Article(id=1322926703760257065, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.09.045, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339904966, onlineDateStr=2026-10-30, pubDate=1757433600000, pubDateStr=2025-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339904966, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339904966, creator=13701087609, updateTime=1793339904966, updator=13701087609, issue=Issue{id=1322926492627378659, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='9', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1757433600000', pubDateStr='2025-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339854628, creator='13701087609', updateTime=1793340762858, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930302095590169, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930302095590170, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=238, endPage=242, ext={EN=ArticleExt(id=1322926703928029226, articleId=1322926703760257065, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Dingkun Pill(定坤丹)Combined with Electrical Stimulation Therapy on Endometrial Morphology and Ovulatory Function in Infertility Women with Thin Endometrium, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the effectof Dingkun Pill(定坤丹)combined with electrical stimulation therapy on endometrialmorphology and ovulatory function in infertility women with thin endometrium.

Methods

One hundred and six infertility women with thin endometrium admitted to the hospital from October 2020 to October 2022 were collected and randomly grouped,each with 53 cases. The control group was treated with electrical stimulation therapy. Based on this,the study group added Dingkun Pill. Then the clinical outcome,endometrial morphology(type A,B,C),endometrial thickness,follicular development,pulsatility index(PI),resistance index(RI),luteinizing hormone(LH),oestradiol(E2),follicle-stimulating hormone(FSH),clinical pregnancy rate,human chorionic gonadotropin(HCG)positive rate,live birth rate and early miscarriage rate were compared between groups.

Results

The overall efficacy rate was 92.45% in the study group,which was higher than 77.36% in the control group(P<0.05). An increase in percentage of endometrial morphology type A,and a decrease in percentage of type B and Cwere observed in all patients,and the improvements were more notable in the study group than those in the control group(P<0.05). The endometrial thickness and diameter of dominant follicles showed an increase in all patients,and the increase was more remarkable in the study group than that in the control group(P<0.05). The values of PIand RIdecreased in all patients after treatment,and the two indiceswere lower in the study group than those in the control group(P<0.05). An increase in E2,and a decrease in LH and FSH were detected in all patients after treatment,and both changes were more significant in the study group than those in the control group(P<0.05). The study group reported a higher clinical pregnancy rate and HCG positive rate than the controlgroup(P<0.05),and no statistical difference was found in earlymiscarriage rate and live birth rate between two groups(P>0.05).

Conclusion

The application of Dingkun Pill combined with electrical stimulation therapy in infertility women with thin endometrium can effectively improve endometrial morphology and ovulatory function,and thus increasing the pregnancy rate.

, authors=Hao WU, Jing ZHANG, authorsList=Hao WU, Jing ZHANG, authorCompany=null, correspAuthors=Jing ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926705182126133, articleId=1322926703760257065, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者子宫内膜形态、排卵功能影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

探讨定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者子宫内膜形态、排卵功能影响。

方法

收集2020年10月—2022年10月医院收治的106例子宫内膜薄型不孕症患者,随机分为研究组和对照组各53例。对照组采用电刺激治疗,研究组在对照组的基础上联合定坤丹进行治疗。对比患者临床疗效、子宫内膜形态(A型、B型、C型)、子宫内膜厚度及卵泡发育情况、子宫动脉搏动指数(pulse index,PI)、子宫动脉阻力指数(resistance index,RI)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、促卵泡激素(follicle-stimulating hormone,FSH)、临床妊娠、绒毛膜促性腺激素(human choionic gonadotophin,HCG)阳性、活产率以及早期流产率。

结果

治疗后,研究组的总有效率92.45%高于对照组77.36%(P<0.05)。治疗后,两组子宫内膜形态A型占比均上升,B型、C型占比均下降,且研究组改善程度优于对照组(P<0.05)。治疗后,两组子宫内膜厚度及成熟卵泡直径均增加,卵泡排出时间均减少,且研究组改善程度优于对照组(P<0.05)。治疗后,两组PI、RI水平均降低,且研究组较对照组更低(P<0.05)。治疗后,两组E2水平均提升,LH、FSH水平均下降,且研究组改善程度优于对照组(P<0.05)。治疗后,研究组临床妊娠率、HCG阳性率高于对照组(P<0.05),早期流产率、活产率差异无统计学意义(P>0.05)。

