补胞汤改善肾阳虚型黄体功能不全不孕症的临床观察

  目的  探讨补胞汤对肾阳虚型黄体功能不全不孕症的改善效果及对子宫内膜血流动力学的作用，分析用药的安全性。  方法  选取2018年3月—2019年11月就诊于温州市中医院妇科门诊的黄体功能不全性不孕症患者80例，按随机数字表法分为观察组(40例)和对照组(40例)。观察组给予补胞汤，对照组口服地屈孕酮片。连续治疗3个月经周期后观察2组患者临床疗效，采用中医肾阳虚症状积分观察患者症状改善情况，检测2组患者黄体中期血清雌二醇(E₂)、孕酮(P)水平；超声检测患者治疗前后黄体中期子宫内膜厚度、子宫动脉血流阻力指数(RI)及搏动指数(PI)；随访6个月，记录2组患者临床妊娠情况以及不良反应发生情况。  结果  观察组临床有效率明显高于对照组[87.50%(35/40) vs. 67.50%(27/40)，Z=4.588，P=0.032]；治疗后观察组中医肾阳虚症状积分低于对照组，黄体中期血清E₂、P水平高于对照组(t=9.046、4.507、5.143, 均P < 0.05)；观察组治疗后子宫内膜厚度高于对照组，RI、PI低于对照组(t=5.228、4.005、2.923, 均P < 0.05)；随访6个月，观察组临床妊娠率高于对照组(χ2=4.267，P=0.039)；2组不良反应发生情况比较差异无统计学意义(P=0.999)。  结论  补胞汤治疗肾阳虚型黄体功能不全的不孕症患者疗效显著，能够明显改善患者黄体指标，提高妊娠率。 

Clinical observation of Bu Bao Decoction in improving infertility with luteal insufficiency caused by kidney yang deficiency type

  Objective  To investigate the clinical efficacy of Bu Bao Decoction in improving infertility with luteal insufficiency caused by kidney yang deficiency type and its effect on the endometrial haemodynamics, and analyse the safety during medication.  Methods  Eighty infertility patients with luteal insufficiency who were treated in Wenzhou Traditional Chinese Medicine Gynecology Clinic from January 2018 to March 2019 were selected and randomly divided into the observation group (40 cases) and control group (40 cases). The observation group was given Bu Bao Decoction, While the control group was given dydrogesterone tablets. The patients in both groups were treated continuously for three menstrual cycles. The clinical efficacy of the two groups, the improvement of kidney yang deficiency symptoms and the serum estradiol (E₂) and progesterone (P) levels in the metaphase luteum were observed. Endometrial thickness, uterine artery blood flow resistance index (RI) and pulsatility index (PI) of patients were detected by ultrasound before and after treatment. Six-month follow-up was used to record the clinical pregnancy and adverse reactions in the two groups.  Results  The clinical effectiveness of the observation group was significantly higher than that of the control group [(35/40, 87.50%) vs. (27/40, 67.50%)], and the difference was statistically significant (Z=4.588, P=0.032). After treatment, the score of TCM kidney yang deficiency syndrome in the observation group was lower than that of the control group, and the serum E₂ and P levels in the metaphase luteum were higher than those in the control group, the difference was statistically significant (t=9.046, 4.507, 5.143, all P < 0.05). The endometrial thickness of the observation group after treatment was higher than that of the control group, while RI and PI were lower than the control group, the difference was statistically significant (t=5.228, 4.005, 2.923, all P < 0.05). After follow-up for 6 months, the clinical pregnancy rate of the observation group was higher than that of the control group, and the difference was statistically significant (χ2=4.267, P=0.039). No statistically significant difference in the occurrence of adverse reactions was found between the two groups during treatment (P=0.999).  Conclusion  Bu Bao Decoction has a significant effect on treating infertility patients with luteum insufficiency caused by kidney yang deficiency. Moreover, it can significantly improve the luteum index and increase the pregnancy rate.