1. 上海市第一人民医院中医科,上海,200080
2. 上海市第一人民医院妇产科,上海,200080
3. 同济大学附属东方医院妇产科,上海,200120
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许华云, 高晓红, 王国增. 中西医结合促排卵治疗肾精不足型多囊卵巢综合征不孕症的临床观察[J]. 上海中医药杂志, 2020,54(8):66-70.
XU Huayun, GAO Xiaohong, WANG Guozeng. Clinical observation on ovulation induction of integrated Chinese and western medicine in the treatment of polycystic ovary syndrome with infertility of kidney-enssence insuficiency type[J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(8):66-70.
许华云, 高晓红, 王国增. 中西医结合促排卵治疗肾精不足型多囊卵巢综合征不孕症的临床观察[J]. 上海中医药杂志, 2020,54(8):66-70. DOI: 10.16305/j.1007-1334.2020.08.007.
XU Huayun, GAO Xiaohong, WANG Guozeng. Clinical observation on ovulation induction of integrated Chinese and western medicine in the treatment of polycystic ovary syndrome with infertility of kidney-enssence insuficiency type[J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(8):66-70. DOI: 10.16305/j.1007-1334.2020.08.007.
目的:观察育肾通络颗粒联合氯米芬促排卵治疗肾精不足型多囊卵巢综合征(PCOS)不孕症的临床疗效。 方法:纳入62例肾精不足型PCOS不孕症患者,随机分为治疗组(31例)和对照组(31例)。两组患者均在月经周期或孕酮撤退性出血第5天开始口服枸橼酸氯米芬片,连服5 d;在此基础上,治疗组患者于经净后予育肾通络颗粒口服,对照组患者予育肾通络颗粒模拟剂口服,直至排卵期。两组疗程均为3个月经周期。评价两组的临床疗效,比较两组患者的妊娠情况及中医证候积分,通过阴道超声监测患者的排卵情况和排卵期子宫内膜厚度,比较两组未妊娠患者治疗前后的睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)水平及LH/FSH比值。 结果:① 治疗后,治疗组和对照组的总有效率分别为96.8%和90.3%,两组临床疗效差异具有统计学意义(P<0.05),治疗组疗效优于对照组。②治疗组和对照组患者的排卵率分别为91.5%和75.9%,治疗组患者的排卵率高于对照组(P<0.05)。③治疗过程中,治疗组患者的妊娠率为54.8%,对照组患者的妊娠率为35.5%,两组妊娠率比较,差异无统计学意义(P>0.05)。④治疗后,治疗组患者的中医证候积分明显降低(P<0.01),且治疗组患者的积分明显低于对照组(P<0.01)。⑤在治疗的第1、第2、第3月经周期中,治疗组患者的排卵期子宫内膜厚度较对照组均明显增厚(P<0.01)。⑥治疗后,两组未妊娠患者的T、LH水平及LH/FSH比值较治疗前均明显降低(P<0.05),且治疗组患者的LH/FSH比值低于对照组(P<0.05)。 结论:育肾通络颗粒联合氯米芬治疗肾精不足型PCOS不孕症具有协同作用,可明显提高患者的排卵率,改善中医证候,增加子宫内膜厚度,改善性激素水平,其总体临床疗效优于单用氯米芬治疗。
Objective:To observe the ovulation induction effect of Yushen Tongluo Granule combined with clomiphene in treating infertility patients with polycystic ovary syndrome(PCOS) of kidney-essence insufficiency type. MethodsSixty-two infertility patients with PCOS of kidney-essence insufficiency type were included and randomly divided into the treatment group(31 cases) and the control group(31 cases). The patients in both groups were orally treated with clomiphene citrate tablet from the fifth day of the menstrual cycle or progesterone withdrawal bleeding, lasting for 5 days. Based on above, the patients in the treatment group were orally treated with Yushen Tongluo Granule and the patients in the control group were orally treated with Yushen Tongluo Granule placebo after menstruation, until ovulation.The treatment course of the two groups was 3 menstrual cycles.The clinical effect of the two groups was evaluated, the pregnancy outcomes and the scores of Chinese medical syndrome were compared between the two groups, the ovulation and the endometrial thickness of ovulatory period were monitored by transvaginal ultrasound, the levels of testosterone(T), follicle stimulating hormone(FSH), and luteinizing hormone(LH), and LH/FSH ratio in unpregnant patients were compared between the two groups before and after treatment. Results:①After treatment, the total clinical effective rates of the treatment group and the control group were 96.8% and 90.3% respectively with a significantly statistical difference between the two groups(P<0.05), and the effect of the treatment group was better than that of the control group.②The ovulation rates of the treatment group and the control group were 91.5% and 75.9% respectively, and the ovulation rate of the treatment group was higher than that of the control group(P<0.05).③In the course of treatment, the clinical pregnancy rates of the treatment group and the control group were 54.8% and 35.5% respectively, with no statistical difference between the two groups(P>0.05).④After treatment, the scores of Chinese medical syndrome in the treatment group were significantly decreased(P<0.01), and the scores of the treatment group were lower than those of the control group(P<0.01).⑤During the first, second and third menstrual cycles of treatment, the endometrial thickness of ovulatory period in the treatment group was significantly thicker than that in the control group(P<0.01).⑥After treatment, the levels of T and LH, and LH/FSH ratio of the unpregnant patients in both groups were significantly decreased compared with treatment before(P<0.05), and the LH/FSH ratio in the treatment group was lower than that in the control group(P<0.05). Conclusion:Yushen Tongluo Granule combined with clomiphene has a synergistic effect in the treatment of infertility patients with PCOS of kidney-essence insufficiency type, which can obviously enhance the ovulation rates, improve the Chinese medical syndrome, increase the endometrial thickness and improve the level of sex hormone, and its total clinical effect is better than that of clomiphene alone.
多囊卵巢综合征不孕症育肾通络颗粒氯米芬中西医结合
polycystic ovary syndromeinfertilityYushen Tongluo Granuleclomipheneintegrated Chinese and western medicine
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