【作者】 刘卉；

【导师】 连方；

【作者基本信息】 山东中医药大学 ， 中医妇科学， 2007， 博士

【摘要】 目的:探讨体外受精-胚胎移植(IVF-ET)降调节后的证候特点,及证候与子宫内膜容受性的相关性。方法:临床研究对200例行IVF-ET的患者,采用流行病学调查方法,结合聚类分析总结IVF-ET降调节后的中医证候特点;同时应用以药测证的方法,对60例行IVF-ET的患者进行系统的临床观察,其中中药治疗组30例,对照组30例。分别对两组患者中医证候积分变化、子宫内膜血流、优质卵率、受精率、优质胚胎率、妊娠率及临床妊娠率进行评定。实验研究分别采用GnRH-a降调节小鼠模型和GnRH-a超排卵小鼠模型,与正常小鼠及加用二至天癸颗粒小鼠对照,观察对阴道涂片、子宫、卵巢指数、子宫、卵巢组织形态学、血浆cAMP、cGMP含量、子宫内膜HOXA10mRNA表达的影响。结果:聚类分析结果表明IVF-ET降调节后主要表现为肾虚证,以肾阴虚为主,兼有肾阳虚症状。经补肾中药二至天癸颗粒治疗后,可明显改善患者肾虚症状。GnRH-a降调节后,小鼠体重下降;阴道涂片表现动情间期;子宫、卵巢指数下降;子宫内膜厚度明显变薄,腺体显著减少,部分腺体萎缩消失;卵泡层次紊乱,部分卵泡闭锁,部分卵泡细胞坏死,炎细胞浸润,部分间质纤维组织增生;cAMP含量及cAMP/cGMP比值明显升高;HOXA10基因表达下调;二至天癸颗粒可改善上述指标;从微观角度证实其肾虚本质。二至天癸颗粒还可通过改善子宫内膜血流及GnRH-a超排卵小鼠着床期子宫内膜组织形态学指标、提高cAMP含量、上调HOXA10基因发挥改善子宫内膜容受性的作用。结论:体外受精-胚胎移植降调节后主要表现为肾虚证,以肾阴虚为主,补肾中药二至天癸颗粒可提高子宫内膜容受性,表明了肾虚与子宫内膜容受性的相关性。为中医药在IVF-ET的应用提供依据,丰富了中医肾主生殖的理论内涵。更多还原

【Abstract】 Objective: To study the characteristics of Traditional Chinese Medical syndrome after in vitro fertilization and embryo transfer (IVF-ET) down regulation and the relationship between Traditional Chinese Medical syndrome and endometrial receptivity.Methods: In clinical study, 200 infertile patients undergoing IVF-ET were studied using epidemiologic method and cluster analysis, and the method of syndrome differentiation by effects of drug was also employed to determine the characteristics of Traditional Chinese Medical syndrome after IVF-ET down regulation. In experimental study, the mice model of GnRH-a down regulation and GnRH-a assisted controlled ovarian hyperstimulation were adopted, compared with the normal group and the TCM group. Vaginal smear, the index of uterine and ovary were observed; the endometrial and ovarian morphology were investigated by light microscope; the concentration of cAMP and cGMP were measured by radioimmunoassay (RIA) and the expression of HOXA10 in the endometrium was detected by in situ hybridization method.Results: According to the cluster analysis, the characteristics of Traditional Chinese Medical Syndrome of IVF-ET down regulation were identified as deficiency of kidney which were mainly yin deficiency of kidney combined with the symptom of yang deficiency of kidney. And symptoms of Shenxu had been significantly improved by taking Erzhi Tiangui Granules. In experimental study, the characteristics were also proved. And Erzhi Tiangui Granules can improve the endometrial receptivity by enhancing the blood perfusion in the endometrium, ameliorating morphological index in mice endometrial tissue and increasing the concentration of cAMP and expression of HOXA10.Conclusion: The characteristics of Traditional Chinese Medical syndrome of IVF-ET down regulation are identified as deficiency of kidney which are mainly yin deficiency of kidney, and the endometrial receptivity can be improved by tonifying kidney, which indicated the relationship between the deficiency of kidney and the endometrial receptivity.更多还原