疏肝滋肾方对肝肾亏虚型卵巢储备功能下降患者性激素水平及IVF-ET治疗结局的影响

Effects of Shugan Zishen Formula on sex hormone levels and IVF-ET treatment outcomes in patients with decreased ovarian reserve function of liver and kidney deficiency type

关键词:  疏肝滋肾方  卵巢储备功能下降  卵巢微环境  卵巢储备功能  IVF-ET治疗结局

Key words:  Shugan Zishen Formula  decreased ovarian reserve function  ovarian microenvironment  ovarian reserve function  outcome of IVF-ET treatment

摘要:

[目的]探讨疏肝滋肾方对肝肾亏虚型卵巢储备功能下降患者性激素水平及体外受精-胚胎移植(IVF-ET)治疗结局的影响。[方法]选择2020年11月—2021年11月于河北省沧州中西医结合医院治疗的98例卵巢储备功能下降患者,按照随机数字表法随机分组,49例患者为西医组,给予IVF-ET治疗,49例患者为疏肝滋肾方组,在西医组基础上给予患者疏肝滋肾方治疗,比较两组患者治疗前后性激素水平[促卵泡刺激素(FSH)、黄体生成素(LH)]及生长分化因子-9(GDF-9)、抗苗勒氏管激素(AMH)、Toll样受体2(TLR2)水平,卵巢状态[卵巢动脉收缩期峰值流速(PSV)、卵巢窦卵泡数(AFC)];比较治疗前后中医证候评分;记录两组患者促性腺激素(Gn)使用剂量、成熟卵率(MII卵率)、获取卵泡个数、受精率、临床妊娠率、流产率及不良反应。[结果]治疗后,疏肝滋肾方组患者LH、FSH含量显著低于西医组、AMH含量显著高于西医组,差异有统计学意义(P＜0.05);疏肝滋肾方组患者TLR2含量显著低于西医组、GDF-9水平显著高于西医组,差异有统计学意义(P＜0.05);疏肝滋肾方组PSV、AFC显著高于西医组,差异有统计学意义(P＜0.05);疏肝滋肾方组中医证候评分显著低于西医组,差异有统计学意义(P＜0.05);疏肝滋肾方组Gn使用剂量较西医组少、获取卵泡个数较西医组多,差异有统计学意义(P＜0.05),疏肝滋肾方组受精率、MII卵率、临床妊娠率较西医组高,差异有统计学意义(P＜0.05),两组流产率比较,差异无统计学意义(P＞0.05),治疗期间两组患者均无明显不良反应产生。[结论]疏肝滋肾方治疗肝肾亏虚型卵巢储备功能下降患者,可调节患者性激素水平,抑制机体炎症,改善卵巢微环境,提升卵巢储备功能,缓解临床症状,减少Gn使用剂量,提升受精率、MII卵率、临床妊娠率,改善IVF-ET治疗结局。

Abstract:

[Objective] To investigate the effects of Shugan Zishen Formula on sex hormone levels and IVF-ET treatment outcomes in patients with decreased ovarian reserve function of liver and kidney deficiency type. [Methods] A total of 98 patients with decreased ovarian reserve function were selected from the hospital and enrolled from November 2020 to November 2021. The grouping method was random number table method. The 49 patients were in the Western medicine group and received IVF-ET treatment,while 49 patients were in the Shugan Zishen Formula group and were treated with Shugan Zishen Formula on the basis of the Western medicine group. Sex hormone levels [follicle-stimulating hormone(FSH),luteinizing hormone(LH)],growth differentiation factor-9(GDF-9),anti-Muller's tube hormone(AMH) and Toll-like receptor 2(TLR2) before and after treatment were compared between the two groups. Ovarian status [peak systolic flow rate of ovarian artery(PSV),number of follicles in ovarian sinus(AFC)];traditional Chinese medicine(TCM) syndrome score before and after treatment;The dosage of gonadotropin(Gn),egg rate of MII,number of harvested follicles,fertilization rate,clinical pregnancy rate,abortion rate and adverse reactions were recorded in the two groups. [Results] After treatment,the contents of LH and FSH in Shugan Zishen Formula group were significantly lower than those in Western medicine group,and the contents of AMH were significantly higher than those in Western medicine group,with statistical significance(P＜0.05). The TLR2 content of Shugan Zishen Formula group was significantly lower than that of Western medicine group,and GDF-9 level was significantly higher than that of Western medicine group,with statistical significance(P＜0.05). PSV and AFC in Shugan Zishen Formula group were significantly higher than those in Western medicine group,and the difference was statistically significant(P＜0.05). The TCM syndrome score of Shugan Zishen Formula group was significantly lower than that of Western medicine group,and the difference was statistically significant(P＜0.05). The dose of Gn used in Shugan Zishen Formula group was lower than that in western medicine group,and the number of follicles obtained was more than that in western medicine group,with statistical significance(P＜0.05);the fertilization rate,MII egg rate and clinical pregnancy rate in Shugan Zishen Formula group were higher than those in Western medicine group,with statistical significance(P＜0.05);there was no statistical significance in abortion rate between the two groups(P＜0.05). There was no obvious adverse reaction in both groups during treatment. [Conclusion] In the treatment of patients with decreased ovarian reserve function of liver and kidney deficiency type,Shugan Zishen Formula can adjust sex hormone levels,inhibit body inflammation,improve ovarian microenvironment,enhance ovarian reserve function,relieve clinical symptoms,reduce the dosage of Gn,increase fertilization rate,MII egg rate and clinical pregnancy rate,and improve the outcome of IVF-ET treatment.