针药结合对肾虚痰湿型多囊卵巢综合征不孕患者生殖激素及卵泡发育的影响
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摘要
目的观察中药调经祛痰方联合电针对肾虚痰湿型多囊卵巢综合征(PCOS)不孕患者生殖激素及卵泡发育的影响。方法 90例PCOS不孕患者随机分为两组,对照组45例口服达英-35(月经第5天起,1片/d,连服21 d)治疗1个疗程,第1个疗程结束后给予来曲唑(月经来潮第5天,1片/d,连服5 d)促排卵治疗1个疗程。治疗组45例在对照组基础上加用中药调经祛痰方配合电针(关元、足三里、阴陵泉、丰隆等)治疗,连续治疗2个疗程。观察两组第1个疗程结束后血清性激素[卵泡刺激素(FSH)、黄体生成激素(LH)、总睾酮(T)、雌二醇(E2)]及生殖激素[血清抗苗勒氏管激素(AMH)及抑制素B(IHNB)]水平。第2个疗程结束后观察月经周期,比较两组临床疗效、排卵率、妊娠率及卵泡未破裂黄素化综合征(LUFS)、卵巢过度刺激综合征(OHSS)发生率。结果 (1)治疗组总有效率为91. 1%,对照组为80. 0%,治疗组优于对照组(P <0. 05)。(2) 2个疗程结束后两组月经周期均较前明显缩短,治疗组第2疗程月经周期改善优于对照组(P <0. 05)。(3)第1个疗程结束后治疗组血清LH、T、LH/FSH比值及AMH水平明显较前下降,其中T、AMH水平低于对照组(P <0. 05)。(4)第2个疗程结束后治疗组排卵率、妊娠率均显著高于对照组(P <0. 05),LUFS发生率低于对照组(P <0. 05)。结论针药结合治疗能调节PCOS不孕患者LH/FSH比值,降低高雄激素及血清AMH水平,缩短患者月经周期,显著提高PCOS不孕患者排卵率及妊娠率,降低LUFS发生率,疗效优于单纯达英-35、来曲唑治疗。
Objective To observe the effects of the combination of acupuncture and herbal medicine on reproductive hormones and follicular development in infertility of PCOS differentiated as kidney deficiency and phlegm damp in the patients. Methods A total of 90 patients with PCOS infertility were randomized into two groups. In the control group,45 cases were treated with the oral administration of Diane-35 for 1 session( starting on the 5 th day of menstruation,one tablet a day,consecutively for 21 days). After 1 session of medication with Diane-35,letrozole was given for another 1 session to promote ovulation( starting on the 5 th day of menstruation,one tablet a day,consecutively for 5 days). In the treatment group( 45 cases),on the base of the treatment as the control group,tiaojing qutan formula combined with electroacupuncture were supplemented,consecutively for 2 courses. The acupoints were Guanyuan( CV 4),Zusanli( ST 36),Yinlingquan( SP 9),Fenglong( ST 40). After the 1 st course of treatment,the levels of serum sexual hormones( FSH,LH,T and E2) and reproductive hormones( AMH and IHNB) were observed in the two groups. After the 2 nd course of treatment,the menstrual cycle was observed,the clinical effects,ovulation rate,pregnancy rate and the incident rates of luteinized unruptured follicle syndrome( LUFS) and ovarian hyperstimulation syndrome( OHSS) were compared between the two groups. Results 1. The total effective rate was 91. 1% in the treatment group and was 80. 0% in the control group. The result in the treatment group was better than the control group( P < 0. 05). 2. After 2 courses of treatment,the menstrual cycle was shortened obviously as compared with the cycle before treatment. The improvement in the treatment group was better than the control group in the 2 nd course of treatment( P < 0. 05). 3. After the 1 st course of treatment,the levels of LH,T,LH/FSH and AMH in the treatment group were all reduced obviously as compared with the levels before treatment,in which,the levels of T and AMH were lower than the control group( P < 0. 05). 4. After the 2 nd course of treatment,the ovulation rate and pregnancy rate in the treatment group were higher significantly than the control group( P < 0. 05) and the incident rate of LUFS was lower than the control group( P < 0. 05). Conclusion The combination of acupuncture and medicines down-regulates LH/FSH ratio,reduces androgen excess and serum AMH level,shortens menstrual cycle,significantly improves the ovulation rate and pregnancy rate and reduces the incident rate of LUFS in the patients with PCOS infertility. The effects are better than the simple medications with Diane-35 and letrozole.
