| 王玮,马大正,杨石慧,等.补肾填精中药联合阿司匹林对反复种植失败患者子宫血液动力学及冻融胚胎移植周期妊娠结局的影响[J].浙江中医药大学学报,2019,43(8):792-797. |
| 补肾填精中药联合阿司匹林对反复种植失败患者子宫血液动力学及冻融胚胎移植周期妊娠结局的影响 |
| Effects of Kidney-tonifying Herbs Combined with Aspirin on Uterine Hemodynamics and Pregnancy Outcomes of FET Cycle in Patients with Repeated Implantation Failure |
| DOI：10.16466/j.issn1005-5509.2019.08.014 |
| 中文关键词: 反复种植失败 补胞汤 阿司匹林 子宫动脉血流 子宫内膜血流 子宫内膜容受性 |
| 英文关键词: repeated implantation failure Bubao Decoction aspirin uterine artery blood flow endometrial blood flow endometrial receptivity |
| 基金项目:浙江省中医药科技计划青年人才基金项目(2016ZQ030) |
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| 中文摘要: |
| [目的]研究反复种植失败(repeated implantation failure，RIF)患者黄体中期子宫血流灌注特征，观察补肾填精中药联合阿司匹林对子宫血液动力学及后续冻融胚胎移植(frozen-thawed embryo transfer，FET)妊娠结局的影响。[方法]利用经阴道三维/二维彩色多普勒超声检测80例RIF女性(RIF组)和40例正常育龄女性(正常对照组)黄体中期子宫内膜厚度、容积和子宫血流参数，并按随机数字表法将RIF组患者分为阿司匹林组(40例)和中药联合治疗组(40例)。阿司匹林组予阿司匹林片50mg/d口服，经期停药。中药联合治疗组在上述治疗基础上，月经周期第5天开始口服补肾填精中药(补胞汤)，每日1剂，经期停药。各组患者连续治疗2个月后，黄体中期复测子宫内膜厚度和子宫血流参数，并在治疗第3个月时进入FET周期。观察治疗前后各组子宫血液动力学的变化及FET周期妊娠结局。[结果]RIF组黄体中期子宫内膜厚度、容积、子宫内膜血管指数(vascular index，VI)、血流指数(flow index，FI)、血管血流指数(vascular flow index，VFI)均显著低于正常对照组(P＜0.05)；子宫动脉平均阻力指数(mean resistant index，mRI)、平均搏动指数(mean pulsatility index，mPI)、双侧收缩期峰值流速/舒张末期流速之和(sum of systolic/diastolic ratio value，sS/D)均显著高于正常对照组(P＜0.01)。治疗2个月后，中药联合治疗组子宫内膜厚度显著高于阿司匹林组(P＜0.01)；子宫内膜血流搏动指数(pulsatility index，PI)、收缩期峰值流速/舒张末期流速(systolic/diastolic ratio value，S/D)及子宫动脉mRI、mPI、sS/D均显著低于阿司匹林组(P＜0.05)。中药联合治疗组与治疗前比较，子宫内膜厚度显著增加，子宫血流参数均显著下降(P＜0.01)。阿司匹林组与治疗前比较，子宫内膜RI、S/D及子宫动脉血流mPI、mRI、sS/D均显著下降(P＜0.05)。与阿司匹林组比较，中药联合治疗组FET周期胚胎移植日的内膜厚度及生化妊娠率、临床妊娠率均显著增加(P＜0.05)。[结论]RIF患者黄体中期子宫血流阻力较正常育龄妇女显著增加，内膜厚度及容积则显著下降。以补肾填精为主要功效的补胞汤能改善子宫内膜厚度，增加子宫血流灌注，有利于改善患者子宫内膜容受性及早期妊娠结局。 |
| 英文摘要: |
| [Objective]To study the hemodynamic parameters of uterine at midluteal phase in patients with repeated implantation failure(RIF)and effect of kidney-tonifying herbs combined with aspirin on uterine hemodynamics and pregnancy outcomes of subsequent frozen-thawed embryo transfer (FET).[Methods] Transvaginal three/two-dimensional color Doppler ultrasonography was used to measure the parameters of uterine blood flow and the endometrial thickness, volume at midluteal phase of 80 women with RIF(RIF group) and 40 normal fertile women(normal control group).Then RIF group were assigned to the aspirin group(40 cases) and TCM combined treatment group(40 cases) according to random digit table. Aspirin group administered with aspirin 50 mg/d orally for 2 months and TCM combined treatment group plus kidney-tonifying herbs(Bubao Decoction) from the 5th day of menstruation until the menstrual period. After 2 months of continuous treatment, endometrial thickness and parameters of uterine blood flow were remeasured at midluteal phase in each group and the FET cycle was entered at the third treatment month. To observe the changes of uterine hemodynamics before and after treatment and the effect on pregnancy outcome of FET cycle.[Results] At midluteal phase, the endometrial thickness, volume, vascular index (VI), blood flow index (FI), vascular flow index (VFI) was significantly lower in RIF group than normal control group(P＜0.05).Mean pulsatility index (mPI),mean resistance index(mRI),and sum of systolic/diastolic ratio value(sS/D) of uterine arteries were significantly higher in RIF group than normal control group(P＜0.01).After 2 months treatment, the endometrial thickness was significantly increased(P＜0.01), and the endometrial pulsatility index(PI), systolic/diastolic ratio value(S/D), uterine blood flow mRI, mPI, sS/D were significantly lower in TCM combined treatment group than aspirin group(P＜0.05).In TCM combined treatment group, the endometrial thickness increased; the parameters of uterine blood flow reduced significantly than before treatment(P＜0.01).In aspirin group, the endometrial RI, S/D and uterine blood flow mPI, mRI, sS/D significantly reduced than before treatment(P＜0.05). At the ET day during FET cycle, the endometrial thickness, biochemical pregnancy rate and clinical pregnancy rate were significantly higher in TCM combined treatment group than aspirin group(P＜0.05).[Conclusion] In comparison with normal fertile women, RIF patients have significantly higher resistance of uterine blood flow, thinner endometrium and smaller endometrial volume. Bubao Decoction, with the action of kidney-tonifying can improve endometrial thickness and uterine blood perfusion, which improves endometrial receptivity and early pregnancy outcome. |
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