加减开郁种玉汤联合团体心理干预对肝郁肾虚型不明原因不孕症患者子宫内膜容受性的影响

Effect of Jiajian Kaiyu Zhongyu Recipe combined with group psychotherapy for the endometrial receptivity of unexplained infertility female with liver stasis and kidney deficiency syndrome

关键词:  不明原因不孕症  加减开郁种玉汤  团体心理干预  子宫内膜容受性

Key words:  unexplained infertility  Jiajian Kaiyu Zhongyu Recipe  group psychotherapy  endometrial receptivity

摘要:

[目的] 探讨加减开郁种玉汤及联合团体心理干预对不明原因不孕症（UI）患者子宫内膜容受性的影响。[方法] 选择2018年11月—2019年11月就诊于天津中医药大学第一附属医院生殖中心符合标准的90例UI患者，随机分为中药组、对照组和联合组，每组各30例。中药组于月经周期第5天开始口服加减开郁种玉汤，每日1剂，连服14 d为1个疗程，并监测排卵，指导同房，共治疗3个疗程。治疗结束后随访3个月。对照组不予任何干预，每月随访1次，观察6个月。联合组在中药组基础上予以6次团体心理干预治疗。观察各组子宫内膜容受性相关指标，包括人绒毛膜促性腺激素（HCG）日子宫内膜厚度、内膜分型、子宫内膜下血流状态及子宫动脉动力学参数，及血清血管内皮生长因子（VEGF）水平。[结果] 1）子宫内膜容受性相关性指标：联合组HCG日子宫内膜厚度、A型内膜、子宫内膜下血流、中药组HCG日子宫内膜厚度较治疗前改善（P＜0.05）；治疗后，联合组HCG日子宫内膜厚度、A型内膜、子宫内膜下血流、中药组HCG日子宫内膜厚度较对照组显著改善（P＜0.05）。联合组及中药组双侧子宫动脉血流灌注指数（PI）之和、血流阻力指数（RI）之和及血管收缩压与舒张压比值（S/D）较前显著降低（P＜0.05），对照组双侧PI之和、RI之和及S/D较前显著升高（P＜0.05）；治疗后，联合组、中药组双侧PI之和、RI之和及S/D较对照组显著降低，且联合组双侧RI之和较中药组显著降低（P＜0.05）。2）血清VEGF：联合组、中药组VEGF水平较前显著升高（P＜0.05）。[结论] 加减开郁种玉汤联合团体心理干预能够改善UI患者子宫内膜厚度、形态及子宫动脉血流灌注，进而改善子宫内膜容受性。

Abstract:

[Objective] To investigate the effect on endometrial receptivity in unexplained infertility (UI) patients with liver stasis and kidney deficiency syndrome when treated by Jiajian Kaiyu Zhongyu Recipe combined with group psychological intervention. [Methods] A total of 90 patients with UI who met the criterion from the Reproductive Center of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from November 2018 to November 2019 were randomly assigned to Traditional Chinese Medicine (TCM) group,control group and the TCM combined with group psychological intervention group (combination group).The patients in TCM group received Jiajian Kaiyu Zhongyu Recipe (JJKYZY)daily from menstrual day 5 for fourteen days eachcourse,and a total of 3 courses of treatment were taken,with follicular monitoring. The patients in the control group received expectant treatmentfor 6 months. The patients in the combination group were given 6 times of group psychological intervention on the basis of the TCM group. Indicators included theindicators related to endometrial receptivity (including endometrial thickness,endometrial classification,subendometrial blood flow status and dynamic parameters of uterine artery on HCG day),andthe level of serum vascular endothelial growth factor (VEGF). [Results] 1)The indicators related to endometrial receptivity：the endometrial thickness,type A endometrium,blood flow under the endometrium of the combination group and the endometrial thickness of TCM group were significantly improved after treatment (P＜ 0.05),and compared with the control group,the indicators mentionedabove were also significantly improved (P＜0.05). The sum of bilateral perfusion index (PI) and resistance index (RI),uterine artery systolic peak flow rate/end-diastolic flow rate ratio (S/D)of combination group and TCM group were significantly reduced after treatment (P＜0.05),while these indicators in the control group were significantly increased after treatment (P＜0.05). The indicators mentionedabove of combination group and TCM group were also significantly decreased comparing to the control group (P＜0.05),and the sum of bilateral RI of the combination group was significantly decreased comparing to the TCM group (P＜0.05). 2) The level of serum VEGF：the level of serum VEGF in the combination group and TCM group were significantly improved after treatment (P＜0.05). [Conclusion] Jiajian Kaiyu Zhongyu recipe combined with group psychotherapy can improve the endometrial thickness,morphology and uterine artery blood perfusion,thereby improve endometrial receptivity.