世界中医药

作者	单位
金志春，郑洁，夏敏，刘杰，孙虹，雷亚兰，胡兴文，张纯，吴艳婷，叶朝阳，徐小芳，刘敏，吴璇，何联，姚娟，张倩，艾华	湖北省妇幼保健院，武汉，430070

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中文摘要:

目的:观察补肾益气和血法中药介入体外授精-胚胎移植（IVF-ET）的作用效果，并从血清和卵泡液相关生殖激素、细胞因子等指标探索补肾和血法中药改善IVF-ET妊娠结局的作用机制。方法:选取2016年1月至2019年6月湖北省妇幼保健院收治的符合研究标准的患者171例作为研究对象，随机分为观察组（n＝85）与对照组（n＝86），2组均采用短效长方案，观察组在取卵前3个月加用中药。观察2组患者不同时期的血清和卵泡液生殖内分泌激素、相关因子水平、子宫动脉血流和临床妊娠率。结果:观察组着床率、临床妊娠率分别为54.43%、68.23%，对照组分别为36.69%、53.48%，观察组优于对照组（均P<0.05）。与对照组比较，血清中观察组人绒毛膜促性腺激素（hCG）注射日、雌激素（E2）、孕激素（P）和睾酮（T）水平降低；取卵日E2、P水平降低；移植日E2水平降低；移植7日E2水平升高（均P<0.05）。取卵日和移植日血清胰岛素样生长因子-2（IGF-2）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白血病抑制因子（LIF）、转化生长因子-β1（TGF-β1）和血管内皮生长因子（VEGF）水平升高，肿瘤坏死因子-α（TNF-α）水平降低（均P<0.05）。移植7日血清IGF-2、IL-1β、IL-6、LIF和VEGF水平升高，TNF-α水平降低（均P<0.05）。卵泡液中E2水平升高，P水平降低（均P<0.05）；卵泡液中IGF-2、IL-1β、IL-6、LIF、TGF-β1和VEGF水平升高，TNF-α水平降低（均P<0.05）。与对照组比较，观察组明显改善子宫动脉血流情况（P<0.05）。结论:补肾益气和血法中药可显著改善IVF-ET妊娠结局，其机制可能与补肾益气和血法中药可以调节血清和卵泡液相关生殖激素、细胞因子和子宫动脉血流有关。

English Summary:

To observe the intervention effects of Bushen Yiqi Hexue therapy by Chinese medicine in in vitro fertilization-embryo transfer(IVF-ET) and explore the underlying mechanisms in improving IVF-ET pregnancy outcomes through the analysis of serum and follicular fluid reproductive hormones，cytokines，and related indicators.Methods:A total of 171 patients who met the research criteria and were admitted to Maternity and Child Health Care Hospital Hubei from January 2016 to June 2019 were randomly divided into a observation group(85 cases) and a control group(86 cases).Both groups underwent a short-long protocol，with the observation group additionally receiving Chinese medicine treatment for three months before oocyte retrieval.The serum and follicular fluid levels of reproductive endocrine hormones and related factors，uterine artery blood flow，and clinical pregnancy rates were observed at different time points in both groups.Results:The implantation rate and clinical pregnancy rate in the observation group were 54.43% and 68.23%，respectively，and 36.69% and 53.48% in the control group，respectively，and the observation group was superior to the control group(both P<0.05).Compared with the control group，the observation group had lower levels of human chorionic gonadotropin(hCG) on the day of injection and lower levels of estrogen(E2)，progesterone(P)，and testosterone(T) in the serum(P<0.05).On the day of oocyte retrieval，the observation group had lower E2 and P levels(P<0.05).On the day of ET，the E2 level was reduced，and on the 7th day after ET，the E2 level was higher in the observation group(both P<0.05).The observation group had higher levels of insulin-like growth factor-2(IGF-2)，interleukin-1β(IL-1β)，interleukin-6(IL-6)，leukemia inhibitory factor(LIF)，transforming growth factor-β1(TGF-β1)，and vascular endothelial growth factor(VEGF) in the serum on the day of oocyte retrieval and ET，while tumor necrosis factor-α(TNF-α) levels were lower(all P<0.05).On the 7th day after ET，the serum levels of IGF-2，IL-1β，IL-6，LIF，and VEGF were higher，and TNF-α levels were lower(all P<0.05).The observation group had a higher E2 level and a lower P level in the follicular fluid(both P<0.05)，as well as higher levels of IGF-2，IL-1β，IL-6，LIF，TGF-β1，and VEGF，and lower TNF-α levels(all P<0.05).Compared with the control group，the observation group showed significant improvement in uterine artery blood flow(P<0.05).Conclusion:Bushen Yiqi Hexue therapy by Chinese medicine significantly improves IVF-ET pregnancy outcomes，possibly through their regulation of serum and follicular fluid reproductive hormones，cytokines，and uterine artery blood flow.

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