知柏地黄丸对卵巢储备功能低下性激素及妊娠的影响及其作用机制研究
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摘要
目的:评价知柏地黄丸对卵巢储备功能低下性激素水平以及妊娠的影响,同时探讨其相关作用机制。方法:选取2017年1月至2018年1月无锡市中西医结合医院收治的卵巢储备功能低下患者60例纳入研究,按照随机数字表法随机分为对照组和观察组,每组30例,对照组口服戊酸雌二醇片,1 mg/次,1次/d。观察组在对照组基础上加用知柏地黄丸,8丸/次,3次/d。2组均连续治疗3个月经周期,疗程结束后比较2组患者中医证候积分、子宫内膜厚度、子宫动脉血流频谱变化,妊娠率、月经恢复率以及卵泡刺激素(FSH)、雌二醇(E2)、促黄体生成素(LH)、血清抗苗勒管激素(AMH)基础窦卵泡数(AFC)的差异。结果:1) 2组患者治疗后中医症状积分均有所下降,与治疗前比较,差异有统计学意义(P <0. 05),2组比较显示观察组分值明显低于对照组,差异有统计学意义(P <0. 05); 2)经过治疗后观察组妊娠率为50%,月经恢复率为90%,流产率33. 33%,与对照组的26. 67%、60%及87. 5%比较,差异均有统计学意义(P <0. 05),观察组疗效优于对照组; 3)治疗前2组患者的各激素指标水平差异无统计学意义(P> 0. 05),经过3个月经周期的治疗,2组FSH、E、LH均下降,组间比较显示观察组优于对照组(P <0. 05),2组AMH表达均增加,观察组增加的幅度较对照组明显,差异有统计学意义(P <0. 05); 4)治疗后2组子宫内膜厚度均明显上调,子宫动脉的阻力指数以及搏动指数均下降,与治疗前比较差异有统计学意义(P <0. 05),经过3个月经周期的治疗,组间比较显示观察组优于对照组(P <0. 05)。结论:知柏地黄丸可有效纠正卵巢储备功能低下,其作用机制与调整机体激素水平,增强卵泡敏感度有关,临床建议推广运用。
Objective: To evaluate the effects of Zhibai Dihuang Pills on hormone levels,and pregnancy,and ovarian reserve dysfunction,and to explore its related mechanism. Methods: A total of 60 patients with low ovarian reserve function were enrolled in the study and were randomly divided into control group( n = 30) and observation group( n = 30) by digital random table method.The control group was given estradiol valerate tablets 1 mg/day. The observation group was added with Zhibai Dihuang Pills 8 pills/time and 3 times/d on the basis of the control group. The two groups were treated continuously for 3 menstrual cycles. After the treatment,the scores of TCM syndrome,the thickness of the endometrium,the spectrum of uterine artery blood flow,the pregnancy rate,the rate of menstrual recovery,follicular stimulating hormone( FSH),estradiol( E),luteinizing hormone( LH) and the basal sinus follicle( AFC),and serum anti-Mullerian hormone( AMH) were compared. Results: 1) The scores of TCM syndromes in the two groups were decreased compared with that before treatment,and the difference was statistically significant( P < 0. 05). The two groups showed that the score of the observation group was significantly lower than that of the control group,and the difference was statistically significant( P < 0. 05). 2) After treatment,the pregnancy rate of the observation group was 50%,and the recovery rate of menstruation was 90%. The abortion rate was 33. 33%,and the effect of the observation group was better than that of the control group( 26. 67%,60% and 87. 5%),and the difference was statistically significant( P < 0. 05). 3) There was no significant difference in the level of hormone indexes between the two groups before treatment( P > 0. 05). After 3 menstrual cycles,the FSH,E and LH of the two groups decreased. The comparison between the groups showed that the observation group was superior to the control group( P < 0. 05). The AMH expressions of the two groups increased,and the increase of the observation group was significantly higher than that of the control group. The difference was statistically significant( P < 0. 05). 4) After treatment,the thickness of endometrium in the two groups was obviously up-regulated,and the resistance index of the uterine artery and the pulsation index were all decreased compared with that before the treatment,and the difference was statistically significant( P < 0. 05). After 3 menstrual cycles,the comparison between the groups showed that the observation group was superior to the control group( P < 0. 05). Conclusion: Zhibai Dihuang Pills can effectively improve the low ovarian reserve function,and its mechanism relates to adjusting the level of body hormone and enhancing the sensitivity of follicle,and it is recommended in clinical practice.
