针灸改善子宫内膜容受性疗效的Meta分析
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摘要
目的:系统评价单纯针灸改善子宫内膜容受性的有效性。方法:计算机检索CBM、CNKI、万方、维普、PubMed,搜集针灸改善子宫内膜容受性的随机对照试验(RCT),检索时限均为从建库至2018年3月。由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:纳入文献12篇,1059例参与结局指标数据Meta分析,GRADE证据质量评价总体文献质量偏低。针灸在改善子宫内膜厚度、A型子宫内膜占比、子宫螺旋动脉血流搏动指数(Pulse Index, PI)方面优于西药,在改善PI、子宫螺旋动脉血流阻力指数(Resistive Index, RI)方面优于空白组及安慰针灸,且针灸联合西药在子宫内膜厚度、A型子宫内膜占比、PI、RI方面均优于西药,而针灸联合中药及西药在改善子宫内膜容受性上均优于西药。结论:因此,单用针灸或者联合其他治疗方法对子宫内膜容受性有较好的改善作用。
Objective:To evaluate the efficacy of pure acupuncture and moxibustion in improving endometrial receptivity. Methods:Data sources were CBM, CNKI, WanFang,VIP database and PubMed from the establishment to March 2018 and the randomized controlled trials(RCTs) were collected for the improvement of endometrial tolerance of acupuncture and moxibustion. A Meta-analysis was conducted by using RevMan 5.3 software. After two evaluators independently screenning the literature, the extracting data and evaluating the risk of bias were included in the study. Results:Twelve articles were included in the literature and 1057 were involved in the Meta-analysis of the outcome index data. GRADE evidence quality evaluation of improving the proportion of A type of endometrium was moderate quality and the rest were extremely low quality. Acupuncture and moxibustion were superior to western medicine in improving the proportion of type A endometrium and were superior to the blank group/placebo group in the endometrial thickness,the proportion of type A endometrium,PI and RI. Conclusion:Single acupuncture therapy or other treatment methods can improve ER but there is no significant difference with western medicine.
Objective:To evaluate the efficacy of pure acupuncture and moxibustion in improving endometrial receptivity. Methods:Data sources were CBM, CNKI, WanFang,VIP database and PubMed from the establishment to March 2018 and the randomized controlled trials(RCTs) were collected for the improvement of endometrial tolerance of acupuncture and moxibustion. A Meta-analysis was conducted by using RevMan 5.3 software. After two evaluators independently screenning the literature, the extracting data and evaluating the risk of bias were included in the study. Results:Twelve articles were included in the literature and 1057 were involved in the Meta-analysis of the outcome index data. GRADE evidence quality evaluation of improving the proportion of A type of endometrium was moderate quality and the rest were extremely low quality. Acupuncture and moxibustion were superior to western medicine in improving the proportion of type A endometrium and were superior to the blank group/placebo group in the endometrial thickness,the proportion of type A endometrium,PI and RI. Conclusion:Single acupuncture therapy or other treatment methods can improve ER but there is no significant difference with western medicine.
引文
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[19] 汪秀梅,田丽娟,袁红丽,等.温针灸对胚胎移植患者子宫内膜容受性影响的疗效观察[J].四川中医,2017,35(6):184-187.
[20] 陈芊,郝翠芳.针灸对IVF-ET反复种植失败患者子宫内膜血流及胞饮突表达的影响[J].生殖与避孕,2015,35(3):159-165.
[21] 陈雪梅,高颖.针刺疗法运用于辅助生殖技术对提高子宫内膜容受性的研究[J].成都医学院学报,2012,7(2):106-106.
[22] 李玉,冯晓军,孙伟,等.经皮穴位电刺激改善冻融胚胎移植周期患者子宫内膜容受性的临床研究[J].现代中医药,2012,32(3):12-15.
[23] 周彬,王缤.针刺配合克罗米芬促排卵的疗效观察[J].山东中医杂志,2012,31(2):121-122.
[24] 林树煌,邹小玲,张美玲,等.针灸理疗对PCOS不孕症患者子宫内膜容受性的影响研究[J].湖南中医杂志,2015,31(5):84-86.
