中药周期疗法治疗不孕症患者AMH变化与中医证型的相关性研究

Study on the Correlation between AMH Changes in Infertility Patients Treated with TCM Cycle Therapy and TCM Syndrome Pattern

摘要: 目的：研究中药周期疗法治疗不孕症患者(已发为不孕症)及孕前检查者(尚未发病为不孕症或尚未能诊断为不孕症) AMH变化与中医证型的相关性，为中药周期疗法治疗不孕症提供实践依据，欲探索中药周期疗法对不同中医证型不孕症患者治疗的敏感性，且欲用临床指标AMH论证阴阳虚实。方法：选取124例不孕症患者及144例孕前检查者，不孕症患者采用中药周期疗法治疗3个月，孕前检查者未作任何处理仅观察3个月，分析中药周期疗法治疗不孕症患者AMH变化与中医证型是否存在相关性。结果：1) 不孕症组患者治疗后AMH较治疗前下降(P < 0.01)；2) 不孕症组肾虚型患者治疗后AMH较治疗前下降(P < 0.01)，不孕症组痰湿型患者治疗后AMH较治疗前下降(P < 0.05)；3) 不孕症组间比较AMH，与肾虚型小组治疗前比，肝郁型、痰湿型组AMH偏高(P < 0.01)，血瘀型组AMH亦较高(P < 0.05)，其中痰湿型组AMH最高，血瘀型组与之相比(P = 0.01)，肝郁型组与之相比(P < 0.05)；与肾虚型小组治疗后比，痰湿型、肝郁型、血瘀型组AMH均偏高(P < 0.01)，其中痰湿型组AMH仍是最高，血瘀型组与之相比(P < 0.05)；组间比较FSH/AMH，与肾虚型小组治疗前比，痰湿型组FSH/AMH偏低(P < 0.01)，肝郁、血瘀型组FSH/AMH亦较低(P < 0.05)；与肾虚型小组治疗后比，痰湿型、肝郁型组FSH/AMH均偏低(P < 0.01)，痰湿型最低；4) 不孕症肾虚型患者三个肾虚小组内比较AMH，肾阴虚型患者治疗后下降(P < 0.05)，组间比较AMH，与肾阳虚型小组治疗后比，肾阴虚型AMH偏低(P < 0.05)；组内比较FSH/AMH，肾阴虚型治疗后上升(P < 0.05)，组间比较FSH/AMH，与肾阴虚型小组治疗后比，肾阳虚、肾气虚型FSH/AMH偏低(P < 0.05)，肾阳虚型最低；5) 孕前检查组肾虚型患者观察后AMH较观察前下降(P < 0.05)；6) 孕前检查组组间比较AMH，与肾虚型小组观察前比，肝郁型、痰湿型小组AMH偏高(P < 0.01)，其中痰湿型组AMH最高，血瘀、肝郁型组与之相比(P < 0.01)；与肾虚型小组观察后比，痰湿型小组AMH偏高(P < 0.01)；组间比较FSH/AMH，与肾虚型小组观察前比，痰湿、肝郁型小组FSH/AMH偏低(P < 0.01)，其中痰湿型组最低，血瘀型小组FSH/AMH与之相比(P < 0.01)；与肾虚型小组观察后比，痰湿型小组FSH/AMH偏低(P < 0.01)；组间比较FSH，与肾虚型小组观察前比，痰湿、肝郁型小组FSH偏低(P < 0.01)；7) 孕前检查组肾虚型患者三个肾虚小组组内比较FSH/AMH，肾阴虚型小组观察后上升(P < 0.05)；组间比较FSH/AMH，与肾阴虚型小组观察后比，肾气虚、肾阳虚型FSH/AMH偏低(P < 0.05)，肾阳虚型最低。结论：中药周期疗法对于降低痰湿型不孕症高AMH的效果较显著，值得临床应用推广。中医证型与AMH、FSH/AMH的变化呈现一定的相关性。

