Study On The Relevant Clinical Characteristics Of DOR And Analysis Of Its TCM Syndrome Type

Objective:Through analysis of the general cinical data、endocrine、ultrasound of patients with normal ovarian function and cases of diminished ovarian reserve, analysis of the characteristics of the general cinical data、endocrine、MOD of the cases with diminished ovarian reserve,at the same time, discuss the relevance of them; In addition, understanding of the etiology and pathogenesis of DOR from the Chinese perspective, to explore the correlation between TCM syndrome type of the DOR with its menstrual cycle length%endocrine、MOD,and provide objective basis for clinical diagnosis and treatment of the disease.Methods:Part1:Selects60patients with normal ovarian function and182cases with diminished ovarian reserve due to infertility in June,2012to December,2014visit to the Hunan second people’s Hospital polycystic ovary syndrom (PCOS) and infertility treatment center, The two group of age is in25～39years old. Comparative analysis of the characteristics of the DOR in clinical pregnant abnormalities,menstrual cycle length,endocrine and MOD,and to explore the relationship among them, thus,analysis of age, MCL, endocrine and MOD on the DOR diagnostic significance. Part2:The investigation of TCM syndromes in182patients with DOR, and to sum up the clinical syndrome, divided into three syndrome type deficiency of kidney essence syndrome, kidney deficiency and phlegm dampness syndrome, and kidney deficiency and blood stasis syndrome, and analyzed the characteristics of each syndrome type symptoms, endocrine, and MOD, to explore the correlation between TCM syndrome type of the DOR with its endocrine, deepening the cognition of TCM etiology and pathogenesis of DOR.Results:Part one:In60cases of normal ovarian function and182DOR patients in comparison, the incidence of adverse pregnancy and abnormal menstrual cycle of DOR group was higher than that of normal ovarian reserve group, the difference was statistically significant(P<0.01orP<0.05). DOR patients with menstrual cycle changes to oligomenorrhea were the most common,followed by frequent menstruation. The patients in the two groups of six hormone levels and MOD in comparison,the FSH level, FSH/LH ratio and PRL in DOR patients were higher than that of the normal group,and the LH level,T level,MOD were lower than that of normal group,and there was significant difference between them (P<0.05),but the serum E2and the P level had no significant difference in two groups(P>0.05); DOR patients with endocrine changes mainly increased as the FSH/LH ratio.182cases of DOR patients by age is divided into a, b, c three group,25～29years,30～34years,35～39years old. Three age groups of adverse pregnancy rate in group35～39was the highest. The patients in the three groups of six hormone levels in comparison, FSH, LH, E2, T, P, PRL level had no significant difference in three groups(P>0.05); The ratio of FSH/LH in C group higher than in the other two groups,C group compared with A group, the difference was statistically significant (P<0.05), the other groups showed no statistical significance compared with each other(P>0.05). The comparison of MOD, C is the smallest group, then B group, A group,differences between the three groups were statistical significance(P<0.05orP<0.01). Comparison of group of normal menstrual cycle and menstrual abnormalities group, age, LH, E2, T, P, PRL level, FSH/LH ratio and MOD had no significant difference in two groups(P>0.05); the FSH level in abnormal menstrual cycle group was higher than that of the normal group, and there was significant difference between them(P<005).Part two:TCM syndrome type with the largest proportion of deficiency of kidney essence syndrome in182DOR patients, followed by kidney deficiency and phlegm dampness syndrome,and kidney deficiency and blood stasis syndrome;Several clinical symptom frequency higher were Yaoxisuanruan, alopecia, forgetfulness, insomnia and dreaminess, Shenpi fatigue, chills, upset, etc. Oligomenorrhea found more common in the kidney of dampness syndromes of DOR patients. The serum P, PRL levels and MOD had no significant difference in the three syndromes (P>0.05);the LH level of kidney deficiency and phlegm dampness syndrome was lower than the other syndromes,and FSH/LH ratio was higher than that of the other two syndromes. the difference was statistically significant (P<0.05); The serum E2level of kidney deficiency and blood stasis syndrome was lower than the other two groups, compared with kidney deficiency and phlegm dampness syndrome, the difference was statistically significant (P<0.05);the serum T level of kidney deficiency and blood stasis syndrome and deficiency of kidney essence syndrome were lower than kidney deficiency and phlegm dampness syndrome, the difference was statistically significant in the three syndromes (P<0.01).Conclusions:Poor ovarian reserve function in patients with endocrine characteristic main performance for high FSH, low LH, high FSH/LH ratio and low androgen, ovarian morphology showed smaller MOD. Age is a sensitive predictor of ovarian function; The menstrual cycle change is one of the manifestations and predictors of ovarian dysfunction. DOR patients with menstrual cycle changes mainly were oligomenorrhea; the menstrual abnormal patients should alert the occurrence of DOR. LH like FSH can predict the ovarian reserve, the ratio of FSH/LH on ovarian function evaluation is more objective; The high basal E2level is predictive of a supplementary ovarian function decline. Androgen is also an indispensable significance as an index of testosterone ovarian function evaluation; Ultrasonic measurement of ovarian maximum plane mean diameter (MOD) is simple and intuitive, there is a certain value on the evaluation of the ovarian reserve function. Low ovarian reserve leads to increased incidence of adverse pregnancy outcome, Early prediction of ovarian function, ovarian dysfunction patients once pregnancy, tocolytic treatment as soon as possible, is the key of successful pregnancy.Renal deficiency is the main pathogenesis of DOR, phlegm and blood stasis are the two important pathogenic factors. The deficiency of the kidney essence is the main type of syndrome, followed by kidney deficiency and phlegm dampness syndrome, and kidney deficiency and blood stasis syndrome; Oligomenorrhea multiple kidney deficiency and phlegm damp type, Kidney essence deficiency is mainly manifested as low LH, high FSH/LH ratio, kidney deficiency and blood stasis are closely associated with low testosterone.