Exploring The Efficacy Mechanism Of Yijing Decoction In The Treatment Of Diminished Ovarian Reserve Function Based On Immunomodulation And Oxidative Stress

Objective: Evaluation of the clinical efficacy of Yijing Decoction combined with artificial cycle(estradiol tablets/estradiol digestrol tablets)in the treatment of patients with kidney deficiency and liver depression type of Diminished ovarian reserve(DOR),and to investigate the possible mechanism of action of drug treatment of kidney deficiency and liver depression type DOR through the changes of peripheral blood T lymphocyte subsets and superoxide dismutase(SOD)levels before and after treatment,so as to provide scientific basis for the clinical treatment strategy of DOR.Methods: From November 2021 to December 2022,82 patients with kidney deficiency and liver depression type DOR were selected from the outpatient clinic of the Department of Reproduction and Genetics of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine.They were randomly divided into observation group(41 cases)and control group(41 cases).The control group was given artificial cycle treatment,and the observation group was treated with Yijing Decoction on this basis,and both groups underwent 3 menstrual cycles.The levels of serum sex hormones [follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),FSH/LH,anti-mullerian hormone(AMH)],antral follicle count(AFC),TCM syndrome score,peripheral blood T lymphocyte subsets(CD3+、CD4+、CD8+)and SOD levels before and after treatment were observed in the two groups,and any adverse events during treatment were followed up.Excel software database was established and SPSS26.0 software was used for statistical analysis.Results: 1.The age of the two groups of patients is concentrated in the 31-45 years old,of which the highest proportion is 41-45 years old.2.The overall effective rate of the observation group was 94.74% higher than 75.68% of the control group(P<0.01).3.After treatment,FSH,LH and FSH/LH levels decreased and E2 levels increased in both groups,with statistically significant differences(P<0.05),while the levels of AFC and AMH did not change significantly(P>0.05).When comparing between groups after treatment,the FSH level decreased and E2 level increased in the observation group compared with the control group(P<0.05),while LH,FSH/LH,AFC and AMH levels were not significantly different compared to the control group(P>0.05).4.After treatment,the total scores of TCM syndromes in the two groups were significantly decreased(P<0.01).When compared between groups after treatment,the observation group had better improvements in menstrual flow,menstrual quality,waist and knee soreness,chest or breast tenderness,insomnia and dreaminess,irritability,chest tightness and sighing,and total points than the control group(P<0.05),while the rest of symptoms improved comparably to the control group(P>0.05).5.After treatment,CD4+,CD4+/CD8+ and SOD levels increased and CD8+ level decreased in both groups,and the differences were statistically significant(P<0.05),while CD3+ levels did not change significantly(P>0.05).When compared between groups after treatment,the CD4+,CD4+/CD8+ and SOD levels were higher in the observation group than in the control group(P<0.05),while CD3+ and CD8+ levels were not significantly different than the control group(P>0.05).6.Pearson correlation analysis showed that FSH levels were negatively correlated with CD4+ and CD4+/CD8+ levels(P<0.05),E2 levels were positively correlated with CD4+/CD8+ levels(P<0.05),while FSH,LH,E2 levels were not correlated with CD3+ and CD8+ levels(P>0.05)in the baseline data.7.During the treatment,no adverse reactions were found in both groups,and the safety was good.Conclusion:1.Yijing Decoction combined with artificial cycle was effective in treating patients with kidney deficiency and liver depression type DOR,and could effectively improve the patients’ basal sex hormone levels and kidney deficiency and liver depression type TCM symptoms,the observation group had better improvements in menstrual flow,menstrual quality,waist and knee soreness,chest or breast tenderness,insomnia and dreaminess,irritability,chest tightness and sighing,and total points than the control group.2.Yijing Decoction combined with artificial cycle treatment could elevate peripheral blood CD4+,CD4+/CD8+ and SOD levels and decrease CD8+ levels in patients,both in terms of T lymphocyte immunomodulation and oxidative stress.3.Baseline data showed a negative correlation between FSH levels and CD4+ and CD4+/CD8+ levels and a positive correlation between E2 levels and CD4+/CD8+ levels,suggesting a correlation between sex hormone levels and T lymphocyte subsets,possibly because sex hormones influence T cell development and function through sex hormone receptors present in thymic stromal cells and lamina propria cells.