结论

定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者疗效明显,能有效改善子宫内膜形态、促进排卵功能,从而提高妊娠率。

, authors=吴浩, 张婧, authorsList=吴浩, 张婧, authorCompany=null, correspAuthors=张婧, authorNote=

吴浩(1988-),男,湖北枣阳人,主治医师,硕士,研究方向:盆底功能障碍性疾病。

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张婧(1980-),女,湖北浠水人,副主任医师,硕士,研究方向:盆底功能障碍性疾病,尿失禁,子宫腺肌病,子宫肌瘤。E-mail:。
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吴浩(1988-),男,湖北枣阳人,主治医师,硕士,研究方向:盆底功能障碍性疾病。

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组别例数年龄(岁)病程(年)
研究组5334.85±5.223.08±1.75
对照组5335.13±5.582.94±1.60
t/χ20.2670.430
P值0.7900.668
), ArticleFig(id=1322926706922762318, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=CN, label=表1, caption=

两组子宫内膜薄型不孕症患者一般资料比较(±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数年龄(岁)病程(年)
研究组5334.85±5.223.08±1.75
对照组5335.13±5.582.94±1.60
t/χ20.2670.430
P值0.7900.668
), ArticleFig(id=1322926707002454095, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
研究组5326(49.06)23(43.40)4(7.55)49(92.45)
对照组5321(39.62)20(37.74)12(22.64)41(77.36)
χ2值4.711
P值0.030
), ArticleFig(id=1322926707061174352, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=CN, label=表2, caption=

两组子宫内膜薄型不孕症患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
研究组5326(49.06)23(43.40)4(7.55)49(92.45)
对照组5321(39.62)20(37.74)12(22.64)41(77.36)
χ2值4.711
P值0.030
), ArticleFig(id=1322926707119894609, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数A型B型C型
治疗前治疗后治疗前治疗后治疗前治疗后
研究组5315(28.30)43(81.13)a20(37.74)4(7.55)a18(33.96)5(9.43)a
对照组539(16.98)30(56.60)a22(41.51)12(22.64)a20(37.74)13(24.53)a
χ2值1.9397.4360.1584.7110.1644.283
P值0.1640.0060.6910.0300.6850.039
), ArticleFig(id=1322926707182809170, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=CN, label=表3, caption=

两组子宫内膜薄型不孕症患者子宫内膜形态比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数A型B型C型
治疗前治疗后治疗前治疗后治疗前治疗后
研究组5315(28.30)43(81.13)a20(37.74)4(7.55)a18(33.96)5(9.43)a
对照组539(16.98)30(56.60)a22(41.51)12(22.64)a20(37.74)13(24.53)a
χ2值1.9397.4360.1584.7110.1644.283
P值0.1640.0060.6910.0300.6850.039
), ArticleFig(id=1322926707254112339, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数子宫内膜厚度/(mm)成熟卵泡直径/(mm)卵泡排出时间/(d)
治疗前治疗后治疗前治疗后治疗前治疗后
研究组536.13±0.748.31±0.78a18.42±1.5121.76±1.58a15.65±2.1011.73±1.84a
对照组536.17±0.697.20±0.62a18.48±1.4419.57±1.49a15.59±2.0813.52±2.11a
χ2值0.2888.1100.2097.3410.1484.655
P值0.7740.0000.8350.0000.8830.000
), ArticleFig(id=1322926707312832596, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=CN, label=表4, caption=

两组子宫内膜薄型不孕症患者子宫内膜厚度及卵泡发育情况对比(±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数子宫内膜厚度/(mm)成熟卵泡直径/(mm)卵泡排出时间/(d)
治疗前治疗后治疗前治疗后治疗前治疗后
研究组536.13±0.748.31±0.78a18.42±1.5121.76±1.58a15.65±2.1011.73±1.84a
对照组536.17±0.697.20±0.62a18.48±1.4419.57±1.49a15.59±2.0813.52±2.11a
χ2值0.2888.1100.2097.3410.1484.655
P值0.7740.0000.8350.0000.8830.000
), ArticleFig(id=1322926707375747157, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数PIRI
治疗前治疗后治疗前治疗后
研究组531.84±0.341.03±0.19a0.85±0.150.46±0.18a
对照组531.89±0.281.46±0.20a0.89±0.170.61±0.20a
χ2值0.82611.3481.2844.058
P值0.4110.0000.2020.000
), ArticleFig(id=1322926707438661718, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=CN, label=表5, caption=