Abstract: Objective: This paper aims to study the correlation between different TCM syndrome types and AMH changes of infertility (already diagnosed as infertility) patients and pre-pregnancy examiners (not yet developed infertility or not yet diagnosed as infertility), to provide practical basis for tradi-tional Chinese medicine cycle treatment of infertility, to explore the traditional Chinese medicine cycle therapy of different TCM syndrome infertility patients treatment sensitivity, and to use AMH to argument Yin and Yang, deficient and sthenic syndrome. Methods: 124 infertility patients and 144 pre-pregnancy examiners were selected. The infertility patients were treated with TCM cycle therapy for 3 months, and the pre-pregnancy examiners received no treatment for 3 months, both of them were observed. Results: 1) AMH decreased after treatment compared with before treat-ment of infertility patients (P < 0.01); 2) AMH decreased after treatment compared with before treatment in the kidney deficiency group of infertility patients (P < 0.01), AMH decreased after treatment compared with before treatment in the phlegm dampness group of infertility patients(P < 0.05); 3) Comparison between the infertility groups of AMH, Compared with pre-treatment kidney deficiency group, Higher AMH were in liver depression and phlegm dampness groups (P < 0.01), AMH was also higher in the blood stasis type group (P < 0.05). Among them, the phlegm dampness group had the highest AMH, blood stasis group was lower than it (P = 0.01), liver depression group was also lower than it (P < 0.05); Compared with that after treatment of kidney deficiency group, AMH was higher in phlegm dampness, liver depression and blood stasis groups (P < 0.01), AMH was still the highest in the phlegm dampness group, the blood stasis group was lower than it (P < 0.05); Compared with pre-treatment kidney deficiency group, FSH/AMH was lower in phlegm dampness group (P < 0.01), FSH/AMH was also lower in liver depression and blood stasis group (P < 0.05); Compared with that after treatment of kidney deficiency group, FSH/AMH in phlegm dampness and liver depression were all lower (P < 0.01), and the lowest was phlegm dampness group; 4) Among the three kidney deficiency groups in infertility patients, AMH decreased after treatment compared with before treatment in the kidney Yin deficiency group (P < 0.05), comparison among the groups, After the treatment compared with the renal Yang deficiency group, The AMH of kidney Yin defi-ciency group was lower (P < 0.05); Within-group comparison of FSH/AMH, rising after renal Yin de-ficiency treatment (P < 0.05); Compared with the kidney Yin deficiency group after treatment, the FSH/AMH with renal Yang deficiency and renal Qi deficiency were lower (P < 0.05), and the lowest was kidney Yang deficiency group; 5) AMH decreased after observation than before observation (P < 0.05); 6) AMH between pre-pregnancy examination group, compared with the kidney deficiency group, AMH in liver depression and phlegm dampness group were higher (P < 0.01). Among them, the phlegm dampness group had the highest AMH, the blood stasis and liver depression group were lower than it (P < 0.01); Compared with the kidney deficiency group, higher AMH was in phlegm dampness group (P < 0.01); Comparison among the groups, compared with the kidney deficiency group, lower FSH/AMH were in phlegm dampness and liver depression groups (P < 0.01), The phlegm dampness group was the lowest, the FSH/AMH of blood stasis group was higher than it (P < 0.01); Compared with the kidney deficiency group after observation, Lower FSH/AMH was in phlegm dampness group (P < 0.01); Comparison among the groups, compared with the kidney defi-ciency group before observation, the FSH in phlegm dampness and liver depression group were lower (P < 0.01); 7) FSH/AMH among three kidney deficiency group patients in pre-pregnancy ex-amination group, the kidney Yin deficiency group increased after observation (P < 0.05); Compari-son among the groups, compared with the kidney Yin deficiency group after observation, the FSH/AMH of kidney Yang deficiency and kidney Qi deficiency were lower (P < 0.05), the kidney Yang deficiency group was the lowest. Conclusion: TCM cycle treatment has a significant effect on reduc-ing high AMH of Infertility patients in phlegm dampness group, which is worthy of clinical applica-tion and promotion. FSH/AMH shows some correlation with different TCM syndrome types.