反复种植失败患者中药左归丸干预的临床效果分析

目的:探讨反复种植失败(RIF)患者冻融胚胎移植(FET)周期中药左归丸临床应用效果。方法:选择2014年6月—2015年12月于兰州大学第一医院生殖医学专科医院采用促性腺激素释放激素激动剂(GnRHa)降调节激素替代方案准备子宫内膜进行FET周期的RIF患者80例,根据随机数字表法,分为中药组(40例)和对照组(40例)。中药组予GnRHa降调节4个周期,每个周期间加用中药左归丸14 d。对照组只予GnRHa降调节4个周期。观察2组患者降调节期间临床症状,人绒毛膜促性腺激素(h CG)日和移植日血清性激素水平及临床妊娠率,血流指标。结果:2组患者hCG日雌二醇(E_2)、黄体生成激素(LH)及移植日孕激素(P)比较差异无统计学意义(均P0.05)。中药组移植日E_2、胚胎种植率及临床妊娠率均高于对照组(均P0.05)。与对照组比较,中药组子宫内膜基底动脉阻力指数(RI)降低,阴道超声显示子宫内膜-肌层交界(EMI)区回声有所改善,差异有统计学意义(均P0.05),两组间内膜基底区搏动指数(PI)及血流分支差异无统计学意义(均P0.05)。降调期予中药治疗后潮热出汗、腰膝酸软等肾阴虚症状明显改善(均P0.05)。结论:中药左归丸可协调激素水平,改善降调节期间肾阴虚症状,改善子宫内膜血流,从而增加胚胎种植率。

Evaluation of Treatment of Zuogui Pill,a Chinese Medicine,for Recurrent Implantation Failure

Objective:To investigate the clinical effectiveness of Zuogui pill, a Chinese medicine, for those infertility women with recurrent implantation failure (RIF). Methods:Eighty infertility women with RIF were selected, who took frozen-thawed embryo transfer (FET) cycles with GnRHa down-regulation protocol. Patients were randomly divided into two groups: The Chinese medicine group was treated with Zuogui pill, a Chinese medicine (n=40), during down-regulation for 4 cycles, while the control group without Chinese medicine during their cycles (n=40). The pregnancy rate, the levels of serum hormones, the echo of EMI and endometrial blood flow under B ultrasound were assessed. Results:The levels of serum E2, LH and P on the day of hCG administation were not significantly different between the Chinese medicine group and the control group (P>0.05). The clinical pregnancy rate and the level of serum E2 in the group treated with Zuogui pill were significantly higher than those in the control group (P<0.05). Compared with control group, the Chinese medicine group had better endometrial blood flow RI and echo of EMI (P<0.05), and no significant changes in blood flow PI and blood branches of endometrium (P>0.05). Meanwhile, the adverse reaction in the Chinese medicine group, such as hot flashes and weakness of the lumbar region, were lower (P<0.05). Conclusions:Our data showed that the Zuogui pill may be benefit for the treatment of RIF, with balance of serum hormones, improvement of endometrial blood flow, and the improved clinical outcomes.