排卵障碍性不孕症的中西医结合诊治思考
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摘要
<正>排卵障碍性不孕症(ovulatory disorder infertility,ODI)是涉及多种原因的疑难病症。据WHO统计,不育夫妇占已婚夫妇的7%～15%,其中排卵障碍是引发不孕症的重要原因之一,占20%～40%~([1])。随着现代辅助生育医疗的发展,虽然能很好地解决这一类病症,但由于促排卵所带来的风险和危害,临床上需亟待解决的问题也有很多,现就中西医结合诊治ODI思考分述如下。
引文
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[2] Tomioka RB,Ferreira GRV,Aikawa NE,et al.Non-steroidal anti-inflammatory drug induces luteinized unruptured follicle syndrome in young female juvenile idiopathic arthritis patients[J].Clin Rheumatol,2018,37(10):2869-2873.
[3] Hosotani M,Ichii O,Nakamura T,et al.Autoimmune abnormality affects ovulation and oocyte-pick-up in MRL/MpJ-Faslpr/lpr mice[J].Lupus,2017,27(1):82-94.
[4] Stone S,Khamashta MA,Nelson-Piercy C.Nonsteroidal anti-inflammatory drugs and reversible female infertility:is there a link?[J].Drug Saf,2002,25(8):545-551.
[5] Ji SY,Liu XM,Li BT,et al.The polycystic ovary syndrome-associated gene Yap1 is regulated by gonadotropins and sex steroid hormones in hyperandrogenism-induced oligo-ovulation in mouse[J].Mol Hum Reprod,2017,23(10):698-707.
[6] 金哲,贡欣.从排卵障碍性不孕症探讨中医药促排卵的理论及应用[J].中华中医药杂志,2015,30(10):3524-3527.
[7] Bashir ST,Gastal MO,Tazawa SP,et al.The mare as a model for luteinized unruptured follicle syndrome:intrafollicular endocrine milieu[J].Reproduction,2016,151(3):271-283.
[8] 宋翠淼,段彦苍,刘亚华,等.孕激素受体调控排卵过程中卵泡破裂的机制[J].生理科学进展,2018,49(2):115-119.
[9] Stewart MD,Deng JM,Stewart CA,et al.Mice harboring Gnrhr E90K,a mutation that causes protein misfolding and hypogonadotropic hypogonadism in humans,exhibit testis size reduction and ovulation failure[J].Mol Endocrinol,2012,26(11):1847-1856.
[10] Monget P,Bondy C.Importance of the IGF system in early folliculogenesis[J].Mol Cell Endocrinol,2000,163(1-2):89-93.
[11] Rodriguez KF,Couse JF,Jayes FL,et al.Insufficient luteinizing hormone-induced intracellular signaling disrupts ovulation in preovulatory follicles lacking estrogen receptor-β[J].Endocrinology,2010,151(6):2826-2834.
[12] 包日强,王静,张春平.糖尿病对卵巢卵泡发育的影响[J].生殖与避孕,2016,36(11):923-930.
[13] 周伯如,周惠芳,刘贝,等.补肾助孕方对LPD模型大鼠垂体GnRH受体信号转导系统的影响[J].南京中医药大学学报,2017,33(6):554-559.
[14] 白俊,吴克明,郜然然.基于“肾主生殖”探赜细胞自噬机制与卵泡发育的微观联系[J].中国中药杂志,2018,43(5):921-925.
[15] 黄金珠,周昕,黄昕,等.通脉大生片对肾虚排卵障碍型不孕大鼠卵巢TGF-β1及Smad7表达的影响[J].中华中医药杂志,2015,30(3):833-836.
[16] 宋帮丽,傅春华,赵毅,等.通脉大生片对肾虚排卵障碍不孕大鼠子宫组织形态学的影响[J].时珍国医国药,2016,27(11):2584-2587.
[17] 黄凯裕,梁爽,于美玲,等.试述针灸介入排卵障碍性不孕症治疗的可行性[J].中国中西医结合杂志,2017,37(7):870-874.
[18] Braam SC,de Bruin JP,Buisman ETIA,et al.Treatment strategies and cumulative live birth rates in WHO-Ⅱ ovulation disorders[J].Eur J Obstetr Gynecol Reproduct Biol,2018,225(6):84-89.
[19] 唐培培,谈勇.多囊卵巢综合征中医证型分布规律及性激素水平、糖代谢特点[J].中国中西医结合杂志,2016,36(7):801-805.
