目的 观察复方玄驹胶囊联合电温针、跳跃运动通治法治疗未破裂卵泡黄素化综合征(Luteinized Unruptured Follicle Synodrome,LUFS)性不孕患者的临床疗效.方法 选取2017年1月—2019年6月期间在中国中医科学院西苑医院不孕不育科收治的LUFS性不孕患者186例.根据随机数字抽样法分为治疗组和对照组,每组各93例.治疗组给予复方玄驹胶囊+电温针+跳跃运动,对照组给予人绒膜促性腺激素肌肉注射,治疗3个月后,观察比较两组患者的临床疗效、排卵率、治疗前后促黄体生成素(Luteotropic hormone,LH)、雌二醇(Estrogen,E2)水平及排卵后1周孕酮(Progesterone Prog,P)水平和子宫内膜发育情况,并随访1年观察患者受孕情况.结果 治疗1年后,治疗组治愈率37.97％(30/79)明显优于对照组21.95％(18/82),差异有统计学意义(P<0.05).治疗后治疗组总有效率78.48％(62/79)与对照组54.88％(45/82)比较,差异有统计学意义(P<0.05).治疗后治疗组排卵率76.96％与对照组排卵率48.50％比较,差异有统计学意义(P<0.05).治疗后治疗组LH、E2、P水平均较治疗前明显升高,差异有统计学意义(P<0.05);对照组LH、P水平均较治疗前明显升高,差异有统计学意义(P<0.05);且治疗组LH、E2、P水平较对照组明显升高,差异有统计学意义(P<0.05).治疗组治疗后子宫内膜厚度较治疗前明显增厚,差异有统计学意义(P<0.05);且治疗组子宫内膜厚度较对照组明显增厚,差异有统计学意义(P<0.05).结论 复方玄驹胶囊联合电温针、跳跃运动通治法能够提高LUFS性不孕患者排卵率和受孕率,改善其子宫内膜厚度.
当归芍药散出自东汉张仲景的《金匮要略》:"妇人怀妊,腹中?痛,当归芍药散主之","妇人腹中诸疾痛,当归芍药散主之",原方用于治疗肝脾失调、气血郁滞所致腹中拘急、绵绵作痛之症.笔者根据"异病同治"的原则将当归芍药散灵活运用于多种疾病的治疗,均取得了良好的效果,兹选验案4则如下.
Objectives:To observe the effect of Yishen Huoxue decoction on improvement of uterine receptivity in patients with kidney deficiency and blood stasis infertility.Methods:A total of 60 patients with kidney deficiency and blood stasis infertility in Xiyuan Hospital Infertility Clinic of China Academy of Traditional Chinese Medicine from June 2015 to June 2016 were randomly divided into 2 groups,with 30 cases in each group.The observation group was treated with Yishen Huoxue decoction and the control group was treated with estradiol valerate.The ovulation was monitored by B ultrasonic examination.The endometrial condition was monitored by B-ultrasound 6-8 days after ovulation and the Salle score was calculated.The non-inferiority study was performed to evaluate the clinical efficacy.Results:After treatment,it was found that there were significant differences in Salle score and PI score between the two groups before and after treatment (P ＜ 0.05).The non-inferiority in observation group was higher than that in control group.The pregnancy rate of observation group and control group was 40％ (12/30) and 20％ (6/30),with statistically significant difference (P ＜ 0.5).Conclusion:Yishen Huoxue decoction can improve the blood stasis in patients with infertility and uterine receptivity,and increase pregnancy rate.
薄型子宫内膜是指子宫内膜厚度低于能够获得妊娠的阈厚度。临床超声测量子宫内膜厚度在排卵当日、人绒毛膜促性腺激素(human chorionic gonadotropin, HCG)日或激素补充治疗孕激素使用日＜7～8 mm，可诊断为薄型子宫内膜[1]。薄型子宫内膜是不孕症的主要原因，西医以雌激素(戊酸雌二醇)治疗为主，同时配合促性腺腺素释放激素类似物、小剂量阿斯匹林、西地那非、维生素 E、生长激素等[2]，但临床疗效欠佳且不良反应较大，不宜长期服用。此案以肾藏精、主生殖为根本原则，以复方玄驹为主温肾暖宫增加子宫内膜容受性(endometrial receptivity, ER)，并以中药辨证施治调和阴阳，调经助孕。
