中药治疗隐匿型高催乳素血症伴早期复发性流产的临床研究

目的 探讨中药滋肾育胎丸治疗隐匿型高催乳素血症伴早期复发性流产的疗效。方法用促甲状腺释放激素负荷试验从151例不明原因复发性流产患者中检测出56例为隐匿型高催乳素血症，将其随机分为口服中药滋肾育胎丸（31例）及西药溴隐亭（25例）两组。检测其治疗前后围着床期血清雌二醇、孕酮的水平；并在同日行阴道超声检测子宫内膜的厚度；检测受孕8周内血清孕酮、催乳素和绒毛膜促性腺激素水平。结果治疗前后两组血清雌二醇变化差异无统计学意义，而孕酮和子宫内膜厚度的变化差异有统计学意义（分别为P〈0．01和P〈0．05）。中药组受孕29例，受孕后检测孕酮，提示黄体功能不全1例（3．4％）；流产2例，流产治愈率为87．1％（27／31）例。西药组受孕20例，黄体功能不全4例（加．0％）；流产1例，流产治愈率为76．0％（19／25）。两组黄体功能不全发生率差异有统计学意义（P〈0．05），流产治愈率差异无统计学意义（P〉0．05）。结论复发性流产与隐匿型高催乳素血症密切相关。可通过促甲状腺释放激素负荷试验检测出不明原因复发性流产中的隐匿型高催乳血症。中药滋肾育胎丸对改善黄体功能及子宫内膜的容受性优于溴隐亭。

The study on treatment for occult hyperprolactinemia with early recurrent abortion by traditional Chinese herbal medicine

Objective To investigate the effect of Zishengyutaiwan (ZSYTW), a kind of traditional Chinese herbal medicine, in treating occult hyperprolactinemia (OHP) with early recurrent abortion. Methods Fifty-six cases of OHP were detected from 151 cases with cause-unknown recurrent abortion by thyroid-releasing hormone (TRH) load test, who were randomly divided into two groups, one group (31 cases) was treated with ZSYTW and the other (25 cases) with bromocriptine as controls. Serum levels of estradiol (E_2) and progesterone (P) were measured and vaginal ultrasound scanning was performed on the 21st to 25th days of menstruation to measure their endometrial thickness for all the subjects before and after treatment. And, serum levels of P, prolactine (PL) and chorionic gonodotrophin (CGT) were measured within eight weeks of conception. Results There was no significant difference in serum level of E_2 before and after treatment in both groups. But, serum level of P and endometrial thickness showed significant difference before and after treatment between two groups (P<0.05 and P<0.01, respectively). Serum level of P indicated insufficient luteal function in one (3.4%) of 29 cases with ZSYTW after conception, with 27 successful pregnancy (87.1%) and two abortions, and insufficient luteal function in four cases (20.0%) of 20 cases with western medicine after conception, with 19 successful pregnancy (76.0%) and one abortion (P<0.05 and P>0.05, respectively). Conclusions SOHP closely related to recurrent abortion. OHP in cause-unknown recurrent abortion could be detected by TRH load test. Traditional Chinese herbal medicine ZSYTW could improve luteal function and intro-environment of endometrium more than bromocriptine could.