两组子宫内膜薄型不孕症患者子宫内膜血流参数比较(±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数PIRI
治疗前治疗后治疗前治疗后
研究组531.84±0.341.03±0.19a0.85±0.150.46±0.18a
对照组531.89±0.281.46±0.20a0.89±0.170.61±0.20a
χ2值0.82611.3481.2844.058
P值0.4110.0000.2020.000
), ArticleFig(id=1322926707514159191, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数E2/(pmol/L)LH/(mU/mL)FSH/(ng/L)
治疗前治疗后治疗前治疗后治疗前治疗后
研究组53116.64±15.25158.51±17.10a1368.68±31.26985.16±33.91a6.51±0.634.17±0.38a
对照组53116.53±14.87139.27±15.19a1365.27±30.541063.46±35.96a6.58±0.615.12±0.44a
χ2值0.0386.1240.56811.5330.58111.896
P值0.9700.0000.5710.0000.5620.000
), ArticleFig(id=1322926707585462360, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=CN, label=表6, caption=

两组子宫内膜薄型不孕症患者激素水平比较(±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数E2/(pmol/L)LH/(mU/mL)FSH/(ng/L)
治疗前治疗后治疗前治疗后治疗前治疗后
研究组53116.64±15.25158.51±17.10a1368.68±31.26985.16±33.91a6.51±0.634.17±0.38a
对照组53116.53±14.87139.27±15.19a1365.27±30.541063.46±35.96a6.58±0.615.12±0.44a
χ2值0.0386.1240.56811.5330.58111.896
P值0.9700.0000.5710.0000.5620.000
), ArticleFig(id=1322926707761623129, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数临床妊娠HCG阳性活产早期流产
研究组5340(75.47)41(77.36)32/40(80.00)3/40(7.50)
对照组5321(39.62)30(56.60)12/21(57.14)5/21(23.81)
χ2值13.9405.1613.5793.215
P值0.0000.0230.0590.073
), ArticleFig(id=1322926707837120602, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926703760257065, language=CN, label=表7, caption=

两组子宫内膜薄型不孕症患者妊娠情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数临床妊娠HCG阳性活产早期流产
研究组5340(75.47)41(77.36)32/40(80.00)3/40(7.50)
对照组5321(39.62)30(56.60)12/21(57.14)5/21(23.81)
χ2值13.9405.1613.5793.215
P值0.0000.0230.0590.073
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定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者子宫内膜形态、排卵功能影响
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吴浩 , 张婧
中华中医药学刊 | 省级项目平台 2025,43(9): 238-242
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中华中医药学刊 |省级项目平台 2025 , 43 (9) : 238 -242
定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者子宫内膜形态、排卵功能影响
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吴浩(1988-),男,湖北枣阳人,主治医师,硕士,研究方向:盆底功能障碍性疾病。

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吴浩, 张婧
作者信息
  • 湖北文理学院附属襄阳市中心医院,湖北 襄阳 441000
通讯作者:
张婧(1980-),女,湖北浠水人,副主任医师,硕士,研究方向:盆底功能障碍性疾病,尿失禁,子宫腺肌病,子宫肌瘤。E-mail:。
作者简介:

吴浩(1988-),男,湖北枣阳人,主治医师,硕士,研究方向:盆底功能障碍性疾病。

Effect of Dingkun Pill(定坤丹)Combined with Electrical Stimulation Therapy on Endometrial Morphology and Ovulatory Function in Infertility Women with Thin Endometrium
Hao WU, Jing ZHANG
Affiliations
  • Department of Obstetrics and Gynecology,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang 441000,Hubei,China
出版时间: 2025-09-10 doi: 10.13193/j.issn.1673-7717.2025.09.045
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目的

探讨定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者子宫内膜形态、排卵功能影响。

方法

收集2020年10月—2022年10月医院收治的106例子宫内膜薄型不孕症患者,随机分为研究组和对照组各53例。对照组采用电刺激治疗,研究组在对照组的基础上联合定坤丹进行治疗。对比患者临床疗效、子宫内膜形态(A型、B型、C型)、子宫内膜厚度及卵泡发育情况、子宫动脉搏动指数(pulse index,PI)、子宫动脉阻力指数(resistance index,RI)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、促卵泡激素(follicle-stimulating hormone,FSH)、临床妊娠、绒毛膜促性腺激素(human choionic gonadotophin,HCG)阳性、活产率以及早期流产率。

