摘要
目的:客观评价中医药多途径介入低预后再次体外受精-胚胎移植(IVF-ET)拮抗剂方案患者的临床助孕疗效。方法:选取四川大学华西第二医院拟再次行IVF-ET拮抗剂方案助孕的肾阴虚肝郁血瘀型患者128例,按随机数表法分为2组,观察组(64例)予中医药多途径(中药汤剂口服+导法+耳穴贴压法)+脱氢表雄酮(DHEA)口服,对照组(64例)仅单纯DHEA口服,治疗3个月经周期后,两组患者均予拮抗剂方案进周促排、取卵、移植及移植后黄体支持,观察两组治疗前后中医证候积分、基础性激素及窦卵泡数、促性腺激素(Gn)使用情况、内膜容受性、胚胎质量及妊娠结局等指标变化情况。结果:与本组治疗前比较,观察组治疗后促卵泡生成素(FSH)/促黄体生成素(LH)、雌二醇(E2)水平明显降低,窦卵泡(AFC)个数明显增加,Gn总量和使用天数明显减少,内膜容受性相关指标(扳机日及移植日内膜厚度、扳机日A型子宫内膜占比及E2水平)、胚胎质量相关指标(成熟卵子率、受精率,正常受精率、优胚率)及中医证候积分明显改善(P<0.05,P<0.01);与对照组治疗后比较,观察组在降低FSH/LH、E2水平,增加AFC个数,减少Gn使用量,改善内膜容受性及胚胎质量,降低中医证候积分方面疗效均更优(P<0.05,P<0.01),且观察组除3例自然妊娠者外,在提高启动周期临床妊娠率、移植周期临床妊娠率、临床妊娠率,降低生化妊娠率及早期流产率方面均优于对照组(P<0.05)。结论:中医药多途径介入低预后再次IVF-ET拮抗剂方案肾阴虚肝郁血瘀型患者,能改善患者的临床症状,降低中医证候积分,改善卵巢对Gn的反应性,提高胚胎数量及质量,增长子宫内膜厚度、优化子宫内膜形态,改善子宫内膜容受性,协调子宫内膜与胚胎同步发育,增加临床妊娠率,降低生化妊娠率及早期流产率而助孕。
Objective:To objectively evaluate the clinical efficacy of multiple therapies of traditional Chinese medicine(TCM)in low-prognosis patients who received antagonist protocol for in vitro fertilization and embryo transfer(IVF-ET)again.Method:A total of 128 patients with kidney Yin deficiency,liver depression,and blood stasis who planned to receive antagonist protocol for IVF-ET in the West China Second Hospital of Sichuan University were enrolled and assigned into two groups by random number table method.The observation group(64 casces)was treated by oral administration of Chinese medicine decoction+enema of kidney-tonifying and blood-activating method+auricular point sticking+oral administration of dehydroepiandrosterone(DHEA),while the control group(64 casces)was treated by only oral administration of DHEA.After treatment for three menstrual cycles,both groups received the antagonist protocol for IVF-ET.The TCM syndrome scores,basic sex hormone levels,antral follicle count(AFC),the usage of gonadotropin(Gn),endometrial receptivity indicators,embryo quality indicators,and pregnancy outcomes were compared between the two groups.Result:After treatment,the observation group showed decreased follicle-stimulating hormone(FSH)/luteinizing hormone(LH)ratio,lowered level of estradiol(E2),increased AFC,decreased amount and days of Gn usage,improved endometrial receptivity indicators(endometrial thickness on trigger and ET days,proportion of endometrial type A in endometrial types and the level of E2 on trigger day)and embryo quality indicators(the rates of mature follicles,fertilization,normal fertilization,and premium embryos),and decreased TCM syndrome scores(P<0.05,P<0.01).Moreover,the observation group had lower FSH/LH ratio,E2 level,and amount of Gn usage,higher AFC,poorer endometrial receptivity and embryo quality indicators,and lower TCM syndrome scores than the control group after treatment(P<0.05,P<0.01).In addition,except for 3 cases of natural pregnancy,the observation group outperformed the control group in terms of improving the clinical pregnancy rates during initiation cycle and transplantation cycle and clinical pregnancy rate and decreasing biochemical pregnancy rate and early abortion rate(P<0.05).Conclusion:Combined therapies of TCM can alleviate the clinical symptoms,reduce TCM syndrome scores,reduce the Gn usage amount,improve the number and quality of embryos and endometrial receptivity,and coordinate the synchronous development of endometrium and embryo.In this way,they can increase the clinical pregnancy rate and reduce biochemical pregnancy rate and early abortion rate in the low prognosis patients with kidney yin deficiency,liver depression,and blood stasis who are undergoing IVF-ET again.
作者
张璇
夏宛廷
黄金珠
马黔红
徐云姬
曾倩
ZHANG Xuan;XIA Wanting;HUANG Jinzhu;MA Qianhong;XU Yunji;ZENG Qian(Hospital of Chengdu University of Traditional Chinese Medicine(TCM),Chengdu 610075,China;School of Nursing,Chengdu University of TCM,Chengdu 611137,China;West China Second University Hospital of Sichuan University,Chengdu 610041,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2024年第1期160-169,共10页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金委员会面上项目(81973901,82174430)
四川省科技厅重点研发项目(2020YFSY0043)。
关键词
中医药多途径
再次IVF-ET拮抗剂方案
低预后
肾阴虚肝郁血瘀
助孕疗效
combined therapies of TCM
undergoing IVF-ET again
low prognosis
kidney Yin deficiency,liver depression,and blood stasis
assisted pregnancy efficacy
