【目的】 观察益肾破茧方联合来曲唑对肾虚血瘀型多囊卵巢综合征（PCOS）排卵障碍性不孕症的临床疗效。【方法】 选取 2024 年 2 月～2024 年 12 月就诊于广州中医药大学附属清远中医院生殖医学科的肾虚血瘀型 PCOS 排卵障碍性不孕症患者 60例，采用随机数字表法将患者随机分为观察组（益肾破茧方+来曲唑）和对照组（来曲唑），每组各30例。对照组给予来曲唑 治疗，观察组给予益肾破茧方联合来曲唑治疗。2组患者均以 1个月经周期为 1个疗程，治疗 3个疗程并随访 3个月。观察 2 组患者治疗前后中医证候积分、血清性激素[卵泡刺激素（FSH）、黄体生成素（LH）、睾酮（T）、抗缪勒管激素（AMH）]水平 及卵巢功能指标[卵巢窦卵泡数（AFC）、最大卵泡直径（FD）、子宫内膜厚度（EM）]的变化情况，并比较2组患者的排卵率和妊 娠率。【结果】（1）中医证候积分方面，治疗后，2组患者的中医证候积分均较治疗前降低（P＜0.05），且观察组的降低幅度明 显优于对照组（P＜0.05）。（2）性激素水平方面，治疗后，2组患者的血清FSH均较治疗前升高（P＜0.05），血清LH、T、AMH 水平均较治疗前降低（P＜0.05），且观察组对血清FSH水平的升高幅度及对血清LH、T、AMH水平的降低幅度均明显优于对 照组（P＜0.05）。（3）卵巢功能方面，治疗后，2 组患者的 AFC 均较治疗前减少（P＜0.05），FD、EM 均较治疗前升高（P＜ 0.05），且观察组对 AFC 的减少幅度及对 FD、EM 的升高幅度均明显优于对照组（P＜0.05）。（4）排卵率及妊娠率方面，治疗 后，观察组的排卵率和妊娠率分别为 90.00%（27/30）、50.00%（15/30），均高于对照组的 70.00%（21/30）和 30.00%（9/30），组 间比较，差异均有统计学意义（P＜0.05）。【结论】 益肾破茧方联合来曲唑对肾虚血瘀型PCOS排卵障碍型不孕症患者临床效果 显著，可有效改善患者中医证候，调节血清性激素水平，改善患者的卵巢功能，提高患者的排卵率及妊娠率。

Objective To evaluate the clinical efficacy of Yishen Pojian Formula （YSPJF） combined with Letrozole in treating infertility due to ovulatory dysfunction in polycystic ovary syndrome （PCOS） patients of kidney deficiency and blood stasis type. Methods Sixty PCOS patients diagnosed as ovulatory-dysfunction-induced infertility （kidney deficiency and blood stasis type） at the Reproductive Medicine Department of Qingyuan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from February 2024 to December 2024 were randomized into an observation group and a control group using a random number table，with 30 cases in each group. The control group received Letrozole alone，while the observation group received YSPJF combined with Letrozole. Both groups were treated for three menstrual cycles and followed up for three months. The changes in traditional Chinese medicine （TCM） syndrome scores， serum levels of sex hormones [folliclestimulating hormone（FSH），luteinizing hormone（LH），testosterone（T），and anti-Müllerian hormone （AMH）]， ovarian function parameters [antral follicle count （AFC）， maximum follicle diameter （FD）， and endometrial thickness （EM）] in the two groups were observed. Moreover，the ovulation rate and pregnancy rate were compared. Results （1） After treatment，the TCM syndrome scores of the two groups were lower than those before treatment （P＜0.05），and the decrease in the observation group was significantly superior to that in the control group （P＜ 0.05）.（2） After treatment，the serum FSH of the two groups was higher than that before treatment （P＜0.05）， and the levels of serum LH，T，and AMH were lower than those before treatment （P＜0.05），and the increase of the serum FSH level and the decrease of the levels of serum LH，T，and AMH in the observation group were significantly superior to those in the control group，the differences being all statistically significant （P＜0.05）.（3） After treatment，AFC was reduced （P＜0.05） and FD and EM were elevated （P＜0.05） in both groups compared with those before treatment，and the reduction of AFC and the elevation of FD and EM in the observation group were significantly superior to that in the control group （P＜0.05）.（4） After treatment， the ovulation rate and pregnancy rate of the observation group were 90.00% （27/30） and 50.00% （15/30），respectively，which were higher than those of the control group [70.00% （21/30） and 30.00% （9/30）]，and the differences were statistically significant （P＜0.05）. Conclusion YSPJF combined with Letrozole exerts significant clinical efficacy for PCOS patients with infertility due to ovulatory dysfunction of kidney deficiency and blood stasis type，and the combined therapy is effective on alleviating TCM syndromes，modulating sex hormone levels，improving ovarian function， and elevating ovulation rate and pregnancy rate.

R271.14

广东省中医药局科研项目（编号：20251483）；清远市科技计划自筹经费项目