IVF取卵后应用补肾活血方防治肾气虚型卵巢过度刺激综合征的临床结局与机制研究
|
摘要
目的:研究IVF取卵后应用补肾活血方对于防治肾气虚型卵巢过度刺激综合征的临床影响,并对其可能作用机制进行探讨。方法:选取符合纳入标准的输卵管阻塞性不孕症并同时符合中医辨证为肾气虚型的患者84例,根据就诊时间分为对照组和治疗组,各42例。两组患者均进行体外受精-胚胎移植(IVF-ET),在应用相同的控制性超排卵(COH)方案基础上,治疗组加用补肾活血方防治卵巢过度刺激综合征(OHSS)。比较两组患者治疗前后肾虚评分以及HCG日相关生化指标的情况,统计患者OHSS的发生率差异,并对妊娠结局的影响进行统计学分析。结果:两组患者治疗前后的肾虚评分改善情况对比,治疗组明显好于对照组(P <0. 05),差异具有统计学意义。两组患者HCG日卵泡液E2指标对比,治疗组明显高于对照组; VEGF指标对比,治疗组明显低于对照组(P <0. 05),差异具有统计学意义。两组患者OHSS发生率进行对比,治疗组明显好于对照组(P <0. 05),差异具有统计学意义。两组患者的妊娠情况进行对比,治疗组明显好于对照组(P <0. 05),差异具有统计学意义。结论:IVF-ET患者采用补肾活血方防治OHSS效果明显,能够显著降低OHSS的发生率、提高妊娠成功率,同时改善患者临床症状,其机制可能与调整机体E2及VEGF水平有关。
Objective: To study the clinical effect of Bushen Huoxue Formula on the prevention and treatment of ovarian hyperstimulation syndrome(OHSS) of Kidney-deficiency after IVF ovulation,and to explore its possible mechanism. Methods: 84 patients with oviduct obstructive infertility conform to the diagnosis of Kidney-deficiency were randomly divided into the control group(n = 42) and the observation group(n = 42). In both groups,in vitro fertilization and embryo transfer(IVF-ET) were performed. On the basis of the same controlling ovulatory hyperstimulation(COH),the observation group was intervened with Bushen Huoxue Formula to prevent OHSS. The scores of Kidney-deficiency on ovulation day and relevant biochemical indexes were compared between the two groups,the difference in the incidence of OHSS and the influence of pregnancy outcome were statistically analyzed. Results: The improvement of the scores of Kidney-deficiency was better in the observation group compared to that in the control group(P < 0. 05). E_2 index of follicular fluid during ovulation was significantly higher and the VEGF index was significantly lower in the observation group than those in the control group(P < 0. 05). The incidence of OHSS was less in the observation group than that in the control group(P < 0. 05). The pregnancy rate was significantly higher in the observation group than that in the control group(P < 0. 05). Conclusion: For IVE-ET patients,the application of Bushen Huoxue Formula to prevent and treat OHSS has obvious effects,which can significantly reduce the incidence of OHSS,increase the success rate of pregnancy,and improve the clinical symptoms of the patients. The mechanism may be related to the regulation of E_2 and VEGF.