结果

治疗后,研究组的总有效率92.45%高于对照组77.36%(P<0.05)。治疗后,两组子宫内膜形态A型占比均上升,B型、C型占比均下降,且研究组改善程度优于对照组(P<0.05)。治疗后,两组子宫内膜厚度及成熟卵泡直径均增加,卵泡排出时间均减少,且研究组改善程度优于对照组(P<0.05)。治疗后,两组PI、RI水平均降低,且研究组较对照组更低(P<0.05)。治疗后,两组E2水平均提升,LH、FSH水平均下降,且研究组改善程度优于对照组(P<0.05)。治疗后,研究组临床妊娠率、HCG阳性率高于对照组(P<0.05),早期流产率、活产率差异无统计学意义(P>0.05)。

结论

定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者疗效明显,能有效改善子宫内膜形态、促进排卵功能,从而提高妊娠率。

定坤丹  /  电刺激  /  子宫内膜型不孕症  /  子宫内膜形态  /  排卵功能
Objective

To investigate the effectof Dingkun Pill(定坤丹)combined with electrical stimulation therapy on endometrialmorphology and ovulatory function in infertility women with thin endometrium.

Methods

One hundred and six infertility women with thin endometrium admitted to the hospital from October 2020 to October 2022 were collected and randomly grouped,each with 53 cases. The control group was treated with electrical stimulation therapy. Based on this,the study group added Dingkun Pill. Then the clinical outcome,endometrial morphology(type A,B,C),endometrial thickness,follicular development,pulsatility index(PI),resistance index(RI),luteinizing hormone(LH),oestradiol(E2),follicle-stimulating hormone(FSH),clinical pregnancy rate,human chorionic gonadotropin(HCG)positive rate,live birth rate and early miscarriage rate were compared between groups.

Results

The overall efficacy rate was 92.45% in the study group,which was higher than 77.36% in the control group(P<0.05). An increase in percentage of endometrial morphology type A,and a decrease in percentage of type B and Cwere observed in all patients,and the improvements were more notable in the study group than those in the control group(P<0.05). The endometrial thickness and diameter of dominant follicles showed an increase in all patients,and the increase was more remarkable in the study group than that in the control group(P<0.05). The values of PIand RIdecreased in all patients after treatment,and the two indiceswere lower in the study group than those in the control group(P<0.05). An increase in E2,and a decrease in LH and FSH were detected in all patients after treatment,and both changes were more significant in the study group than those in the control group(P<0.05). The study group reported a higher clinical pregnancy rate and HCG positive rate than the controlgroup(P<0.05),and no statistical difference was found in earlymiscarriage rate and live birth rate between two groups(P>0.05).

Conclusion

The application of Dingkun Pill combined with electrical stimulation therapy in infertility women with thin endometrium can effectively improve endometrial morphology and ovulatory function,and thus increasing the pregnancy rate.