Objective: To evaluate the effects of Zhibai Dihuang Pills on hormone levels,and pregnancy,and ovarian reserve dysfunction,and to explore its related mechanism. Methods: A total of 60 patients with low ovarian reserve function were enrolled in the study and were randomly divided into control group( n = 30) and observation group( n = 30) by digital random table method.The control group was given estradiol valerate tablets 1 mg/day. The observation group was added with Zhibai Dihuang Pills 8 pills/time and 3 times/d on the basis of the control group. The two groups were treated continuously for 3 menstrual cycles. After the treatment,the scores of TCM syndrome,the thickness of the endometrium,the spectrum of uterine artery blood flow,the pregnancy rate,the rate of menstrual recovery,follicular stimulating hormone( FSH),estradiol( E),luteinizing hormone( LH) and the basal sinus follicle( AFC),and serum anti-Mullerian hormone( AMH) were compared. Results: 1) The scores of TCM syndromes in the two groups were decreased compared with that before treatment,and the difference was statistically significant( P < 0. 05). The two groups showed that the score of the observation group was significantly lower than that of the control group,and the difference was statistically significant( P < 0. 05). 2) After treatment,the pregnancy rate of the observation group was 50%,and the recovery rate of menstruation was 90%. The abortion rate was 33. 33%,and the effect of the observation group was better than that of the control group( 26. 67%,60% and 87. 5%),and the difference was statistically significant( P < 0. 05). 3) There was no significant difference in the level of hormone indexes between the two groups before treatment( P > 0. 05). After 3 menstrual cycles,the FSH,E and LH of the two groups decreased. The comparison between the groups showed that the observation group was superior to the control group( P < 0. 05). The AMH expressions of the two groups increased,and the increase of the observation group was significantly higher than that of the control group. The difference was statistically significant( P < 0. 05). 4) After treatment,the thickness of endometrium in the two groups was obviously up-regulated,and the resistance index of the uterine artery and the pulsation index were all decreased compared with that before the treatment,and the difference was statistically significant( P < 0. 05). After 3 menstrual cycles,the comparison between the groups showed that the observation group was superior to the control group( P < 0. 05). Conclusion: Zhibai Dihuang Pills can effectively improve the low ovarian reserve function,and its mechanism relates to adjusting the level of body hormone and enhancing the sensitivity of follicle,and it is recommended in clinical practice.
引文
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[8]崔晓萍,陈蕊,张勤,等.循期阴阳序贯疗法改善卵巢早衰前期卵巢储备功能的临床研究思路探讨[J].陕西中医,2010,31(2):198-199.
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[11]Gleicher N,Darmon S K,Kushnir V A,et al. How FSH and AMH reflect probabilities of oocyte numbers in poor prognosis patients with small oocyte yields[J]. Endocrine,2016,54(2):476-483.
[12]惠雪莲,丁红卫,舒瑾.补肾方治疗卵巢储备能力下降100例[J].陕西中医,2014,35(11):1443-1444.
[13]来玉芹.卵巢储备功能下降的中医药研究进展[J].光明中医,2011,26(8):1739-1740.
[14]彭连双,张志强,孙建辉,等.知柏地黄丸加减治疗女性更年期综合征108例疗效观察[J].中医临床研究,2015,7(16):124-125.
[15]闫军红.知柏地黄丸联合雌激素补充治疗更年期综合征的疗效评价[J].实用妇科内分泌电子杂志,2015,2(11):118-119.
