
北大核心
2023年第2期681-687,共7页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
湖北省自然科学基金委员会一般面上项目(2019CFB820):补肾益气和血法中药改善种植窗子宫内膜容受性的作用及其机制研究,负责人:杨雅琴
关键词
多囊卵巢综合征
胰岛素抵抗
补肾活血化痰方
针灸
子宫内膜容受性
Polycystic ovary syndrome
Insulin resistance
Chinsese herbal formula for tonifying kidney and Invigorate the circulation of phlegm
Acupuncture
Endometrial receptivity
作者简介
通讯作者:杨雅琴,副主任医师,主要研究方向:中西医结合妇科内分泌疾病及不孕症。