Dingkun Pill(定坤丹)  /  electrical stimulation therapy  /  infertility due to thin endometrium  /  endometrialmorphology  /  ovulatory function
吴浩, 张婧. 定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者子宫内膜形态、排卵功能影响. 中华中医药学刊, 2025 , 43 (9) : 238 -242 . DOI: 10.13193/j.issn.1673-7717.2025.09.045
Hao WU, Jing ZHANG. Effect of Dingkun Pill(定坤丹)Combined with Electrical Stimulation Therapy on Endometrial Morphology and Ovulatory Function in Infertility Women with Thin Endometrium[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (9) : 238 -242 . DOI: 10.13193/j.issn.1673-7717.2025.09.045
不孕症是指育龄期女子婚后未避孕而不受孕的一类疾病,可由多种原因导致,包括排卵障碍、子宫因素、内分泌因素、生理因素等[1-2]。近年来,受社会压力、不良生活习惯、环境污染等影响,不孕症的人数越来越多[3-4]。子宫内膜容受性是指子宫内膜允许囊胚定位、黏附、穿透、植入,并使胚胎着床、发育的能力,是决定孕育成功与否的关键因素之一[5]。子宫内膜容受性异常,则易导致不孕症的发生,其中子宫内膜的厚度与子宫内膜的容受性密切相关[6]。子宫内膜的厚度主要取决于女性体内的雌激素,当厚度小于7 mm时为薄型子宫内膜,此时不利于受精卵着床,临床妊娠率和活产率容易受到影响[7-8]。电刺激治疗是子宫内膜薄型不孕症患者的一类有效干预措施,可以通过电流刺激增强盆底肌肉的收缩能力,改善内膜厚度以及血流灌注情况,从而提高临床妊娠率,但单一使用存在一定局限性,所需治疗周期较长,部分患者效果欠佳[9-10]。近年来,采用中医药治疗子宫内膜薄型不孕症也在临床中得以广泛应用,其中定坤丹有滋补气血、调经疏郁之功效,可以调节相关受体和细胞因子的表达,使子宫内膜厚度增加,改善妊娠率,且安全性较高,但与电刺激联合治疗的报道相对较少[11]。基于此,本研究将定坤丹与电刺激治疗相结合,与单纯使用电刺激治疗相比,观察其对子宫内膜薄型不孕症患者子宫内膜形态、排卵功能影响,为临床提供更多有效治疗方案。
收集2020年10月—2022年10月本院收治的106例子宫内膜薄型不孕症患者。诊断标准:符合中华医学会生殖医学分会第四届委员会[12]制定的诊断标准。纳入标准:(1)符合上述诊断标准,年龄20~45岁的育龄期女性;(2)影像学显示患者子宫和卵巢形态功能正常;(3)子宫内膜无器质性病变;(4)心、肝、肾等功能正常;(5)治疗近期未使用雌激素进行治疗;(6)患者及家属对研究内容知情,自愿签署知情同意书。排除标准:(1)不符合相关诊断标准,没有生育需求;(2)合并有卵巢早衰、输卵管障碍等生殖内分泌疾病;(3)配偶原因导致的不孕;(4)对治疗过程中使用的药物成分过敏或抵触进行电刺激治疗;(5)心、肝、肾等重要器官功能障碍或器官严重衰竭;(6)存在精神障碍,自主意识不清;(7)临床资料信息不全。
采用随机数字表法,将子宫内膜薄型不孕症患者分为研究组和对照组各53例。两组一般资料比较差异无统计学意义(P>0.05),见表1。
对照组于患者月经干净2~3 d后采用江西天淳医用制品有限公司提供的神经肌肉刺激仪,嘱患者排空膀胱后取仰卧位,将治疗头置入患者阴部,电极片分别对称贴于腹部,调整电流强度15~50 mA、脉宽3 μs、频率2 Hz的治疗仪参数予以电刺激治疗,每次治疗时间为35 min,1次/d,治疗疗程为3个月经周期。研究组在对照组的基础上,于月经第5天给予定坤丹(山西广誉远国药有限公司,国药准字Z14020656)联合治疗,10.8 g/次,2次/d,治疗疗程为3个月经周期。
显效:患者子宫内膜厚度增加、排卵功能显著提升;有效:患者子宫内膜厚度及排卵功能得到改善;无效:患者子宫内膜厚度及排卵功能未见明显变化。有效率=显效率+有效率。
