针刺在治疗卵巢低反应的临床应用进展
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摘要
卵巢低反应(poor ovarian response,POR)是卵巢对促性腺激素(Gn)刺激反应不良的病理状态,患者在控制性超促排卵(COH)中效果不理想,体外受精-胚胎移植(IVF-ET)妊娠率低下。如今对于POR的常规治疗仍存在局限。针刺疗法作为祖国传统医学的重要组成部分,操作简便,经济安全。目前临床针刺治疗POR包括毫针刺法、经皮穴位电刺激(TEAS)和针药结合等方法。研究表明POR患者经针刺治疗后基础内分泌、肾虚症状和卵巢功能等有所改善,接受IVF-ET患者获卵数与妊娠率有所提高。其治疗机制可能是通过调节中枢相关神经元活性和下丘脑-垂体-卵巢轴的分泌功能,改善血清性激素水平和卵巢血液供应,提高IVFET妊娠率。现将针刺治疗POR的临床研究进展从治疗的机制、方法、疗效、安全性等方面进行综述。
Poor ovarian response(POR) is a pathological state of ovarian stimulation to the gonadotropin(Gn), which leads to the poor outcome of controlled ovarian hyperstimulation(COH) and the low pregnancy rate in in-vitro fertilization and embryo transfer(IVF-ET). Nowadays there are also limitations of conventional therapy. As a vital part of traditional Chinese medicine, acupuncture is economical, secure and easy to do. At present, the methods of clinical acupuncture for POR include the filiform needle acupuncture, the transcutanclus electrical acupoint stimulation(TEAS) and the acupuncture combined with medicine,etc. The basal hormone levels,symptoms of "kidney deficiency" and ovarian function were improved in those POR patients underwent acupuncture treatment, and the pregnancy rate and the quantity of oocytes were raised in their IVF-ET cycles. The underlying mechanisms of acupuncture treatment could include the positive regulation of central neuron, the improvement of hypothalamic-pituitary-ovarian axis, and the improved ovarian blood supply. In this review, the clinical research progress of acupuncture treatment of POR is summarized.
Poor ovarian response(POR) is a pathological state of ovarian stimulation to the gonadotropin(Gn), which leads to the poor outcome of controlled ovarian hyperstimulation(COH) and the low pregnancy rate in in-vitro fertilization and embryo transfer(IVF-ET). Nowadays there are also limitations of conventional therapy. As a vital part of traditional Chinese medicine, acupuncture is economical, secure and easy to do. At present, the methods of clinical acupuncture for POR include the filiform needle acupuncture, the transcutanclus electrical acupoint stimulation(TEAS) and the acupuncture combined with medicine,etc. The basal hormone levels,symptoms of "kidney deficiency" and ovarian function were improved in those POR patients underwent acupuncture treatment, and the pregnancy rate and the quantity of oocytes were raised in their IVF-ET cycles. The underlying mechanisms of acupuncture treatment could include the positive regulation of central neuron, the improvement of hypothalamic-pituitary-ovarian axis, and the improved ovarian blood supply. In this review, the clinical research progress of acupuncture treatment of POR is summarized.
引文
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[12]王铮,滕晓明,张婷婷.卵巢低反应关键通路与基因分析及中医药相关干预作用研究进展[J].上海中医药大学学报,201,8(3):103-108.
[13]金志春,郑洁,夏敏,等.针刺改善体外受精-胚胎移植患者临床妊娠结局及其机制的研究[J/OL].中国中西医结合杂志,1-6[2018-10-12].http://kns.cnki.net/kcms/detail/11.2787.R.20180912.0746.002.html.
[14]李蓉,孙伟,林戈,等.电针/经皮穴位电刺激技术在生殖医学中的应用专家共识[J].生殖与避孕,2016,36(7):527-535.
[15]高修安,陈曼珍,马文敏,等.针刺结合中药人工周期疗法治疗体外受精卵巢反应低下患者的临床疗效[J].佛山科学技术学院学报(自然科学版),2017,35(6):57-61.
[16]连方,李冉.经皮穴位电刺激联合腔内理疗治疗肾虚型卵巢低反应临床研究[J].中国中西医结合杂志,2017,37(5):522-525.