Objective: To study the clinical effect of Bushen Huoxue Formula on the prevention and treatment of ovarian hyperstimulation syndrome(OHSS) of Kidney-deficiency after IVF ovulation,and to explore its possible mechanism. Methods: 84 patients with oviduct obstructive infertility conform to the diagnosis of Kidney-deficiency were randomly divided into the control group(n = 42) and the observation group(n = 42). In both groups,in vitro fertilization and embryo transfer(IVF-ET) were performed. On the basis of the same controlling ovulatory hyperstimulation(COH),the observation group was intervened with Bushen Huoxue Formula to prevent OHSS. The scores of Kidney-deficiency on ovulation day and relevant biochemical indexes were compared between the two groups,the difference in the incidence of OHSS and the influence of pregnancy outcome were statistically analyzed. Results: The improvement of the scores of Kidney-deficiency was better in the observation group compared to that in the control group(P < 0. 05). E_2 index of follicular fluid during ovulation was significantly higher and the VEGF index was significantly lower in the observation group than those in the control group(P < 0. 05). The incidence of OHSS was less in the observation group than that in the control group(P < 0. 05). The pregnancy rate was significantly higher in the observation group than that in the control group(P < 0. 05). Conclusion: For IVE-ET patients,the application of Bushen Huoxue Formula to prevent and treat OHSS has obvious effects,which can significantly reduce the incidence of OHSS,increase the success rate of pregnancy,and improve the clinical symptoms of the patients. The mechanism may be related to the regulation of E_2 and VEGF.
引文
[1]田莉,鹿群,沈浣,等. GnRH拮抗剂配伍HMG方案对卵巢低反应患者IVF-ET治疗结局分析[J].中国妇产科临床杂志,2008,9(1):38-40+53.
[2]何钻玉,李琳,陈晓莉,等.不同年龄段不孕患者控制性超排卵中卵巢低反应的预测[J].中国妇产科临床杂志,2011,12(6):410-413.
[3]徐慧灵,李洁,于文娟,等.控制性超排卵治疗中卵巢反应不良与反应不均一患者的临床特征[J].中华临床医师杂志(电子版),2008,2(12):1371-1377.
[4]范光升.卵巢过度刺激综合征(OHSS)[J].中国计划生育学杂志,2007,15(8):505-506.
[5] CHEN X,CHEN S L,HE Y X,et al. Minimum Dose of h CG to Trigger Final Oocyte Maturation and Prevent OHSS in a Long GnRHa Protocol[J]. Journal of Huazhong University of Science and Technology(Medical Sciences),2013,33(1):133-136.
[6]王庆一,吴玉萍,杨桂艳,等.超排卵治疗中VEGF和E2对OHSS的预测作用[J].中国实用妇科与产科杂志,2003,19(5):31-32.
[7]江依群,冯爱辉,周晔.宫腹腔镜联合下输卵管疏通术治疗不孕症的临床分析[J].实用医学杂志,2013,29(2):248-250.
[8]蔡云菲,夏亲华.输卵管性不孕症的临床治疗[J].长春中医药大学学报,2015,31(1):93-95+104.
[9]叶平,丁键红,黄丹云,等. 105例不孕症患者中医体质类型分布研究[J].浙江中医杂志,2011,46(1):24-25.
[10]梁照,许琳,鲁秋丹,等.金哲教授对IVF-ET术前调理的临床经验撷萃[J].世界中西医结合杂志,2017,12(9):1209-1212.
[11]刘金勇,王媁,刘嘉茵.自然周期和促排卵周期宫腔内人工授精临床结局的比较[J].实用妇产科杂志,2010,26(8):601-604.
[12]张金婷,杜淑英,王宁.补肾调经方药对肾虚型排卵障碍者治疗效果分析[J].中国计划生育学杂志,2014,22(7):460-464.
[13]王子一,张元珍.卵巢过度刺激综合征的预防及治疗研究进展[J].医药导报,2016,35(1):62-66.
[14]任昀,李蓉,范燕宏,等.重度卵巢过度刺激综合征发病风险因素的预测研究[J].生殖与避孕,2016,36(9):719-725+744.
[15]李蓉,曾玖芝,黄雪梅,等.中重度卵巢过度刺激综合征27例临床分析[J].实用医院临床杂志,2016,13(3):113-115.
[16]赵魁珍,周宇航.体外受精-胚胎移植后发生重度卵巢过度刺激综合征并发胸腹腔积液的治疗方法[J].检验医学与临床,2016,13(1):90-92.
[17]周芬,郝玉芳,陈岩,等.中药治疗羊水过多系统评价与Meta分析[J].北京中医药,2013,32(1):18-23.