子宫内膜形态根据阴道超声可分为三型,A型指三线型,中央反光线强,宫腔中线回声明显;B型指子宫内膜均匀相对高回声,中央无明显反光线;C型指内膜均匀强回声,无宫腔中线回声。
对患者治疗前后的子宫内膜厚度变化及月经第10天开始的卵泡发育情况进行监测,直至排卵,记录成熟卵泡直径与卵泡排出时间,仪器为广州索诺星信息科技有限公司提供的全数字彩色多普勒超声诊断系统。
对治疗前后患者的子宫动脉搏动指数(pulse index,PI)、子宫动脉阻力指数(resistance index,RI)进行记录,检测使用经阴道彩色多普勒超声技术。
记录治疗前后患者于月经第2-5天血清学检测中相关激素水平,包括黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)及促卵泡激素(follicle-stimulating hormone,FSH),试剂盒由天津亿康先达生物科技有限公司提供。
一年内对治疗后的两组患者进行随访,以孕1月后的B超检查为准,记录两组患者的临床妊娠率、绒毛膜促性腺激素(human choionic gonadotophin,HCG)阳性率、活产率以及早期流产率。
采用SPSS 20.0进行统计分析。计量资料以()表示,以t检验,计数资料以(%)表示,以χ2检验,记P<0.05为差异有统计学意义。
治疗后,研究组的总有效率92.45%高于对照组77.36%(P<0.05)。见表2。
治疗后,两组子宫内膜形态A型占比均上升,B型、C型占比均下降,且研究组改善程度优于对照组(P<0.05)。见表3。
治疗后,两组子宫内膜厚度及成熟卵泡直径均增加,卵泡排出时间均减少,且研究组改善程度优于对照组(P<0.05)。见表4。
治疗后,两组PI、RI水平均降低,且研究组较对照组更低(P<0.05)。见表5。
治疗后,两组E2水平均提升,LH、FSH水平均下降,且研究组改善程度优于对照组(P<0.05)。见表6。
治疗后,研究组临床妊娠率、HCG阳性率高于对照组(P<0.05),早期流产率、活产率差异无统计学意义(P>0.05)。见表7。
不孕症是育龄期女性常见妇科病,其病因复杂,临床表现纷繁多样,可由排卵功能障碍、子宫内膜异位、盆腔粘连、输卵管阻塞等多种因素导致,其中子宫内膜容受性异常为导致不孕症重要原因之一[13-15]。子宫内膜厚度是反映子宫内膜容受性的重要指标之一,合适的子宫内膜厚度能提高妊娠的成功率[16]。子宫内膜厚度小于7 mm时为子宫内膜薄型,此时不足以顺利完成胚胎植入,易导致早期流产的情况发生。薄型子宫内膜与雌激素、孕激素的缺乏密切相关,因此临床针对子宫内膜薄型不孕症患者主要给予激素进行治疗,有起效较快,疗效明确的特点[17-18]。但由于患者的个体差异性,每个人对激素药品的服从性也不尽相同,且子宫内膜的厚度变化并不完全由激素水平主导,随着病情的发展与治疗进程的推进,患者容易产生依赖性和抗药性,使治疗周期延长。
中医学中,子宫内膜薄型不孕症无具体概念,根据其临床特征可将其归属于“不孕症”范畴,主要与肾气不足、冲任气血失调有关[19]。肾主生长发育与生殖,肾精、肾气是否充足是胚胎顺利着床的关键,若肾气不足,精不化血,则冲任虚衰,胞宫失养,无法摄精成孕,使子宫内膜生长被限制,因此治疗应以温养肾气、调理气血为主[20-21]。定坤丹为中药复方制剂,主要由红参、白芍、西红花、三七、鹿茸熟地黄等中药组成,可以对肾功能进行调理,同时有补血行气、养血调经之功[22]。既往大量研究显示,定坤丹在治疗不孕症效果显著,能使患者的子宫内膜厚度得到明显改善,从而提高临床妊娠率[23-24]。电刺激治疗指应用一定频率的电流,通过电极刺激特定肌肉群使其抽搐或收缩,继而使功能得到修复,是目前治疗不孕症的常用手段,能促进子宫内膜的生长发育,影响子宫内膜血流[25]。因此,本研究以中西医理论知识为基础,观察探讨定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者子宫内膜、排卵功能的影响。
