Ding Cai-Fei, Wang Chen-Ye, Yang Xin, Zheng Ruo-Heng, Yan Zhi-Zhong, Chen Wang-Qiang
Department of Reproductive Disease, Zhejiang Provincial Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Hangzhou, China.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2014 Nov;34(11):1297-301.
To study the effect and potential mechanism of Modified Cangfu Daotan Decoction (MCDD) on endometrial receptivity in infertility patients with polycystic ovarian syndrome (PCOS).
Totally 298 women having normal ovulation who underwent artificial insemination were recruited as the control group, and they received no drug therapy. Another 355 infertility patients with PCOS who received ovarian stimulation therapy were recruited as the treatment group. Then they were further assigned to the treatment group I (195 cases) and the treatment group II (160 cases) according to random digit table. Patients in the treatment group I received clomiphene (CC) + human menopause gonadotropin (HMG) +human chorionic gonadotropin (HCG), while those in the treatment group II received CC + HMG + HCG and additionally took modified MCDD. The therapeutic course for all was three menstrual cycles. The pregnancy ratio, the endometrial thickness, and spiral artery pulsatility index (PI), resistance index (RI), and homeostasis model assessment-insulin resistance (HOMA-IR) were measured. Furthermore, the uncoupling protein 2 (UCP2) level was tested by Western blot.
Compared with the control group, the endometrial thickness decreased and PI and RI increased in the treatment group I (all P < 0.05). Compared with the treatment group I , the endometrial thickness increased and PI and RI decreased in the treatment group II (all P < 0.05). Compared with before treatment, HOMA-IR levels were significantly decreased in the treatment group II after treatment (P < 0.05). Compared with the control group before treatment, the HOMA-IR level increased in the treatment group I and the treatment group II before treatment (P < 0.05). Compared with the control group after treatment, the HOMA-IR level increased in the treatment group I (P < 0.05). But there was no statistical difference in the post-treatment HOMA-IR level between the control group and the treatment group II (P < 0.05). Compared with the control group, the post-treatment UCP2 level was increased in the treatment group II (P < 0.05). After one year follow-up, the pregnancy rate was 16.1% (48/298) in the control group, 23.1% (37/160) in the treatment group I, and 33.8% (66/195) in the treatment group II. Compared with the control group, the pregnancy rate was significantly increased in the treatment group II (P < 0.05).
MCDD was found to be capable of increasing the pregnancy rate of infertility patients with PCOS, which might be associated with improving endometrial blood flow and insulin resistance, increasing the UCP2 expression, and finally improving the endometrial receptivity.
探讨加味苍附导痰汤（MCDD）对多囊卵巢综合征（PCOS）不孕患者子宫内膜容受性的影响及潜在机制。
选取298例排卵正常且接受人工授精的女性作为对照组，不进行药物治疗。另选取355例接受促排卵治疗的PCOS不孕患者作为治疗组，再根据随机数字表将其分为治疗组I（195例）和治疗组II（160例）。治疗组I患者接受氯米芬（CC）+人绝经期促性腺激素（HMG）+人绒毛膜促性腺激素（HCG）治疗，治疗组II患者接受CC+HMG+HCG治疗并加用加味MCDD。所有患者的疗程均为三个月经周期。测量妊娠率、子宫内膜厚度、螺旋动脉搏动指数（PI）、阻力指数（RI）以及稳态模型评估胰岛素抵抗（HOMA-IR）。此外，通过蛋白质免疫印迹法检测解偶联蛋白2（UCP2）水平。
与对照组相比，治疗组I的子宫内膜厚度降低，PI和RI升高（均P<0.05）。与治疗组I相比，治疗组II的子宫内膜厚度增加，PI和RI降低（均P<0.05）。与治疗前相比，治疗组II治疗后HOMA-IR水平显著降低（P<0.05）。与治疗前的对照组相比，治疗组I和治疗组II治疗前的HOMA-IR水平升高（P<0.05）。与治疗后的对照组相比，治疗组I的HOMA-IR水平升高（P<0.05）。但对照组与治疗组II治疗后的HOMA-IR水平差异无统计学意义（P<0.05）。与对照组相比，治疗组II治疗后的UCP2水平升高（P<0.05）。随访一年后，对照组的妊娠率为16.1%（48/298），治疗组I为23.1%（37/160），治疗组II为33.8%（66/195）。与对照组相比，治疗组II的妊娠率显著升高（P<0.05）。
发现加味苍附导痰汤能够提高PCOS不孕患者的妊娠率，这可能与改善子宫内膜血流和胰岛素抵抗、增加UCP2表达并最终提高子宫内膜容受性有关。