Objective To observe the effects of the combination of acupuncture and herbal medicine on reproductive hormones and follicular development in infertility of PCOS differentiated as kidney deficiency and phlegm damp in the patients. Methods A total of 90 patients with PCOS infertility were randomized into two groups. In the control group,45 cases were treated with the oral administration of Diane-35 for 1 session( starting on the 5 th day of menstruation,one tablet a day,consecutively for 21 days). After 1 session of medication with Diane-35,letrozole was given for another 1 session to promote ovulation( starting on the 5 th day of menstruation,one tablet a day,consecutively for 5 days). In the treatment group( 45 cases),on the base of the treatment as the control group,tiaojing qutan formula combined with electroacupuncture were supplemented,consecutively for 2 courses. The acupoints were Guanyuan( CV 4),Zusanli( ST 36),Yinlingquan( SP 9),Fenglong( ST 40). After the 1 st course of treatment,the levels of serum sexual hormones( FSH,LH,T and E2) and reproductive hormones( AMH and IHNB) were observed in the two groups. After the 2 nd course of treatment,the menstrual cycle was observed,the clinical effects,ovulation rate,pregnancy rate and the incident rates of luteinized unruptured follicle syndrome( LUFS) and ovarian hyperstimulation syndrome( OHSS) were compared between the two groups. Results 1. The total effective rate was 91. 1% in the treatment group and was 80. 0% in the control group. The result in the treatment group was better than the control group( P < 0. 05). 2. After 2 courses of treatment,the menstrual cycle was shortened obviously as compared with the cycle before treatment. The improvement in the treatment group was better than the control group in the 2 nd course of treatment( P < 0. 05). 3. After the 1 st course of treatment,the levels of LH,T,LH/FSH and AMH in the treatment group were all reduced obviously as compared with the levels before treatment,in which,the levels of T and AMH were lower than the control group( P < 0. 05). 4. After the 2 nd course of treatment,the ovulation rate and pregnancy rate in the treatment group were higher significantly than the control group( P < 0. 05) and the incident rate of LUFS was lower than the control group( P < 0. 05). Conclusion The combination of acupuncture and medicines down-regulates LH/FSH ratio,reduces androgen excess and serum AMH level,shortens menstrual cycle,significantly improves the ovulation rate and pregnancy rate and reduces the incident rate of LUFS in the patients with PCOS infertility. The effects are better than the simple medications with Diane-35 and letrozole.
引文
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[4]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:240-243.
[5]沈雪勇.经络腧穴学[M].北京:中国中医药出版社,2003:120-121.
[6]吴家满,卓缘圆,钟宇玲,等.调任通督针刺法配合穴位埋线治疗多囊卵巢综合征不孕症[J].吉林中医药,2014,34(5):526-529.
[7]Ni RM,Mo Y,Chen X,et al.Low prevalence of the metabolic syndrome but high occurrence of various metabolic disorders in Chinese women with polycystic ovary syndrome[J].Eur J Endocrinol,2009,161(3):411-418.
[8]Pigny P,Jonard S,Robert Y,et al.Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome[J].J Clin Endocrinol Metab,2006,91(3):941-945.
[9]Baarends WM,Uilenbroek JT,Kramer P,et al.Anti-Müllerian hormone and anti-müllerian hormone type II receptor messenger ribonucleic acid expression in rat ovaries during postnatal development,the estrous cycle,and gonadotropin-induced follicle growth[J].Endocrinology,1995,136(11):4951-4962.
