针药并举治疗肾虚型多囊卵巢综合征不孕症的效果
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摘要
目的评价针刺配合补肾填精方治疗肾虚型多囊卵巢综合征(PCOS)不孕症的效果。方法选择2015年10月～2017年5月在中国中医科学院西苑医院不孕不育科门诊就诊的符合入选标准的60例肾虚型PCOS不孕症患者,采用随机数字表法将其分为对照组与治疗组,每组30例。两组患者均先针对合并症预调节3个月后,于月经来潮或撤退出血第5天起,对照组口服枸橼酸氯米芬,待卵泡>1.8 cm时肌内注射绒促性素;治疗组采用补肾填精方配合针刺治疗。于月经第9天起,采用阴道B超监测排卵情况,计算排卵率,检测血清卵泡刺激素(FSH)、促黄体生成素(LH)、游离睾酮(FT);于排卵后30 d,B超监测并记录妊娠情况,计算妊娠率。结果治疗组排卵率为60.0%,对照组为61.2%,两组比较差异无统计学意义(P> 0.05)。治疗组妊娠率为60.0%,明显高于对照组(37.5%),差异有统计学意义(P <0.05)。治疗后,两组未怀孕患者血清LH水平均较同组治疗前明显升高[治疗组:8.43(6.53,13.26)比6.72(5.33,8.74),Z=2.490,P <0.05;对照组:11.26(8.42,13.34)比6.47(4.18,8.10),Z=3.621,P <0.05]。两组治疗后血清FSH、FT水平与同组治疗前比较,差异均无统计学意义(P> 0.05)。结论针药并举可提高肾虚型PCOS不孕症患者的妊娠率。
Objective To evaluate the efficacy of acupuncture plus Bushen Tianjing Formula in the treatment of infertility due to polycystic ovary syndrome(PCOS) with kidney deficiency. Methods Sixty patients with infertility due to PCOS with kidney deficiency met with inclusion criteria were selected from October 2015 to May 2017 in Department of Infertility, Xiyuan Hospital of China Academy of Chinese Medical Sciences. The patients with infertility due to PCOS with kidney deficiency were divided into control group and treatment group, with 30 cases in each group. The patients in both groups were preadjusted for complications for 3 months, after menstruation or withdrawal bleeding for 5 days,the patients in the control group were given Clomiphene Citrate orally and intramuscular injection of chorionic gonadotrophin while ovarian follicle was more than 1.8 cm, and the treatment group was treated with Bushen Tianjing Formula and acupuncture. On the ninth day of menstruation, the ovulation was monitored by vaginal ultrasound, and the rate of ovulation was calculated, the levels of follicle-stimulating hormone(FSH), luteotropichormone(LH) and freetestosterone(FT) were detected. Thirty days after ovulation, the pregnancy was monitored and recorded by B ultrasound, and the pregnancy rate was calculated. Results The ovulation rate of the treatment group was 60.0%, which of the control group was 61.2%, with no significant difference between the two groups(P > 0.05). The pregnancy rate of the treatment group was 60.0%, which was higher than that of the control group(37.5%), the difference was statistically significant(P < 0.05). After treatment, the levels of serum LH in non pregnant patients of the two groups were higher than those before treatment [the treatment group: 8.43(6.53, 13.26) vs. 6.72(5.33, 8.74), Z = 2.490,P < 0.05; the control group: 11.26(8.42, 13.34) vs. 6.47(4.18, 8.10), Z = 3.621, P < 0.05], and there were no statistically significant differences of the serum FSH and FT levels after treatment compared with those before treatment(P >0.05). Conclusion Combination of acupuncture and medicine can improve the pregnancy rate of infertility due to PCOS with kidney deficiency.
Objective To evaluate the efficacy of acupuncture plus Bushen Tianjing Formula in the treatment of infertility due to polycystic ovary syndrome(PCOS) with kidney deficiency. Methods Sixty patients with infertility due to PCOS with kidney deficiency met with inclusion criteria were selected from October 2015 to May 2017 in Department of Infertility, Xiyuan Hospital of China Academy of Chinese Medical Sciences. The patients with infertility due to PCOS with kidney deficiency were divided into control group and treatment group, with 30 cases in each group. The patients in both groups were preadjusted for complications for 3 months, after menstruation or withdrawal bleeding for 5 days,the patients in the control group were given Clomiphene Citrate orally and intramuscular injection of chorionic gonadotrophin while ovarian follicle was more than 1.8 cm, and the treatment group was treated with Bushen Tianjing Formula and acupuncture. On the ninth day of menstruation, the ovulation was monitored by vaginal ultrasound, and the rate of ovulation was calculated, the levels of follicle-stimulating hormone(FSH), luteotropichormone(LH) and freetestosterone(FT) were detected. Thirty days after ovulation, the pregnancy was monitored and recorded by B ultrasound, and the pregnancy rate was calculated. Results The ovulation rate of the treatment group was 60.0%, which of the control group was 61.2%, with no significant difference between the two groups(P > 0.05). The pregnancy rate of the treatment group was 60.0%, which was higher than that of the control group(37.5%), the difference was statistically significant(P < 0.05). After treatment, the levels of serum LH in non pregnant patients of the two groups were higher than those before treatment [the treatment group: 8.43(6.53, 13.26) vs. 6.72(5.33, 8.74), Z = 2.490,P < 0.05; the control group: 11.26(8.42, 13.34) vs. 6.47(4.18, 8.10), Z = 3.621, P < 0.05], and there were no statistically significant differences of the serum FSH and FT levels after treatment compared with those before treatment(P >0.05). Conclusion Combination of acupuncture and medicine can improve the pregnancy rate of infertility due to PCOS with kidney deficiency.