子宫内膜形态分为A、B、C三型,可反映子宫内膜的不同时期[26]。A型内膜,即“三线型”内膜,是内膜增生早期时的形态,提示子宫内膜处于增殖期,此时子宫内膜容受性最佳,可为胚胎植入提供完好的植入状态,使胚胎着床率提高[27]。本研究中,研究组的总有效率较对照组更高,且治疗后两组子宫内膜形态A型占比均上升,B型、C型占比均下降,研究组改善程度优于对照组,提示定坤丹联合电刺激治疗能提高临床疗效,有助于促进子宫内膜的修复。其原因为:电刺激治疗能够通过对子宫血管平滑肌舒缩的刺激,改善患者子宫内膜血流动力学状态,从而刺激子宫内膜生长[28]。现代药理学显示,定坤丹中所含白芍、黄芩、枸杞子等中药具有雌激素活性,可以对内分泌轴起到调节作用,改善雌激素水平,同时能够促进血液循环,刺激子宫内膜血管增生及腺体发育,使胚胎着床率提高[29]。女性的排卵情况及卵泡发育是否正常与生育关系密切,通过对成熟卵泡直径及卵泡排出时间进行检测,可以使治疗更有针对性。本研究中,治疗后两组子宫厚度及成熟卵泡直径均增加,卵泡排出时间均减少,且研究组改善程度优于对照组,表明联合治疗能增加子宫内膜厚度,促进卵泡的生长发育及排卵。其原因为电刺激可以调节雌激素水平,促进细胞的新陈代谢,改善卵巢储备功能,使卵子质量和反应性得到提高,从而有利于卵泡的发育成熟及排出[25]。同时,定坤丹能够对下丘脑-垂体-卵巢轴进行调节,改善卵子的质量,促进卵泡的发育,提高排卵率[30]。两种治疗方法进行联合能产生协同作用,使子宫内膜肌层增厚,增强子宫内膜容受性。子宫内膜血流参数包括PI、RI,随月经周期呈规律性变化,可以反映子宫的血流灌注情况,其数值越低则代表灌注情况越好,有利于胚体着床率的提高。本研究结果中,两组PI、RI水平均降低,且研究组较对照组更低,表明联合治疗能有效改善子宫内膜血流情况,促进子宫内膜的修复,给子宫更好地提供营养。其原因为定坤丹中成分含有三七,有化瘀止血、活血定痛之效,可能使血小板的黏附和聚集得到抑制,降低血清中相关激素和活化因子水平,改善血流循环,增加血流灌注[31]。电刺激治疗能作用于血管平滑肌,改善子宫平滑肌舒张和收缩作用,从而促进血液循环和子宫内膜的生长[32]。
E2是一种由女性卵巢分泌的雌性激素,能反映子宫和卵巢的生理功能,促进子宫内膜增厚;LH由腺垂体促性腺激素细胞分泌,主要功能为形成黄体、促进卵泡的成熟并排卵;FSH为与生殖系统有关的促性腺激素,可促使卵泡的发育。LH与FSH可产生协同作用,促进E2的合成与释放,同时受其负反馈调节影响,三者共同作用,可对卵巢功能进行反映。E2、LH、FSH分泌失衡可导致排卵的异常,不利于受孕[33]。本研究中,两组E2水平均提升,LH、FSH水平均下降,且研究组改善程度优于对照组,表明联合治疗能有效调节患者激素水平。唐培培等[24]研究结果表明,定坤丹能够对子宫内膜微血流进行改善,调节激素水平,促进卵泡的发育成熟,从而提高卵巢功能。电刺激以人体生物电为基础,作用于卵巢,可兴奋其支配神经,提高细胞新陈代谢,增加微循环,改善卵巢功能,提升激素分泌能力与水平,从而对E2、LH、FSH进行调节[34]。HCG为胎盘绒毛膜细胞分泌的一种糖蛋白,可作为临床诊断妊娠的指标:当血清中HCG>10 IU/L确定为妊娠。治疗后,研究组临床妊娠率、HCG阳性率高于对照组,两组早期流产率、活产率差异无统计学意义,提示联合治疗通过对子宫内膜的改善,能提高患者妊娠率,其结果与金凤羽等[23]使用定坤丹治疗子宫内膜薄型不孕的研究结果相符。然而,本研究为单中心研究,样本量偏小,随访时间较短,不足之处需扩大样本量、延续随访、多中心对照以进一步研究。
综上所述,定坤丹联合电刺激治疗对子宫内膜薄型不孕症患者疗效明显,能有效改善子宫内膜形态、促进排卵功能,从而提高妊娠率。
  • 湖北省自然科学基金面上项目(2017CFB335)
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2025年第43卷第9期
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doi: 10.13193/j.issn.1673-7717.2025.09.045
  • 首发时间:2026-10-30
  • 出版时间:2025-09-10
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湖北省自然科学基金面上项目(2017CFB335)
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    湖北文理学院附属襄阳市中心医院,湖北 襄阳 441000

通讯作者:

张婧(1980-),女,湖北浠水人,副主任医师,硕士,研究方向:盆底功能障碍性疾病,尿失禁,子宫腺肌病,子宫肌瘤。E-mail:。
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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