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目的探讨调更益精汤对卵巢低反应(POR)患者卵泡质量的影响及其作用机制。方法将2015年7-12月烟台毓璜顶生殖医学中心和青岛市海慈医疗集团,行体外受精-胚胎移植(IVF-ET)失败一次及以上的POR患者40例随机分为治疗组及对照组,每组20例。治疗组自月经第7天口服中药调更益精汤,服用14 d,调理3个月经周期,进入下次微刺激促排卵周期,对照组空白对照。对比两组患者性激素水平、抗苗勒管激素(AMH)、窦卵泡数(AFC)、平均卵巢体积变化;肾虚血瘀证候评分;ELISA法检测两组患者取卵日卵泡液中生长分化因子-9(GDF-9)、转化生长因子-β1(TGF-β1)、白血病抑制因子(LIF)、粒细胞集落刺激因子(G-CSF)、血管内皮生长因子(VEGF)的表达;比较两组的促性腺激素(Gn)用量、获卵数、优质胚胎率等。结果治疗组治疗后及与对照组比较卵泡刺激素(FSH)、卵泡刺激素/黄体生成素(FSH/LH)较前下降、AMH较治疗前上升,差异有统计学意义(P<0.01),早卵泡期E_2水平下降,AFC较治疗前增多,治疗前后差异有统计学意义(P<0.05)。治疗组治疗后肾虚血瘀证候评分明显低于治疗前,与对照组比较,差异有统计学意义(P<0.05)。治疗组与对照组卵泡液中GDF-9、TGF-β1、VEGF水平治疗组明显高于对照组,差异有统计学意义(P<0.01)。结论调更益精汤可以提高POR患者的卵泡质量,减少Gn用量,提高获卵数、优质卵率,其机制可能与提高卵泡液中GDF-9、TGF-β1、VEGF的水平有关。
Objective To investigate the effect of Tiaogui Yijing Decoction on follicular quality in patients with low ovarian response (POR) and its mechanism. Methods Forty POR patients who failed IVF-ET one time or more from July to December 2015 in Yantai Yuhuangding Reproductive Medicine Center and Qingdao Haitai Medical Group were randomly divided into treatment group and control group. 20 cases in each group. In the treatment group, oral administration of Yijing decoction was orally taken on the 7th day of menstruation, and for 14 days, the menstrual cycle of 3 menstrual cycles was adjusted to enter the next stimulation cycle of ovulation stimulation and the blank control of the control group. The levels of sex hormones, anti-Mullerian hormone (AMH), AFC and average ovarian volume were compared between two groups. The scores of deficiency of kidney-yang and blood-stasis syndrome were detected by ELISA. The growth and differentiation of follicular fluid The expression of GDF-9, TGF-β1, LIF, G-CSF and VEGF were compared between the two groups The amount of gonadotropin (Gn), the number of oocytes, the rate of high quality embryos and so on. Results Compared with the control group, the FSH and FSH / LH decreased and the AMH increased compared with that before treatment (P <0.01), and the difference was statistically significant Early follicular phase E 2 levels decreased, AFC increased compared with before treatment, before and after treatment, the difference was statistically significant (P <0.05). The score of syndrome of kidney deficiency and blood stasis after treatment in the treatment group was significantly lower than that before treatment, the difference was statistically significant (P <0.05). The levels of GDF-9, TGF-β1 and VEGF in treatment group and control group were significantly higher than those in control group (P <0.01). CONCLUSION: TGPGS can improve follicular quality, reduce Gn dosage, increase the number of oocytes retrieved and high quality egg. The mechanism may be related to increasing the levels of GDF-9, TGF-β1 and VEGF in follicular fluid.