[17]王肖,尤昭玲,刘文娥.尤昭玲教授对卵巢低反应的认识及中医辅助治疗特色[J].中国中西医结合杂志,2016,36(8):1008-1009.
[18]伍洁洁,苏同生,万兆新.经皮穴位电刺激治疗卵巢低反应结局的系统评价[J].世界最新医学信息文摘,2018,18(51):108-109.
[19]马睿杰,陆惠芳.经皮穴位电刺激治疗妇科疾病的临床研究进展[J].新中医,2018,50(2):140-144.
[20]柯嘉敏,夏薇,苏宁,等.卵巢反应性指标的临床研究进展[J].国际生殖健康/计划生育杂志,2018,37(1):62-65.
[2]Lamazou F,Fuchs F,Grynberg M,et al.Cancellation of IVF-ETcycles:poor prognosis,poor responder,or variability of the response to controlled ovarian hyperstimulation?An analysis of 142cancellations[J].J Gynecol Obstet Biol Reprod(Paris),2012,41(1):41-47.
[3]Ferraretti AP,La Marca A,Fauser BC,et al.ESHRE consensus on the definition of′poor response′to ovarian stimulation for in vitro fertilization:the Bologna criteria[J].Hum Reprod,2011,26(7):1616-1624.
[4]王彤,何欣,马延敏.体外受精-胚胎移植中卵巢低反应的治疗研究进展[J].中国优生与遗传杂志,2017,25(6):3-4.
[5]杨茜,腊晓琳,党鑫.卵巢低反应研究进展[J].淮海医药,2017,35(3):371-373.
[6]李冉,连方.卵巢低反应的中医证治思路和优势[J].吉林中医药,2016,36(6):553-556.
[7]赵敏,连小龙,刘景楠,等.不同施加因素对下丘脑-垂体-卵巢轴调节作用的实验研究概况[J].甘肃中医药大学学报,2018,35(3):92-96.
[8]孙懿宣,齐聪.针灸改善卵巢功能的研究进展[J].临床医药文献电子杂志,2015,2(14):2906.
[9]武学清,孔蕊,田莉,等.卵巢低反应专家共识[J].生殖与避孕,2015,35(2):71-79..
[10]焦娇,贾婷,冯晓军,等.经皮穴位电刺激对卵巢反应不良不孕患者临床疗效观察90例[J].中国优生与遗传杂志,2017,25(8):114-116.
[11]王婧.电针关元、三阴交对AD模型小鼠HPO轴及β-APP、Aβ1-42表达的影响[D].北京中医药大学,2017.
[12]王铮,滕晓明,张婷婷.卵巢低反应关键通路与基因分析及中医药相关干预作用研究进展[J].上海中医药大学学报,201,8(3):103-108.
[13]金志春,郑洁,夏敏,等.针刺改善体外受精-胚胎移植患者临床妊娠结局及其机制的研究[J/OL].中国中西医结合杂志,1-6[2018-10-12].http://kns.cnki.net/kcms/detail/11.2787.R.20180912.0746.002.html.
[14]李蓉,孙伟,林戈,等.电针/经皮穴位电刺激技术在生殖医学中的应用专家共识[J].生殖与避孕,2016,36(7):527-535.
[15]高修安,陈曼珍,马文敏,等.针刺结合中药人工周期疗法治疗体外受精卵巢反应低下患者的临床疗效[J].佛山科学技术学院学报(自然科学版),2017,35(6):57-61.
[16]连方,李冉.经皮穴位电刺激联合腔内理疗治疗肾虚型卵巢低反应临床研究[J].中国中西医结合杂志,2017,37(5):522-525.
[17]王肖,尤昭玲,刘文娥.尤昭玲教授对卵巢低反应的认识及中医辅助治疗特色[J].中国中西医结合杂志,2016,36(8):1008-1009.
[18]伍洁洁,苏同生,万兆新.经皮穴位电刺激治疗卵巢低反应结局的系统评价[J].世界最新医学信息文摘,2018,18(51):108-109.
[19]马睿杰,陆惠芳.经皮穴位电刺激治疗妇科疾病的临床研究进展[J].新中医,2018,50(2):140-144.
[20]柯嘉敏,夏薇,苏宁,等.卵巢反应性指标的临床研究进展[J].国际生殖健康/计划生育杂志,2018,37(1):62-65.