[20] 胡欣欣,孙云,卢容萍,等.葛根黑苏汤改善克罗米芬促排卵后子宫内膜容受性低下的疗效观察[J].中国中西医结合杂志,2017,37(12):1431-1434.
[21] 张晓金,归绥琪,黄书慧,等.从“痰瘀”论治多囊卵巢综合征不孕临床研究[J].中华中医药杂志,2016,31(2):415-419.
[22] 滕秀香,李培培,姚海洋,等.“益肾疏肝汤”联合人工周期疗法治疗卵巢早衰肾虚肝郁证的临床研究[J].辽宁中医杂志,2016,43(1):93-96.
[23] 朱玲,罗颂平,许丽绵.左归丸对免疫性卵巢早衰小鼠卵巢超微结构的影响[J].时珍国医国药,2016,27(1):42-44.
[24] 胡立娟,刘慧萍,曾柳庭,等.补肾活血方对免疫性卵巢早衰小鼠PI3、Akt、Bcl2蛋白的影响[J].中华中医药学刊,2017,35(9):2282-2284.
[25] 徐波,殷燕云,谈勇.国医大师夏桂成调周法治疗排卵障碍性不孕症经验撷要[J].中华中医药杂志,2017,32(7):2983-2985.
[26] 耿红玲,许丽绵.中医周期疗法在PCOS不孕症患者促排卵周期中的疗效观察[J].中国实验方剂学杂志,2015,21(10):178-181.
[27] 张岩,谈勇.滋阴补阳中药序贯法联合rFSH低剂量递增方案治疗CC抵抗的临床观察[J].中国妇幼保健,2015,30(34):6099-6103.
[28] 左文婷,谈勇,殷燕云.中西医结合治疗26例中重度卵巢过度刺激综合征的疗效观察[J].中国中西医结合杂志,2017,37(12):1508-1510.
[29] 李蓉,孙伟,林戈,等.电针/经皮穴位电刺激技术在生殖医学中的应用专家共识[J].生殖与避孕,2016,36(7):527-535.
[30] 孔彦芳.中西医结合治疗排卵功能障碍性不孕症的临床观察[J].中医药导报,2015,21(14):78-80.
[31] 李荔,莫蕙,文斌,等.针灸联合二甲双胍治疗肥胖型多囊卵巢综合征不孕症的临床研究[J].中华中医药杂志,2014,29(7):2115-2119.
[2] Tomioka RB,Ferreira GRV,Aikawa NE,et al.Non-steroidal anti-inflammatory drug induces luteinized unruptured follicle syndrome in young female juvenile idiopathic arthritis patients[J].Clin Rheumatol,2018,37(10):2869-2873.
[3] Hosotani M,Ichii O,Nakamura T,et al.Autoimmune abnormality affects ovulation and oocyte-pick-up in MRL/MpJ-Faslpr/lpr mice[J].Lupus,2017,27(1):82-94.
[4] Stone S,Khamashta MA,Nelson-Piercy C.Nonsteroidal anti-inflammatory drugs and reversible female infertility:is there a link?[J].Drug Saf,2002,25(8):545-551.
[5] Ji SY,Liu XM,Li BT,et al.The polycystic ovary syndrome-associated gene Yap1 is regulated by gonadotropins and sex steroid hormones in hyperandrogenism-induced oligo-ovulation in mouse[J].Mol Hum Reprod,2017,23(10):698-707.
[6] 金哲,贡欣.从排卵障碍性不孕症探讨中医药促排卵的理论及应用[J].中华中医药杂志,2015,30(10):3524-3527.
[7] Bashir ST,Gastal MO,Tazawa SP,et al.The mare as a model for luteinized unruptured follicle syndrome:intrafollicular endocrine milieu[J].Reproduction,2016,151(3):271-283.
[8] 宋翠淼,段彦苍,刘亚华,等.孕激素受体调控排卵过程中卵泡破裂的机制[J].生理科学进展,2018,49(2):115-119.
[9] Stewart MD,Deng JM,Stewart CA,et al.Mice harboring Gnrhr E90K,a mutation that causes protein misfolding and hypogonadotropic hypogonadism in humans,exhibit testis size reduction and ovulation failure[J].Mol Endocrinol,2012,26(11):1847-1856.