[10]Durlinger AL,Kramer P,Karels B,et al.Control of primordial follicle recruitment by anti-Müllerian hormone in the mouse ovary[J].Endocrinology,1999,140(12):5789-5796.
[11]Durlinger AL,Gruijters MJ,Kramer P,et al.Anti-Müllerian hormone attenuates the effects of FSH on the follicle development in the mouse ovary[J].Endocrinology,2001,142(11):4891-4899.
[12]Weerakiet S,Lertvikool S,Tingthanatikul Y,et al.Ovarian reserve in women with polycystic ovary syndrome who underwent laparoscopic ovarian driuing[J].Gynecol Endocrinol,2007,23(8):455-460.
[13]Welt CK,Mc Nicholl DJ,Taylor AE,et al.Female reproductive aging is marked by decreased secretion of dimeric inhibin[J].J Clin Endocrinol Metab,1999,84(1):105-111.
[14]Seifer DB,Scott RT Jr,Bergh PA,et al.Women with declining ovarian reserve may demonstrate a decrease in day 3 serum inhibin B before a rise in day 3 follicle-stimulating hormone[J].Fertil Steril,1999,72(1):63-65.
[15]张迎春,张花,陈明,等.穴位埋线配合中药治疗多囊卵巢综合征患者月经影响[C].贵阳:第十三次全国中医妇科学术大会论文集,2013:412-41.
[2]Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group(2004)Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[S].Human reproduction,2004:41-47.
[3]谢幸,苟文丽.妇产科学[M].北京:人民卫生出版社,2013:369.
[4]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:240-243.
[5]沈雪勇.经络腧穴学[M].北京:中国中医药出版社,2003:120-121.
[6]吴家满,卓缘圆,钟宇玲,等.调任通督针刺法配合穴位埋线治疗多囊卵巢综合征不孕症[J].吉林中医药,2014,34(5):526-529.
[7]Ni RM,Mo Y,Chen X,et al.Low prevalence of the metabolic syndrome but high occurrence of various metabolic disorders in Chinese women with polycystic ovary syndrome[J].Eur J Endocrinol,2009,161(3):411-418.
[8]Pigny P,Jonard S,Robert Y,et al.Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome[J].J Clin Endocrinol Metab,2006,91(3):941-945.
[9]Baarends WM,Uilenbroek JT,Kramer P,et al.Anti-Müllerian hormone and anti-müllerian hormone type II receptor messenger ribonucleic acid expression in rat ovaries during postnatal development,the estrous cycle,and gonadotropin-induced follicle growth[J].Endocrinology,1995,136(11):4951-4962.
[10]Durlinger AL,Kramer P,Karels B,et al.Control of primordial follicle recruitment by anti-Müllerian hormone in the mouse ovary[J].Endocrinology,1999,140(12):5789-5796.
[11]Durlinger AL,Gruijters MJ,Kramer P,et al.Anti-Müllerian hormone attenuates the effects of FSH on the follicle development in the mouse ovary[J].Endocrinology,2001,142(11):4891-4899.
[12]Weerakiet S,Lertvikool S,Tingthanatikul Y,et al.Ovarian reserve in women with polycystic ovary syndrome who underwent laparoscopic ovarian driuing[J].Gynecol Endocrinol,2007,23(8):455-460.
[13]Welt CK,Mc Nicholl DJ,Taylor AE,et al.Female reproductive aging is marked by decreased secretion of dimeric inhibin[J].J Clin Endocrinol Metab,1999,84(1):105-111.
[14]Seifer DB,Scott RT Jr,Bergh PA,et al.Women with declining ovarian reserve may demonstrate a decrease in day 3 serum inhibin B before a rise in day 3 follicle-stimulating hormone[J].Fertil Steril,1999,72(1):63-65.
[15]张迎春,张花,陈明,等.穴位埋线配合中药治疗多囊卵巢综合征患者月经影响[C].贵阳:第十三次全国中医妇科学术大会论文集,2013:412-41.