苍附导痰汤加减方对多囊卵巢综合征不孕症患者子宫内膜容受性的影响

目的研究苍附导痰汤加减方对多囊卵巢综合征（polycystic ovarian syndrome,PCOS）不孕症患者子宫内膜容受性的影响及作用机制。方法选取行人工授精有正常排卵的已婚女性298例为对照组,不予任何药物治疗;355例PCOS不孕症患者为治疗组,治疗组按照随机数字表法分为治疗Ⅰ组（160例）和治疗Ⅱ组（195例）,治疗Ⅰ组给予氯米芬片（clomiphene,CC）＋人绝经期促性腺激素（human menopausal gonadotropin,HMG）＋人绒毛膜促性腺激素（human chorionic gonadotropin,HCG）,治疗Ⅱ组给予CC＋HMG＋HCG＋苍附导痰汤加减方,疗程均为3个周期。观察各组患者妊娠率、监测子宫内膜厚度、螺旋动脉搏动指数（pulsatility index,PI）、阻力指数（resistance index,RI）及胰岛素抵抗（homeostasis model assessment-insulin resistance,HOMA-IR）情况,采用Western blot检测解偶联蛋白2（uncoupling protein 2,UCP2）表达。结果治疗后与对照组比较,治疗Ⅰ组子宫内膜厚度下降（P〈0.05）,子宫内膜螺旋动脉PI、RI升高（P〈0.05）;与治疗Ⅰ组比较,治疗Ⅱ组子宫内膜厚度增高（P〈0.05）,子宫内膜螺旋动脉PI、RI降低（P〈0.05）。与本组治疗前比较,治疗后治疗Ⅱ组HOMA-IR水平下降（P〈0.05）;与对照组治疗前比较,治疗前治疗Ⅰ组、Ⅱ组HOMA-IR水平均升高（P〈0.05）;与对照组治疗后比较,治疗Ⅰ组HOMA-IR水平升高（P〈0.05）,而治疗Ⅱ组HOMA-IR水平差异无统计学意义（P〉0.05）。治疗后与对照组比较,治疗Ⅱ组UCP2水平增高（P〈0.05）。随访1年结果显示：对照组妊娠率为16.1%（48/298）,治疗Ⅰ组为23.1%（37/160）,治疗Ⅱ组为33.8%（66/195）。与对照组比较,治疗Ⅱ组妊娠率升高,差异有统计学意义（P〈0.05）。结论中药苍附导痰汤加减方可提高PCOS患者妊娠率,其机制可能与其改善子宫动脉血流和胰岛素抵抗、增加UCP2表达,改善子宫内膜容受性相关,值得在临床

Effect of Modified Cangfu Daotan Decoction in Improving Endometrial Receptivity in Infertility Patients with Polycystic Ovarian Syndrome

Objective To study the effect and potential mechanism of Modified Cangfu Daotan Decoction（ MCDD）on endometrial receptivity in infertility patients with polycystic ovarian syndrome（ PCOS）. Methods Totally 298 women having normal ovulation who underwent artificial insemination were recruited as the control group,and they received no drug therapy. Another 355 infertility patients with PCOS who received ovarian stimulation therapy were recruited as the treatment group. Then they were further assigned to the treatment group Ⅰ（ 195 cases） and the treatment group Ⅱ（ 160 cases） according to random digit table. Patients in the treatment group Ⅰ received clomiphene（ CC） ＋ human menopause gonadotropin（ HMG） ＋ human chorionic gonadotropin（ HCG）,while those in the treatment group Ⅱ received CC ＋ HMG ＋ HCG and additionally took modified MCDD. The therapeutic course for all was three menstrual cycles. The pregnancy ratio,the endometrial thickness,and spiral artery pulsatility index（ PI）,resistance index（ RI）,and homeostasis model assessment-insulin re-sistance（ HOMA-IR） were measured. Furthermore,the uncoupling protein 2（ UCP2） level was tested by Western blot. Results Compared with the control group,the endometrial thickness decreased and PI and RI increased in the treatment group Ⅰ（ all P 〈0. 05）. Compared with the treatment group Ⅰ,the endometrial thickness increased and PI and RI decreased in the treatment group Ⅱ（ all P 〈0. 05）. Compared with before treatment,HOMA-IR levels were significantly decreased in the treatment group Ⅱ after treatment（ P 〈0. 05）. Compared with the control group before treatment,the HOMA-IR level increased in the treatment group Ⅰ and the treatment group Ⅱ before treatment（ P 〈0. 05）. Compared with the control group after treatment,the HOMA-IR level increased in the treatment group Ⅰ（ P 〈0. 05）. But there was no statistical difference in the post-treatment HOMA-IR level between the control group a