| Objective:To explore the characteristics of thermal metabolism of thin endometrium（kidney-yang deficiency syndrome）and the clinical efficacy of Kidney-tonifying and JIEXU prescription no.2 on thin endometrium（kidney-yang deficiency syndrome）by infrared thermal imaging technology.Method:1. Source of cases:The cases of thin endometrium in the tutor’s outpatient department of affiliated hospital of Chengdu university of TCM from January 2018 to January 2020.2. Standard of diagnosis:Diagnostic criteria for thin endometrium were established by referring to practical reproductive medicine and related studies[3-4]:endometrial thickness at luteal metaphase（6-8d after ovulation）is less than0.8cm.The diagnostic criteria for kidney-yang deficiency syndrome were formulated by referring to the guiding principles for clinical research of new Chinese medicine（2002）,gynecology of traditional Chinese medicine（the fourth edition of the new century,China press of traditional Chinese medicine）and the rules for grading factors of kidney-yang deficiency syndrome[13].The determination standard of yang-deficiency constitution was formulated according to the classification and determination of TCM constitution promulgated by China society of traditional Chinese medicine in 2009.3. Inclusion criteria:The cases in the observation group met the diagnostic criteria of thin endometrium and kidney Yang deficiency syndrome,aged 20-45 years old,and had a constitution of Yang deficiency.The cases in the control group met the diagnostic criteria of thin endometrium,aged 20-45 years,and had a constitution of non-yang deficiency.4.research method:The general data（infertility,age,course of disease,number of pregnancies,history of adverse pregnancy,gynecological surgery）,constitution,endometrial thickness in luteal metaphase（6-8 days after ovulation）,difference of calorific value of cerebral and myocardial blood supply and the average calorific value of Shenque,Dumai and uterus measuring by medical infrared thermal imager（ADT-YL100A）were retrospectively collected to compare the differences between the two groups.The cases in observation group were treated with Kidney-tonifying and JIEXU prescription no.2（Main drugs:dodder,herba epimedii,teasel root,mugwort leaves,etc.Directions:after menstruation,one dose a day,take orally,continue for a week）for 3 menstrual cycles.Before and after treatment,the score of TCM syndrome,conversion score of yang-deficiency constitution,endometrial thickness,E2 and P at luteal metaphase（6-8 days after ovulation）,difference of calorific value of cerebral and myocardial blood supply,as well as the mean heat value of Dumai and uterine location were compared.5.evaluation criterion:The evaluation standard of infrared thermal metabolism is the same as the scanning center standard.The evaluation indexes for clinical observation of Kidney-tonifying and JIEXU prescription no.2 include TCM syndrome score,conversion score of yang-deficiency constitution,endometrial thickness,E2 and P at luteal metaphase（6-8 days after ovulation）,difference of calorific value of cerebral and myocardial blood supply,as well as the mean heat value of Dumai and uterine location.It is effective if the difference before and after treatment is statistically significant.The evaluation standard of comprehensive efficacy was made by referring to the relevant contents in the guiding principles for clinical research of new traditional Chinese medicine drugs[11]（2002）.The efficacy index（N）was calculated by nimodipine method.Recovery:endometrial thickness≥0.8cm,N≥95%or pregnancy;Markedly effective:endometrial thickness≥0.8cm,70%≤N<95%;Effective:endometrial thickness increased,but endometrial thickness<0.8cm,30%≤N<70%;Ineffective:endometrial thickness did not increase,N<30%.6.Statistical approach:The collected data were entered into Excel for sorting,and then SPSS24.0 was used for data processing and analysis.T test was used for measurement data conforming to normal distribution,and the results were expressed as mean±standard deviation（c±s）.Mann-whitney U test or Wilcoxon symbolic rank test were used for count level data and measurement data that did not conform to the normal distribution,and the results were represented by median.Results:1.The observation group included 7 cases of primary infertility and 34 cases of secondary infertility.The average age was 32.15±4.16 years olde.The average duration was 3.37±3.00 years.The average times of pregnancy was 2.41±2.28times.The