聂林　王红霞　黄素丽

[摘要] 目的 探討对多囊卵巢综合征（PCOS）不孕症（痰湿内蕴证）患者实施补肾活血化痰调周中药联合西药治疗的效果。 方法 将我院妇产科门诊2015年7月～2017年1月收治的180例PCOS不孕症（痰湿内蕴证）患者根据计算机生成的随机数表分为西药组和中西药组，均给予常规西药，后者另给予补肾活血化痰调周中药。对比治疗前后中医证候积分、血清性激素水平、子宫内膜容受性变化，评价安全性，随访6个月并统计排卵率和自然妊娠率。 结果 治疗后两组中医证候积分、卵泡生成激素（FSH）、睾酮（T）、子宫内膜螺旋动脉搏动指数（PI）、阻力指数（RI）均显著降低（P<0.05），且中西药组均低于西药组（P<0.05），而雌二醇（E2）、黄体生成素（LH）、子宫内膜厚度（ET）均显著升高（P<0.05），且中西药组均高于西药组（P<0.05）；中西药组不良反应发生率与西药组相近（P>0.05）；中西药组排卵率和自然妊娠率均高于西药组（P<0.05）。 结论 补肾活血化痰调周中药联合西药治疗PCOS不孕症（痰湿内蕴证）患者能够减轻症状，改善血清性激素水平和子宫内膜容受性，促进排卵，还可提升自然妊娠率，且并不会显著增加不良反应。

[关键词] 补肾活血化痰调周；多囊卵巢综合征不孕症；痰湿内蕴证；性激素；子宫内膜容受性

[中图分类号] R285.6 [文献标识码] B [文章编号] 1673-9701（2018）12-0059-04

Analysis on the therapeutic effect of Tonifying the kidney， promoting blood circulation and removing phlegm regulating Chinese medicine combined with western medicine on PCOS infertility （Intrinsic Phlegm Dampness Syndrome）

NIE Lin WANG Hongxia HUANG Suli XIONG Jie

Department of Gynecology and Obstetrics， Xiaogan Women and Children's Hospital in Hubei Province， Xiaogan 432000， China

[Abstract] Objective To investigate the effect of Tonifying kidney， promoting blood circulation and removing phlegm regulating traditional Chinese medicine combined with western medicine for the patients with polycystic ovary syndrome （PCOS） complicated with infertility（intrinsic phlegm dampness syndrome）. Methods 180 patients with PCOS infertility （intrinsic phlegm dampness syndrome） who were admitted to the obstetrics and gynecology clinic of our hospital from July 2015 to January 2017 were divided into western medicine group and Chinese medicine and western medicine group according to computer generated random number table. All of them were given conventional western medicine. The latter was further given tonifying kidney， promoting blood circulation and removing phlegm regulating traditional Chinese medicine. Before and after treatment， changes of TCM syndrome scores， serum sex hormone levels， and endometrial receptivity were compared， and the safety was evaluated. The patients were followed up for 6 months and the ovulation rate and natural pregnancy rate were statistically analyzed. Results After treatment， the TCM syndrome scores， FSH， T， PI and RI in both groups were significantly decreased （P<0.05）， and the levels in Chinese medicine and western medicine group were all lower than those in the western medicine group（P<0.05）. Estradiol（E2）， luteinizing hormone （LH） and endometrial thickness （ET） were significantly increased （P<0.05）， and the levels in Chinese medicine and western medicine group were all higher than those in the western medicine group（P<0.05）； the incidence rate of adverse reactions in the Chinese medicine and western medicine group was similar to that in the western medicine group（P>0.05）； the ovulation rate and natural pregnancy rate in the Chinese medicine and western medicine group were higher than those in the western medicine group（P<0.05）. Conclusion Tonifying kidney，promoting blood circulation and removing phlegm regulating traditional Chinese medicine combined with western medicine in the treatment of polycystic ovary syndrome（PCOS） complicated with infertility（intrinsic phlegm dampness syndrome） can reduce symptoms， improve serum sex hormone levels and endometrial receptivity， promote ovulation， but also improve the rate of natural pregnancy， while does not significantly increase adverse reactions.

[Key words] Tonifying kidney，promoting blood circulation and removing phlegm regulating； Polycystic ovary syndrome （PCOS）； Intrinsic phlegm dampness syndrome； Sex hormones； Endometrial receptivity

多囊卵巢综合征（Polycystic ovary syndrome，PCOS）是妇产科常见的一种内分泌及代谢异常综合征，以月经稀发、高雄激素血症、多毛、痤疮和肥胖等为主要临床表现。据统计[1]，我国育龄期女性中PCOS的发病率大约为6%～10%，容易诱发不孕，在PCOS不孕症在所有不孕症患者中的构成比约为75%，对我国女性的生殖健康可造成严重的危害。PCOS不孕症患者常采用来曲唑促排卵治疗，但是由于作用靶点单一，疗效不甚理想[2]。现代中医学家认为[3]，PCOS不孕症患者多见湿热内蕴证型，痰湿阻滞、气血瘀滞、肝肾亏虚、肝经湿热等均是此类中医证型患者常见的中医病因。鉴于此，本研究特筛选孝感市妇幼保健院180例患者展开分组对照试验，重点探讨补肾活血化痰调周法对湿热内蕴证型患者的治疗作用，以期为临床治疗提供一种行之有效、安全可靠的方案，现报道如下。……