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目的:探讨温肾活血法结合克罗米芬(CC)联合补佳乐在治疗排卵障碍性不孕症中的疗效。方法:将排卵障碍性不孕症患者89例随机分为A组(CC+补佳乐)、B组(温肾活血汤+CC+补佳乐)和C组(阿司匹林+CC+补佳乐)3种方案治疗。比较3组的排卵率、未破裂卵泡黄素化综合征(LUFS)发生率、妊娠率、流产率,以经阴道彩色多普勒B超测量3组治疗前、后的排卵期子宫内膜厚度、子宫动脉阻力指数(RI),观察内膜容受性。结果:A组周期排卵率为79.0%,妊娠率为23.3%,流产率为28.6%,LUFS发生率为14.8%。B组周期排卵率达87.6%,妊娠率为56.7%,流产率为0.0%,LUFS发生率为4.1%,C组周期排卵率为86.9%,妊娠率为44.8%,流产率为15.4%,LUFS发生率为8.7%,3组排卵率无统计学差异(P>0.05),3组妊娠率、流产率比较差异有统计学意义(P<0.05),其中,B组妊娠率最高,流产率最低,显著高于A组、C组(P<0.05),C组妊娠率高于A组,流产率低于A组,但差异均无统计学意义(P>0.05)。B组及C组h CG注射日子宫内膜厚度及A型子宫内膜比例明显高于A组(P<0.05),子宫动脉RI明显低于A组(P<0.05);LUFS发生率B组明显低于A组(P<0.05),C组略低于A组,但差异无统计学意义(P>0.05)。结论:温肾活血法能显著提高CC联合补佳乐治疗排卵障碍性不孕症的临床妊娠率,降低流产率,其效果好于阿司匹林。其机制主要与中药降低LUFS发生率、促进卵泡排出及改善CC对子宫内膜容受性的抑制作用有关,其改善内膜容受性的效果好于阿司匹林。
Objective: To investigate the effect of warming the kidney and activating blood circulation combined with clomiphene citrate (CC) and nongjiale on the treatment of infertility with ovulatory dysfunction. Methods: Eighty-nine patients with ovulation disorder infertility were randomly divided into three groups: A group (CC + nociceptin group), B group (Wenshenhuoxue decoction + CC + Bujiale group) and C group (aspirin + CC + Bujiale group) Program treatment. The ovulation rate, the incidence of unruptured follicular luteinizing syndrome (LUFS), pregnancy rate and abortion rate were compared between the three groups. The thickness of endometrium of ovulation group was measured by transvaginal color Doppler ultrasound before and after treatment. Arterial resistance index (RI) was measured for endometrial receptivity. Results: The ovulation rate of group A was 79.0%, the pregnancy rate was 23.3%, the abortion rate was 28.6% and the incidence of LUFS was 14.8%. The ovulation rate was 87.6% in cycle B, pregnancy rate was 56.7%, abortion rate was 0.0%, LUFS rate was 4.1%, C group cycle ovulation rate was 86.9%, pregnancy rate was 44.8%, abortion rate was 15.4%, LUFS (P <0.05). The pregnancy rate and miscarriage rate in the three groups were significantly different (P <0.05), of which the highest pregnancy rate and the lowest miscarriage rate were found in group B (P <0.05). The pregnancy rate in group C was higher than that in group A, and the abortion rate was lower than that in group A, but the difference was not statistically significant (P> 0.05). The endometrial thickness and the ratio of type A endometrium in group B and group C at h CG injection were significantly higher than those in group A (P0.05), and the RI of uterine artery in group B was significantly lower than that of group A (P0.05). The incidence of LUFS in group B (P <0.05), while in C group was slightly lower than that in A group, but the difference was not statistically significant (P> 0.05). Conclusion: Wenshenhuoxue Decoction can significantly improve the clinical pregnancy rate and reduce abortion rate of CC combined with nadrenol in treatment of infertility with ovulation disorder, the effect is better than aspirin. The mechanism is mainly related to reducing the incidence of LUFS with traditional Chinese medicine, promoting follicular discharge and improving the inhibitory effect of CC on endometrial receptivity, and its effect of improving endometrial receptivity is better than that of aspirin.