Analysis of curative effect of Zishen Huoxue Decoction in treating kidney deficiency and blood stasis type of diminished ovarian reserve
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摘要:
目的 观察分析滋肾活血方治疗肾虚血瘀型卵巢储备功能减退的临床疗效，及对卵巢功能和血流的影响，为临床治疗提供依据。 方法 选取2022年7月—2023年11月宁波市中医院收治的750例卵巢储备功能减退(肾虚血瘀型)患者作为研究对象，采用随机数字表法将患者分为A组(滋肾活血方治疗)，B组(戊酸雌二醇片联合地屈孕酮片治疗)，C组(滋肾活血方+戊酸雌二醇片联合地屈孕酮片治疗)，每组250例。比较3组患者治疗效果、治疗前后血清促卵泡刺激素(FSH)、黄体生成素(LH)、抗米勒管激素(AMH)，窦卵泡数量(AFC)、卵巢体积(OV)以及卵巢基质血流指数的变化。 结果 A组、B组、C组总有效率分别为82.0%(205/250)、64.4%(161/250)、90.8%(227/250)，C组总有效率均高于B组、A组，A组总有效率高于B组(P＜0.05)。治疗后C组FSH、LH较A组及B组显著下降，A组FSH、LH较B组显著下降(P＜0.05)；C组AMH较A组及B组显著上升，A组AMH较B组显著上升(P＜0.05)。治疗后C组AFC、OV较A组及B组显著上升，A组AFC、OV较B组显著上升(P＜0.05)。治疗后C组PSV、VI、FI较A组及B组显著上升，A组VI较B组显著上升(P＜0.05)。 结论 滋肾活血方治疗肾虚血瘀型卵巢储备功能减退患者能有效调节卵巢功能，改善患者卵巢血流灌注，临床疗效显著，值得临床应用。 Abstract:Objective To observe and analyze the clinical efficacy of Zishen Huoxue Decoction in treating kidney deficiency and blood stasis type of diminished ovarian reserve, and its effect on ovarian function and ovarian blood flow, providing a basis for clinical treatment. Methods A total of 750 patients with diminished ovarian reserve (kidney deficiency and blood stasis type) admitted to Ningbo Municipal Hospital of Traditional Chinese Medicine(TCM) from July 2022 to November 2023 were selected as the study subjects, and the included patients were divided into group A (treated with Zishen Huoxue Decoction), group B (treated with estradiol valerate tablets combined with dydrogesterone tablets), and group C (treated with Zishen Huoxue Decoction + estradiol valerate tablets combined with dydrogesterone tablets) using the random number table method, with 250 patients in each group. Treatment effects, changes in follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), antral follicle count (AFC), ovarian volume (OV), and ovarian stromal flow index before and after treatment were compared among the three groups of patients. Results The total effective rates of group A, group B, and group C were 82.0% (205/250), 64.4% (161/250), and 90.8% (227/250), respectively, and the total effective rates of group C were all higher than those of group B and A, and the total effective rate of group A was higher than that of group B (P < 0.05). After treatment, FSH and LH decreased more significantly in group C than in groups A and B, and FSH and LH decreased more significantly in group A than in group B (P < 0.05). AMH rose more significantly in group C than in groups A and B, and AMH rose more significantly in group A than in group B (P < 0.05). AFC and OV rose more significantly in group C than in groups A and B after treatment, and AFC and OV rose more significantly in group A than in group B (P < 0.05). PSV, VI, and FI rose were more significantly in group C than in groups A and B after treatment, and VI levels rose was more significantly in group A than in group B (P < 0.05). Conclusion Zishen Huoxue Decoction can effectively regulate ovarian function and improve ovarian blood supply in patients with kidney deficiency and blood stasis type of diminished ovarian reserve, with remarkable clinical efficacy, and is worth applying in clinical practice. -
表 1 3组卵巢储备功能减退(肾虚血瘀型)患者一般资料比较
Table 1. Comparison of general data of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups
组别 例数 年龄范围(岁) 年龄(x±s，岁) 初潮年龄范围(岁) 初潮年龄(x±s，岁) 生育次数(x±s) A组 250 23~40 35.67±3.14 9~19 13.24±1.32 1.35±0.66 B组 250 26~40 35.94±3.05 8~18 13.15±1.36 1.38±0.64 C组 250 27~40 35.98±3.22 10~18 13.26±1.20 1.36±0.68 F值 0.725 0.492 0.159 P值 0.485 0.611 0.853 
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表 2 3组卵巢储备功能减退(肾虚血瘀型)患者临床疗效比较
Table 2. Comparison of clinical efficacy of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups
组别 例数 治愈(例) 显效(例) 有效(例) 无效(例) 有效率(%) A组 250 48 103 54 45 82.0(205/250)a B组 250 29 51 81 89 64.4(161/250) C组 250 89 75 63 23 90.8(227/250)ab χ2值 54.481 P值 ＜0.001 注：与B组比较，aP＜0.017；与A组比较，bP＜0.017。
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表 3 3组卵巢储备功能减退(肾虚血瘀型)患者FSH、LH、AMH比较(x±s)
Table 3. Comparison of FSH, LH and AMH of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups(x±s)
组别 例数 FSH(IU/L) LH(IU/L) AMH(ng/mL) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 A组 250 16.61±2.20 9.90±2.19a 7.74±2.09 6.43±2.03a 0.72±0.22 1.62±0.55a B组 250 16.67±2.15 10.70±2.16 7.79±2.04 6.88±1.94 0.70±0.23 1.31±0.53 C组 250 16.78±2.30 9.16±2.26ab 7.66±2.02 5.65±1.81ab 0.74±0.21 2.14±0.59ab F值 0.394 30.139 0.287 25.953 1.917 137.494 P值 0.675 ＜0.001 0.751 ＜0.001 0.148 ＜0.001 注：与B组比较，aP＜0.05；与A组比较，bP＜0.05。
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表 4 3组卵巢储备功能减退(肾虚血瘀型)患者AFC、OV比较(x±s)
Table 4. Comparison of AFC, OV of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups(x±s)
组别 例数 AFC(个) OV(cm3) 治疗前 治疗后 治疗前 治疗后 A组 250 3.54±1.49 5.84±2.05a 4.05±1.40 5.21±1.07a B组 250 3.52±1.60 5.34±2.07 3.94±1.30 4.73±1.02 C组 250 3.49±1.57 6.42±2.05ab 4.03±1.32 5.41±1.10a F值 0.081 18.187 0.429 28.792 P值 0.922 ＜0.001 0.652 ＜0.001 注：与B组比较，aP＜0.05；与A组比较，bP＜0.05。
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表 5 3组卵巢储备功能减退(肾虚血瘀型)患者卵巢基质动脉血流指数比较(x±s)
Table 5. Comparison of ovarian stromal artery flow index of patients with kidney deficiency and blood stasis type of diminished ovarian reserve in three groups(x±s)
组别 例数 PSV(cm/s) VI FI 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 A组 250 9.70±3.64 10.85±3.66 3.56±1.31 4.11±1.34b 25.34±3.74 26.55±3.75 B组 250 9.86±3.50 10.76±3.67 3.69±1.32 3.82±1.32 25.44±3.76 26.10±3.92 C组 250 9.63±3.40 11.17±3.90ab 3.64±1.28 4.65±1.37ab 25.51±3.74 26.95±3.82ab F值 0.273 3.954 0.651 24.531 0.128 3.089 P值 0.761 0.020 0.522 ＜0.001 0.880 0.046 注：与A组比较，aP＜0.05；与B组比较，bP＜0.05。
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