多囊卵巢综合征患者中医体质分布及其对体外受精-胚胎移植助孕的影响

目的分析多囊卵巢综合征(PCOS)患者中医体质分布情况,并探讨中医体质对体外受精-胚胎移植助孕的影响。方法计算2014年4月—2018年2月在济宁市第一人民医院生殖医学科接受首个周期体外受精-胚胎移植助助孕的241例PCOS患者《中医体质量表》得分,根据得分判定所属体质。比较3种常见中医体质类型患者(痰湿质、气郁质、平和质)一般资料、Gn时间、Gn总量、卵子及胚胎情况、妊娠结局。结果241例PCOS患者中,痰湿质96例(39.83%),气郁质49例(20.33%),平和质38例(15.77%),湿热质20例(8.30%),阳虚质18例(7.47%),瘀血质10例(4.15%),阴虚质5例(2.07%),气虚质3例(1.24%),特禀质2例(0.83%),以痰湿质、气郁质、平和质为主要体质类型。3种常见中医体质类型患者年龄、不孕年限、基础促卵泡生成素(FSH)水平、基础促黄体生成素(LH)水平、抗苗勒管激素(AMH)水平、获卵数、可移植胚胎数、移植胚胎数、临床妊娠率、异位妊娠率、活产率、卵巢过度刺激综合征发生率比较差异均无统计学意义(P均>0.05);痰湿质患者体质量指数、睾酮(T)水平、促性腺激素(Gn)用量、Gn应用时间均明显高于/长于气郁质、平和质患者(P均<0.05);气郁质患者自然流产率为23.81%(5/21),痰湿质为9.09%(4/44),平和质为0,3种常见中医体质类型患者间自然流产率比较差异有统计学意义(P<0.05)。结论接受体外受精-胚胎移植助孕的PCOS患者整体偏颇体质以痰湿质、气郁质为主;偏颇体质对助孕过程及结局有负面影响,早期调整偏颇体质对改善助孕结局有一定积极意义。

A Study on TCM constitution of patients with polycystic ovary syndrome and the influence on outcomes of in vitro fertilization-embryo transfer

Objective It is to analyze the traditional Chinese medicine(TCM)constitution of patients with polycystic ovary syndrome(PCOS)and the influence on outcomes of in vitro fertilization-embryo transfer.Methods A total of 241 PCOS patients accepted the first cycle of IVF/ICSI-ET in the Department of Reproductive Medicine of Jining First People's Hospital from April 2014 to February 2018 were divided into different groups according to their scores of TCM constitutions questionnaires.Three common TCM constitution types(phlegm-dampness constitution,qi-stagnation constitution,balanced constitution)of PCOS patients were obtained.The main outcomes measured were basic clinical datas,the dosage of gonadotropins(Gn),the duration of Gn treatment,oocyte and embryo conditions,pregnancy outcomes.Results Of the 241 patients with PCOS,there were 96 ones with phlegm-dampness constitution(39.83%),49 ones with qi-stagnation constitution(20.33%),38 ones with balanced constitution(15.77%),20 ones with damp-heat constitution(8.30%),and 18 cases with yang deficiency constitution(7.47%),10 cases with blood stasis constitution(4.15%),5 cases with yin deficiency constitution(2.07%),qi deficiency in 3 cases(1.24%),idiopathic constitution in 2 cases(0.83%),phlegm-dampness constitution,qi-stagnation constitution,balanced constitution were the main physical types.There were no significant differences in the age,infertility years,basal follicle stimulating hormone(FSH)level,basal luteinizing hormone(LH)level,anti-Müllerian hormone(AMH)level,number of eggs obtained,number of transplantable embryos,number of transferred embryos,clinical pregnancy rate,ectopic pregnancy rate,live birth rate,and the incidence of ovarian hyperstimulation syndrome in the three common constitution(P>0.05).The body mass index,testosterone(T)level,gonadotropin(Gn)dosage,and Gn application time were significantly higher/longer of phlegm-dampness constitution than those in qi-stagnation and balanced constitution(P<0.05);the natural abortion rate of Qi-stagnation patients was 23.81%(5/21),that of sputum dampness was 9.09%(4/44),and balanced constitution was 0.There was a significant difference in the natural abortion rate among the three common TCM constitution types(P<0.05).Conclusion The overall biased physique of PCOS patients receiving IVF-embryo assisted pregnancy is mainly phlegm-dampness constitution and qi stagnation constitution;Unbalanced constitutions had negative effects on the process and outcomes of assisted pregnancy.The early adjustments to the unbalanced constitution are positive for improving the pregnancy outcomes.