endometrial thickness on average was 0.55±0.10 cm.The most adverse pregnancy history was embryo arrest,accounting for 48.78%.In the history of gynecological surgery,the curettage was the most,accounting for 53.66%.The control group included 6 cases of primary infertility and 28 cases of secondary infertility.The average age was 31.76±4.38 years olde.The average duration was 2.21±1.49years.The average times of pregnancy was 2.44±1.85 times.The endometrial thickness on average was 0.52±0.10 cm.The most adverse pregnancy history was embryo arrest,accounting for 32.35%.In the history of gynecological surgery,the induced abortion/induction of labor was the most,accounting for 64.71%.After examination,there were no statistically significant differences in age,duration,number of pregnancy,endometrial thickness,adverse pregnancy history and gynecological surgery history between the two groups（P>0.05）.2.Among the 41 cases of thin endometrium（kidney-yang deficiency syndrome）,the most were 2 and 4 kinds of partial constitutions,all of which were 9 cases（21.95%）.There were 8 cases with simple Yang deficiency constitution,accounting for19.51%.There were 5 cases with 7 kinds of constitution,accounting for 12.20%.There were 3 cases with 3 kinds of constitution and 6 kinds of constitution,accounting for7.32%.The combination of 5 kinds and 8 kinds of constitution was the least（2 cases）,accounting for 4.88%.In addition to yang-deficiency constitution,the top four constitutions were qi-deficiency constitution（22.02%）,qi-stagnation constitution（19.27%）,blood-stasis constitution（16.51%）,and damp-heat constitution（15.60%）.3.A total of 67 cases completed the locational calorific value measurement,including 33 cases in the observation group and 34 cases in the control group.Between the two groups,the caloric difference of cerebral blood supply location was 0.60±0.28℃,0.38±0.18℃,the caloric difference of myocardial blood supply location was0.32（0.28～0.35）℃,0.21（0.13～0.37）℃,the mean caloric value of Shenqu location was31.17（30.25～31.26）℃,31.10（30.58～31.54）℃,and the caloric value of the Dumai location was 30.83（30.53～31.24）℃,31.34（31.01～31.81）℃,and the calorific value of uterine location was 28.86±0.82℃,29.35±0.71℃.The difference of caloric value in cerebral blood supply and myocardial blood supply sites of the observation group was higher than that of the control group（P<0.05）,the mean calorific value in the dumai and uterine site was lower than that of the control group（P<0.05）.There was no statistically significant difference between the two groups in the mean calorific value of Shenque location（P>0.05）.4. A total of 33 cases of thin endometrium（kidney-yang deficiency syndrome）were treated,and the recovery rate was 9.09%,the markedly effective rate 18.18%,the effective rate 60.61%,and the total effective rate 87.88%.After treatment,the score of TCM syndrome decreased by 20.64±6.28 points（P<0.01）,the mean endometrial thickness increased by 0.18±0.14cm（P<0.01）,the mean conversion score of yang-deficiency constitution decreased by 14.2±11.19 points（P<0.01）,the endometrium blood supply increased by 1.35±1.80cm/s（P<0.01）,EDV increased by 0.58±0.93cm/s（P<0.01）,RI decreased by0.04±0.09（P<0.05）,PI decreased by0.13±0.29（P<0.05）,E2 increased by 54.28±60.17pg/ml（P<0.01）,P increased by6.04±5.40ng/ml（P<0.01）,the difference of caloric value in cerebral blood supply and myocardial blood supply was significantly lower after treatment than before treatment（P<0.01）,the mean caloric value of uterine location was significantly higher than before treatment（P<0.01）,and the mean caloric value of Dumai location was significantly higher than before treatment（P<0.05）.There was no statistically significant difference between the regional calorific value difference/calorific value of each location and that of the first part of the control group（P>0.05）.Conclusion:1.Patients with thin endometrium（kidney-yang deficiency syndrome）mostly have a dual constitution,and Yang deficiency constitution is easy to be combined with qi deficiency constitution and qi stagnation constitution.2.Compared with the thin endometrium（non Yang deficiency constitution）,the thin endometrium（kidney-yang deficiency syndrome）showed the characteristics of decreased heat metabolism in the uterine and Dumai regions.3.Tonifying kidney no.2 prescription is an effective drug for the treatment of thin endometrium（kidney-yang deficiency syndrome）. |
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