苍附导痰汤加减对PCOS患者子宫内膜容受性影响的临床研究

目的：观察苍附导痰汤加减方对多囊卵巢综合征（PCOS）不孕症患者子宫内膜容受性的影响。方法：选取行人工授精有正常排卵的已婚妇女50例设为对照组，不予任何药物治疗；将PCOS不孕症患者随机分为纯西药治疗I组50例（CC＋HMG＋HCG）和中西药结合治疗Ⅱ组50例（CC＋HMG＋HCG＋中药）。随访三个周期，统计妊娠率、超声观察子宫内膜螺旋动脉搏动指数（PI）和阻力指数（RI）、免疫组化和PCR法分别检测子宫内膜雌激素受体（ER）、孕激素受体（PR）、整合素B3蛋白和mRNA水平、免疫夹心法测定胰岛素抵抗情况。结果：妊娠率在治疗Ⅱ组有显著性增高。治疗I组患者的子宫内膜厚度比对照组及治疗Ⅱ组均显著性下降。治疗I组患者子宫内膜螺旋动脉PI及RI较其他二组显著性升高。治疗I组和Ⅱ组HOMA—IR较对照组显著性升高，且治疗Ⅱ组患者治疗后HOMA—IR显著下降。与对照组相比，治疗I组患者子宫内膜ER、PR蛋白和mRNA水平显著下降，而整合素B3仅蛋白水平显著下降；上述指标在治疗Ⅱ组较治疗I组有显著性升高，但与对照组比无显著性差异。结论：中药苍附导痰汤加减改善多囊卵巢综合征患者子宫内膜血流状况、提高子宫内膜ER、PR及整合素β3水平，改善胰岛素抵抗状态，增加PCOS患者子宫内膜容受性，提高其妊娠率。

Clinical Research on Effect of Cangfu Daotan Decoction on Endometrial Receptivity in PCOS Patients

Objective ： To investigate the influence of Cangfu Daotan Decoction on endometrial receptivity in PCOS pa- tients. Methods： Fifty women with normal ovulation who came to our department for artificial insemination were selected as control. PCOS patients with infertility were subdivided into two groups in randomization. Group I （ n = 50） received clomiphene, human menopause gonadotropin and human chorionic gonadotropin. Group II （ n ／ 50 ） received western medicine as in treatment group I , adding traditional Chinese medicine Cangfu Daotan Decoction. After three menstrual cycles, pregnancy ratio, endometrial thickness and spiral artery parameters and insulin resistance were measured. In ad- dition, the mRNA and protein levels of endometrial estrogen receptor（ER） , progesterone receptor（PR） and integrin 133 were detected by PCR and western blot, respectively. Results： The pregnancy rate was significantly increased in group II than that in the other groups. The endometrial thickness in group I was significantly lower than that in control group and group II. The endometrial spiral artery PI and RI were significantly increased in group I than those in the other groups. The HOMA - IR was significantly increased in both control group and group II and was significantly decreased in group II after therapy. The mRNA and protein levels of ER and PR and integrin 63 protein expression in group I were significant- ly lower than those in control group. Those parameters were also significantly increased in group II , when comparing with group I . Conclusion： We found that traditional Chinese medicine Cangfu Daotan Decoction was able to increase pregnan- cy rate in PCOS patients with infertility, which may be through increasing endometrial blood flow and ER, PR and integrin 63 expression, improving insulin resistance and finally the endometrial receptivity.