[10] Monget P,Bondy C.Importance of the IGF system in early folliculogenesis[J].Mol Cell Endocrinol,2000,163(1-2):89-93.
[11] Rodriguez KF,Couse JF,Jayes FL,et al.Insufficient luteinizing hormone-induced intracellular signaling disrupts ovulation in preovulatory follicles lacking estrogen receptor-β[J].Endocrinology,2010,151(6):2826-2834.
[12] 包日强,王静,张春平.糖尿病对卵巢卵泡发育的影响[J].生殖与避孕,2016,36(11):923-930.
[13] 周伯如,周惠芳,刘贝,等.补肾助孕方对LPD模型大鼠垂体GnRH受体信号转导系统的影响[J].南京中医药大学学报,2017,33(6):554-559.
[14] 白俊,吴克明,郜然然.基于“肾主生殖”探赜细胞自噬机制与卵泡发育的微观联系[J].中国中药杂志,2018,43(5):921-925.
[15] 黄金珠,周昕,黄昕,等.通脉大生片对肾虚排卵障碍型不孕大鼠卵巢TGF-β1及Smad7表达的影响[J].中华中医药杂志,2015,30(3):833-836.
[16] 宋帮丽,傅春华,赵毅,等.通脉大生片对肾虚排卵障碍不孕大鼠子宫组织形态学的影响[J].时珍国医国药,2016,27(11):2584-2587.
[17] 黄凯裕,梁爽,于美玲,等.试述针灸介入排卵障碍性不孕症治疗的可行性[J].中国中西医结合杂志,2017,37(7):870-874.
[18] Braam SC,de Bruin JP,Buisman ETIA,et al.Treatment strategies and cumulative live birth rates in WHO-Ⅱ ovulation disorders[J].Eur J Obstetr Gynecol Reproduct Biol,2018,225(6):84-89.
[19] 唐培培,谈勇.多囊卵巢综合征中医证型分布规律及性激素水平、糖代谢特点[J].中国中西医结合杂志,2016,36(7):801-805.
[20] 胡欣欣,孙云,卢容萍,等.葛根黑苏汤改善克罗米芬促排卵后子宫内膜容受性低下的疗效观察[J].中国中西医结合杂志,2017,37(12):1431-1434.
[21] 张晓金,归绥琪,黄书慧,等.从“痰瘀”论治多囊卵巢综合征不孕临床研究[J].中华中医药杂志,2016,31(2):415-419.
[22] 滕秀香,李培培,姚海洋,等.“益肾疏肝汤”联合人工周期疗法治疗卵巢早衰肾虚肝郁证的临床研究[J].辽宁中医杂志,2016,43(1):93-96.
[23] 朱玲,罗颂平,许丽绵.左归丸对免疫性卵巢早衰小鼠卵巢超微结构的影响[J].时珍国医国药,2016,27(1):42-44.
[24] 胡立娟,刘慧萍,曾柳庭,等.补肾活血方对免疫性卵巢早衰小鼠PI3、Akt、Bcl2蛋白的影响[J].中华中医药学刊,2017,35(9):2282-2284.
[25] 徐波,殷燕云,谈勇.国医大师夏桂成调周法治疗排卵障碍性不孕症经验撷要[J].中华中医药杂志,2017,32(7):2983-2985.
[26] 耿红玲,许丽绵.中医周期疗法在PCOS不孕症患者促排卵周期中的疗效观察[J].中国实验方剂学杂志,2015,21(10):178-181.
[27] 张岩,谈勇.滋阴补阳中药序贯法联合rFSH低剂量递增方案治疗CC抵抗的临床观察[J].中国妇幼保健,2015,30(34):6099-6103.
[28] 左文婷,谈勇,殷燕云.中西医结合治疗26例中重度卵巢过度刺激综合征的疗效观察[J].中国中西医结合杂志,2017,37(12):1508-1510.
[29] 李蓉,孙伟,林戈,等.电针/经皮穴位电刺激技术在生殖医学中的应用专家共识[J].生殖与避孕,2016,36(7):527-535.
[30] 孔彦芳.中西医结合治疗排卵功能障碍性不孕症的临床观察[J].中医药导报,2015,21(14):78-80.
[31] 李荔,莫蕙,文斌,等.针灸联合二甲双胍治疗肥胖型多囊卵巢综合征不孕症的临床研究[J].中华中医药杂志,2014,29(7):2115-2119.