[16]刘惠玉.知柏地黄丸治疗女性更年期综合征105例[J].中医临床研究,2015,7(17):118.
[17]Maculan R,Pinto T,Moreira G M,et al. Anti-Mullerian Hormone(AMH),antral follicle count(AFC),external morphometrics and fertility in Tabapua cows[J]. Anim Reprod Sci,2018,189:84-92.
[18]王馥新,孟庆霞,邹琴燕,等.多囊卵巢综合征患者显著升高的抗苗勒管激素水平对超促排卵的影响[J].中华生殖与避孕杂志,2017,37(1):22-26.
[19]李莹,杨晓庆,杨晓葵.抗苗勒管激素和抑制素B预测卵巢储备功能的临床研究[J].实用妇产科杂志,2014,30(1):26-29.
[2]陈文俊,李慧芳,周蓓蓓,等.卵巢储备功能低下评估及治疗方法研究进展[J].实用医学杂志,2016,32(1):19-22.
[3]陈映辉.补肾方治疗卵巢储备能力下降疗效评估报道[J].母婴世界,2015,15(10):37-37.
[4]周笑梅,陈颖异.补肾活血中药治疗卵巢储备功能低下的机制概述[J].中国中医药科技,2014,21(3):345-346.
[5]彭玉清,刘洋,葛辛.卵巢功能储备功能不足的中医调治[Z].深圳:2015383-385.
[6]翁晓晨,张勤华,张琦,等.滋补肝肾法治疗卵巢储备功能低下型不孕的案例分析[Z].昆明:201668-69.
[7]丁岩,刘新莲.卵巢早衰的临床诊治[J].中国计划生育和妇产科,2014,33(2):10-13,21.
[8]崔晓萍,陈蕊,张勤,等.循期阴阳序贯疗法改善卵巢早衰前期卵巢储备功能的临床研究思路探讨[J].陕西中医,2010,31(2):198-199.
[9]Kitajima M,Khan K N,Harada A,et al. Association between ovarian endometrioma and ovarian reserve[J]. Front Biosci(Elite Ed),2018,10:92-102.
[10]Chen Q,Wang Y,Sun L,et al. Controlled ovulation of the dominant follicle using progestin in minimal stimulation in poor responders[J]. Reprod Biol Endocrinol,2017,15(1):71.
[11]Gleicher N,Darmon S K,Kushnir V A,et al. How FSH and AMH reflect probabilities of oocyte numbers in poor prognosis patients with small oocyte yields[J]. Endocrine,2016,54(2):476-483.
[12]惠雪莲,丁红卫,舒瑾.补肾方治疗卵巢储备能力下降100例[J].陕西中医,2014,35(11):1443-1444.
[13]来玉芹.卵巢储备功能下降的中医药研究进展[J].光明中医,2011,26(8):1739-1740.
[14]彭连双,张志强,孙建辉,等.知柏地黄丸加减治疗女性更年期综合征108例疗效观察[J].中医临床研究,2015,7(16):124-125.
[15]闫军红.知柏地黄丸联合雌激素补充治疗更年期综合征的疗效评价[J].实用妇科内分泌电子杂志,2015,2(11):118-119.
[16]刘惠玉.知柏地黄丸治疗女性更年期综合征105例[J].中医临床研究,2015,7(17):118.
[17]Maculan R,Pinto T,Moreira G M,et al. Anti-Mullerian Hormone(AMH),antral follicle count(AFC),external morphometrics and fertility in Tabapua cows[J]. Anim Reprod Sci,2018,189:84-92.
[18]王馥新,孟庆霞,邹琴燕,等.多囊卵巢综合征患者显著升高的抗苗勒管激素水平对超促排卵的影响[J].中华生殖与避孕杂志,2017,37(1):22-26.
[19]李莹,杨晓庆,杨晓葵.抗苗勒管激素和抑制素B预测卵巢储备功能的临床研究[J].实用妇产科杂志,2014,30(1):26-29.