[2] 王琼,周灿权.反复种植失败的病因探讨[J].中国实用妇科与产科杂志,2013,29(2):100-102.
[3] 庄广伦.胚胎种植失败,是内膜更重要吗?[J].生殖与避孕,2014,34(7):522-525.
[4] 黄柳静,李荣,羊海涛,等.改善子宫内膜容受性的研究进展[J].医学综述,2017,23(21):4204-4209.
[5] 田密苏,郑波,吕芳杰,等.中医三联疗法对冻融胚胎移植周期中子宫内膜容受性及临床结局的影响[J].宁夏医科大学学报,2017,39(9):1059-1061.
[6] 文隽,胡兵,赵云.不孕症患者子宫内膜容受性的评估及改善研究[J].中华生殖与避孕杂志,2017,37(7):602-605.
[7] 李华,李蓉,王丽娜,等.子宫内膜容受性治疗方法的新进展[J].生殖医学杂志,2015,24(3):240-244.
[8] 胡文晓.针灸在克罗米芬促排卵周期中对子宫内膜作用的临床观察[J].泰山医学院学报,2016,37(9):1029-1031.
[9] 姜朵生,吴献群,张迎春.温针灸配合长膜汤对促排卵患者子宫内膜容受性的影响[J].中国针灸,2014,34(2):130-134.
[10] 帅振虹,连方.针刺在辅助生殖领域中的应用及其作用机制研究进展[J].中医杂志,2013,54(24):2149-2151.
[11] 潘荣,高洋,闵哲.中药灌肠配合针刺治疗薄型子宫内膜不孕的临床观察[J].光明中医,2017,32(1):57-59.
[12] 邢玉,张庆,刘杰,等.针药结合对卵泡发育不良者卵泡发育情况及子宫内膜超声评分的作用研究[J].世界中西医结合杂志,2016,11(11):1489-1492,1496.
[13] 陈芊,郝翠芳.针灸对体外受精-胚胎移植者妊娠结局的影响[J].中国针灸,2015,35(4):313-317.
[14] 彭冬华,林浩春.针灸对体外受精胚胎移植术患者子宫内膜及妊娠结局的影响[J].中国医学创新,2017,14(17):121-125.
[15] 戴泽琦,孙伟伟,赵瑞华.近10年针灸影响子宫内膜容受性的国内外研究进展[J].中国针灸,2018,38(4):451-455.
[16] 孙振高,连方,张建伟,等.腔内短波理疗联合针刺对体外受精-胚胎移植子宫内膜容受性的影响[J].中医杂志,2012,53(22):1927-1929,1940.
[17] 罗国群,苏文武,马文敏,等.温针灸预处理对冷冻胚胎移植者子宫内膜容受性的影响[J].中国针灸,2017,37(8):831-835.
[18] 刘艳玲,潘丽贞,王英.热敏灸联合穴位注射对输卵管积水性不孕症宫腹腔镜术后患者子宫内膜容受性的影响[J].中国针灸,2018,38(1):22-26.
[19] 汪秀梅,田丽娟,袁红丽,等.温针灸对胚胎移植患者子宫内膜容受性影响的疗效观察[J].四川中医,2017,35(6):184-187.
[20] 陈芊,郝翠芳.针灸对IVF-ET反复种植失败患者子宫内膜血流及胞饮突表达的影响[J].生殖与避孕,2015,35(3):159-165.
[21] 陈雪梅,高颖.针刺疗法运用于辅助生殖技术对提高子宫内膜容受性的研究[J].成都医学院学报,2012,7(2):106-106.
[22] 李玉,冯晓军,孙伟,等.经皮穴位电刺激改善冻融胚胎移植周期患者子宫内膜容受性的临床研究[J].现代中医药,2012,32(3):12-15.
[23] 周彬,王缤.针刺配合克罗米芬促排卵的疗效观察[J].山东中医杂志,2012,31(2):121-122.
[24] 林树煌,邹小玲,张美玲,等.针灸理疗对PCOS不孕症患者子宫内膜容受性的影响研究[J].湖南中医杂志,2015,31(5):84-86.