[18]谈勇.中医药在辅助生殖技术中应用的优势与思路[J].江苏中医药,2002,34(1):7-11.
[19]吴燕虹,于燕,侯丽辉,等.补肾活血法在妇科疾病治疗中的应用探讨[J].实用中西医结合临床,2010,10(1):91-94.
[20]刘凤云,张敏,吴先哲.中医药治疗卵巢过度刺激综合征的思路与方法[J].中医杂志,2004,45(2):143-144.
[2]何钻玉,李琳,陈晓莉,等.不同年龄段不孕患者控制性超排卵中卵巢低反应的预测[J].中国妇产科临床杂志,2011,12(6):410-413.
[3]徐慧灵,李洁,于文娟,等.控制性超排卵治疗中卵巢反应不良与反应不均一患者的临床特征[J].中华临床医师杂志(电子版),2008,2(12):1371-1377.
[4]范光升.卵巢过度刺激综合征(OHSS)[J].中国计划生育学杂志,2007,15(8):505-506.
[5] CHEN X,CHEN S L,HE Y X,et al. Minimum Dose of h CG to Trigger Final Oocyte Maturation and Prevent OHSS in a Long GnRHa Protocol[J]. Journal of Huazhong University of Science and Technology(Medical Sciences),2013,33(1):133-136.
[6]王庆一,吴玉萍,杨桂艳,等.超排卵治疗中VEGF和E2对OHSS的预测作用[J].中国实用妇科与产科杂志,2003,19(5):31-32.
[7]江依群,冯爱辉,周晔.宫腹腔镜联合下输卵管疏通术治疗不孕症的临床分析[J].实用医学杂志,2013,29(2):248-250.
[8]蔡云菲,夏亲华.输卵管性不孕症的临床治疗[J].长春中医药大学学报,2015,31(1):93-95+104.
[9]叶平,丁键红,黄丹云,等. 105例不孕症患者中医体质类型分布研究[J].浙江中医杂志,2011,46(1):24-25.
[10]梁照,许琳,鲁秋丹,等.金哲教授对IVF-ET术前调理的临床经验撷萃[J].世界中西医结合杂志,2017,12(9):1209-1212.
[11]刘金勇,王媁,刘嘉茵.自然周期和促排卵周期宫腔内人工授精临床结局的比较[J].实用妇产科杂志,2010,26(8):601-604.
[12]张金婷,杜淑英,王宁.补肾调经方药对肾虚型排卵障碍者治疗效果分析[J].中国计划生育学杂志,2014,22(7):460-464.
[13]王子一,张元珍.卵巢过度刺激综合征的预防及治疗研究进展[J].医药导报,2016,35(1):62-66.
[14]任昀,李蓉,范燕宏,等.重度卵巢过度刺激综合征发病风险因素的预测研究[J].生殖与避孕,2016,36(9):719-725+744.
[15]李蓉,曾玖芝,黄雪梅,等.中重度卵巢过度刺激综合征27例临床分析[J].实用医院临床杂志,2016,13(3):113-115.
[16]赵魁珍,周宇航.体外受精-胚胎移植后发生重度卵巢过度刺激综合征并发胸腹腔积液的治疗方法[J].检验医学与临床,2016,13(1):90-92.
[17]周芬,郝玉芳,陈岩,等.中药治疗羊水过多系统评价与Meta分析[J].北京中医药,2013,32(1):18-23.
[18]谈勇.中医药在辅助生殖技术中应用的优势与思路[J].江苏中医药,2002,34(1):7-11.
[19]吴燕虹,于燕,侯丽辉,等.补肾活血法在妇科疾病治疗中的应用探讨[J].实用中西医结合临床,2010,10(1):91-94.
[20]刘凤云,张敏,吴先哲.中医药治疗卵巢过度刺激综合征的思路与方法[J].中医杂志,2004,45(2):143-144.