首页|补肾化痰活血方治疗多囊卵巢综合征合并胰岛素抵抗不孕症的临床研究

补肾化痰活血方治疗多囊卵巢综合征合并胰岛素抵抗不孕症的临床研究

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[目的]观察补肾化痰活血方治疗多囊卵巢综合征合并胰岛素抵抗(PCOS-IR)不孕症的临床疗效.[方法]将62 例肾虚痰瘀型PCOS-IR不孕症患者随机分为治疗Ⅰ组和治疗Ⅱ组,每组各 31 例.两组均给予基础干预,治疗Ⅰ组给予二甲双胍,治疗Ⅱ组给予补肾化痰活血方,治疗及随访周期均为 3 个月.统计两组的妊娠及排卵情况,比较两组治疗前后身体质量指数(BMI)、中医证候积分、糖代谢指标[空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]、性激素水平[睾酮(T)、促黄体生成素(LH)、促卵泡刺激素(FSH)、LH/FSH、雌二醇(E2)、催乳素(PRL)]、着床期(排卵后 6~9 d)子宫内膜三维超声参数[厚度、分型、容积、血管化指数(VI)、血流指数(FI)、血管化-血流指数(VFI)]和不良反应.[结果]与治疗前比较,治疗后两组的BMI、中医证候积分、FINS、HOMA-IR、LH、LH/FSH水平均降低(P<0.01 或P<0.05),且治疗Ⅱ组的中医证候积分降低显著(P<0.01).与治疗Ⅰ组比较,治疗Ⅱ组的周期排卵率较高,但比较后差异无统计学意义(P>0.05),着床期子宫内膜血流参数VI、VFI水平较高(P<0.05).治疗结束及随访后,治疗Ⅱ组的临床妊娠率分别为 61.54%(16/26)和 73.08%(19/26),明显高于治疗Ⅰ组对应时间节点的妊娠率[33.33%(8/24)和41.67%(10/24)],差异有统计学意义(P<0.05),且胚胎停育率更低(P<0.05).治疗Ⅱ组的不良反应率显著低于治疗Ⅰ组(15.38%vs 41.67%,P<0.05).[结论]补肾化痰活血方治疗肾虚痰瘀型PCOS-IR不孕症临床效果良好,能够改善胰岛素抵抗及肥胖体征,调节内分泌紊乱,显著增加着床期子宫内膜血流灌注,提高临床妊娠率并改善妊娠结局,且不良反应小,值得推广应用.
Clinical effect of Bushen Huatan Huoxue Decoction treating polycystic ovary syndrome with insulin resistance infertility
[Objective]To observe the clinical effects of Bushen Huatan Huoxue Decoction(BHHD)in the treatment of polycystic ovary syndrome with insulin resistance(PCOS-IR)infertility and its effect on endometrial receptivity.[Methods]A randomized controlled trial was conducted,62 PCOS-IR infertility patients with kidney deficiency and phlegm stasis were divided into treatment group Ⅰ and treatment group Ⅱ,31 in each group.On the premise of routine intervention,metformin was used in group Ⅰ,and BHHD was used in group Ⅱ.The treatment and follow-up period were 3 months.The cycle ovulation rate and clinical pregnancy rate were recorded.The body mass index(BMI),traditional Chinese medicine(TCM)syndrome score,glucose metabolism indexes[fasting blood glucose(FBG),fasting insulin(FINS),insulin resistance index(HOMA-IR)],sex hormone levels[testosterone(T),luteinizing hormone(LH),follicle stimulating hormone(FSH),LH/FSH,estradiol(E2),prolactin(PRL)],three-dimensional ultrasound parameters of endometrium[thickness,classification,volume,vascularization index(Ⅵ),flow index(FI),vascularization-flow index(VFI)]during implantation(6-9 days after ovulation)and adverse effects rate were detected and compared between the two groups of patients before and after the treatments.[Results]Compared with before treatment in the same group,the levels of TCM syndrome score,BMI,FINS,HOMA-IR,LH and LH/FSH of patients in two groups were reduced(P<0.01,P<0.05),and TCM syndrome score in group Ⅱ was obviously reduced(P<0.01).There was no significant difference in cycle ovulation rate between the two groups(P>0.05),and the level of Ⅵ and VFI in group Ⅱ were significantly improved compared with the group Ⅰ(P<0.05).The clinical pregnancy rate of group Ⅱ was 61.54%(16/26)and 73.08%(19/26)after treatment and follow-up,which was significantly higher than the clinical pregnancy rate at the corresponding time point in treatment group Ⅰ[33.33%(8/24)and 41.67%(10/24)](P<0.05),and the embryo abortion rate was lower(P<0.05).The adverse reaction rate of group Ⅱ was significantly lower than that of group Ⅰ(15.38%vs 41.67%,P<0.05).[Conclusion]BHHD could improve the clinical symptoms of PCOS-IR infertility patients with kidney deficiency and phlegm stasis,improved insulin resistance and obesity signs,regulated reproductive endocrine disorders,significant increased endometrial blood perfusion during implantation,promoted clinical pregnancy rate,improved pregnancy outcome and reduced the incidence of adverse reactions,and is worthy of clinical popularization and application.

Bushen Huatan Huoxue DecoctionPCOSinsulin resistancepregnancy rateendometrial blood flow

徐丹、周惠芳、刘迎、徐静、徐敏、鲍粉红、江国荣、宋清霞

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南京中医药大学附属苏州市中医医院妇一科,苏州 215009

南京中医药大学附属医院,南京 210029

南京中医药大学附属苏州市中医医院超声科,苏州 215009

南京中医药大学附属苏州市中医医院吴门医派研究院,苏州 215009

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补肾化痰活血方 PCOS 胰岛素抵抗 妊娠率 子宫内膜血流

国家自然科学基金苏州市科技发展计划(医疗卫生科技创新)项目苏州市姑苏卫生人才计划科研项目苏州市"科教兴卫"青年科技项目南京中医药大学自然科学基金

82305297SKY2021057GSWS2022082KJXW2020046XZR2020037

2024

天津中医药
天津市中医药大学,天津中西医结合学会,天津中医药学会

天津中医药

CSTPCD
影响因子:0.998
ISSN:1672-1519
年,卷(期):2024.41(2)
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