【作者】 孙振高；

【导师】 连方；

【作者基本信息】 山东中医药大学 ， 中医妇科学， 2003， 硕士

【摘要】 目的：通过实验与临床研究，观察二至天癸方在体外受精-胚胎移植过程中对卵细胞质量的影响，并对其可能的作用机理进行探讨。方法：实验研究：将80只小鼠随机分为：1组（二至天癸方配合HMG组），2组（二至天癸方组），3组（HMG组），4组（生理盐水组），对4组进行排卵试验和卵裂试验，观察二至天癸方对卵细胞质量的影响；临床研究：将33例入选的不孕患者随机分为治疗组（二至天癸方配合西药组）和对照组（西药组），观察治疗前后中医证候改善情况，测定注射HCG日血清雌激素（E₂）水平，对比两组卵细胞和胚胎形态学评分及受精率、卵裂率和妊娠率。结果：动物实验表明二至天癸方配合HMG组与HMG组在促排卵疗效上无显著性差异（P＞0.05），但是在卵细胞形态学评分及受精率、卵裂率中比较有显著性差异（P＜0.05）。临床研究表明治疗组可有效的改善患者肾虚症状，症状疗效与对照组比较有显著性差异（P＜0.05）；治疗组注射HCG日血清E₂水平略低于对照组，二者比较无显著性差异（P＞0.05），提示配合二至天癸方有减少OHSS（OHSS,ovarian hyperstimulation syndrome）发生的趋势；治疗组卵细胞及胚胎形态学评分较对照组有显著性差异（P＜0.05），进而受精率、卵裂率、妊娠率较对照组亦有显著性差异（P＜0.05）。结论：在试管婴儿技术运用的超排卵方案中，配合二至天癸方，可与西药发挥协同作用，在保证临床促排卵疗效的前提下，提高卵细胞质量，进而提高受精率、卵裂率、妊娠率。其作用机理与促卵细胞发育、改善生殖内分泌环境、调整免疫功能及提高子宫内膜容受性的中药整体调节作用有关。更多还原

【Abstract】 Objective: To study the effect of Erzhitiangui(EZHTG) decoction in improving quality of oocytes of IVF-ET program, and explore its acting mechanism. Methods: Experimental study : Eighty rats were randomly divided into four groups, the 1st, 2nd, 3rd and 4th group were respectively treated with EZHTG decoction combined with HMG, alone EZHTG decoction, alone HMG and 0. 9% brine. Ovulation and splitting ovums were observed to study the effect of EZHTG decoction to quality of oocytes. Clinical study: Thirty-three patients of sterility were randomly divided into the tested group(EZHTG decoction combined with western medicine) and the control group (western medicine), which were observed on improvement of symptoms of TCM before and after treatment and detected serum estradiol level on the day of injecting HCG. We compared the grades of oocyte and embryo morphology, fecuudation rate, splitting ovums rate and pregnancy rate of the two groups. Results: Experimental study indicated that the groups of EZHTG decoction combined with HMG and alone HMG have no differences in the effect of ovulation(P>0. 05), but the former was better than the later in the grades of embryo morphology, fecuudation rate, splitting ovums rate(P < 0. 05). Clinical study showed the tested group was obviously better than the control group in improving the insufficiency of kidney (P<0. 05). As compared with the control group, serum estradiol level of the tested group on the day of injecting HCG dropped appreciably, but had no differences(P > 0.05). This suggested the tested group had the tendency of decreasing theoccurrence of OHSS . As to the grades of oocyte and embryo morphology, fecuudation rate, splitting ovums rate and pregnancy rate, there were statistically significant differences between the two groups(P<0.05). Conclusion: EZHTG decoction had cooperation with western medicine on ovulation induction. This project not only assured the effect of ovulation induction but also elevated quality of oocytes, fecuudation rate, splitting ovums rate and pregnancy rate. The effective mechanism may have relation to the integral regulating function of Chinese herbal medicine which can promote the upgrowth of oocytes,adjust immune function, improve the level of reproductive endocrine, quality of oocytes and endometrial receptivity.更多还原