引文
[1]左莉,傅亚均.多囊卵巢综合征病因及治疗进展[J].重庆医学,2018,47(9):1247-1249.
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[10]赵菁,肖霞.二甲双胍联合克罗米芬治疗多囊卵巢综合征临床疗效效果观察[J].山东医药,2016,56(46):86-88.
[11]郭华林,韩献琴,冯秋霞,等.补肾活血祛瘀方联合枸橼酸氯米芬胶囊治疗多囊卵巢综合征不孕症48例[J].中医研究,2018,31(1):20-22.
[12]刘玉婷,刘东方,杨刚毅,等.二甲双胍治疗多囊卵巢综合征的临床效果[J].中国当代医药,2017,24(32):46-49.
[13]韩玉芬,吴美兰,徐楠.中药治疗多囊卵巢综合征体会[J].光明中医,2017,32(1):121-122.
[14]曲彬彬.补肾化瘀法联合达英-35治疗多囊卵巢综合征30例临床疗效分析[J].中国现代医生,2017,55(5):116-118.
[15]陈梅,刘霞.杨鉴冰教授对中医“天癸”生理作用的学术探讨[J].陕西中医学院学报,2010,33(1):12-13.
[16]钟燕梅,徐晓娟,黄立华.从“肾主生殖”论多囊卵巢综合征不孕现状分析[J].成都中医药大学学报,2014,37(1):125-127.
[17]李瑞丽,傅金英,于胜男,等.针刺治疗多囊卵巢综合征的研究进展[J].世界中医药,2017,12(9):2258-2261.
[18]陈雨婷,李月梅,罗蛟龙,等.通元针法联合药物治疗顽固性多囊卵巢综合征不孕临床观察[J].上海针灸杂志,2017,36(6):692-696.
[19]陈鹏典,杨卓欣,刘芳,等.针灸治疗多囊卵巢综合征的实验研究进展[J].中国医药导报,2016,13(12):49-52.
[20]王继红,李月梅,黎崖冰,等.赖新生通元针法临床应用探析[J].中医杂志,2016,56(1):17-19.
[21]刘春泥,廖鑫波,周莉云.中医四期疗法合达英-35治疗多囊卵巢综合征的临床研究[J].光明中医,2017,32(9):1335-1337.
[22]郑兰,潘兆兰,童娟娟,等.中药联合针灸治疗未破裂卵泡黄素化不孕患者20例[J].江西中医药,2017,48(3):50-51.
[23]叶咏菊.穿山甲联合针刺治疗多囊卵巢综合征患者卵泡黄素化的疗效观察[J].中国中医药科技,2016,23(1):87-88.
[2] Makjed AK,Sherbjnv ME,Elkabarjty R. Assessmentof ovarian stromal blood flow after metformin treatment in women wifh polycystic ovary syndrome[J]. Arch Gynecor Obstet,2014,289(4):883-891.
[3]张巧利,贾婵维,马延敏,等.克罗米芬与来曲唑临床促排卵应用的研究进展[J].现代妇产科进展,2016,25(1):65-68.
[4]郭银华,谈勇,邹奕洁,等.补肾促排卵汤联合枸橼酸氯米芬片治疗多囊卵巢综合征所致不孕症及妊娠结局临床观察[J].湖北中医药大学学报,2013,15(6):53-54.
[5]金凯黎,许小凤.中医药诱发排卵治疗不孕症研究近况[J].吉林中医药,2014,34(9):965-968.
[6]丰有吉,沈铿.妇产科学[M].北京:人民卫生出版社,2005:252-256.
[7]罗丽兰.不孕与不育[M].2版.北京:人民卫生出版社,2009:202.
[8]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:239-243.
[9]张玉珍.中医妇科学[M].北京:中国中医药出版社,2002:41.
[10]赵菁,肖霞.二甲双胍联合克罗米芬治疗多囊卵巢综合征临床疗效效果观察[J].山东医药,2016,56(46):86-88.
[11]郭华林,韩献琴,冯秋霞,等.补肾活血祛瘀方联合枸橼酸氯米芬胶囊治疗多囊卵巢综合征不孕症48例[J].中医研究,2018,31(1):20-22.
[12]刘玉婷,刘东方,杨刚毅,等.二甲双胍治疗多囊卵巢综合征的临床效果[J].中国当代医药,2017,24(32):46-49.
[13]韩玉芬,吴美兰,徐楠.中药治疗多囊卵巢综合征体会[J].光明中医,2017,32(1):121-122.
[14]曲彬彬.补肾化瘀法联合达英-35治疗多囊卵巢综合征30例临床疗效分析[J].中国现代医生,2017,55(5):116-118.
[15]陈梅,刘霞.杨鉴冰教授对中医“天癸”生理作用的学术探讨[J].陕西中医学院学报,2010,33(1):12-13.
[16]钟燕梅,徐晓娟,黄立华.从“肾主生殖”论多囊卵巢综合征不孕现状分析[J].成都中医药大学学报,2014,37(1):125-127.
[17]李瑞丽,傅金英,于胜男,等.针刺治疗多囊卵巢综合征的研究进展[J].世界中医药,2017,12(9):2258-2261.
[18]陈雨婷,李月梅,罗蛟龙,等.通元针法联合药物治疗顽固性多囊卵巢综合征不孕临床观察[J].上海针灸杂志,2017,36(6):692-696.
[19]陈鹏典,杨卓欣,刘芳,等.针灸治疗多囊卵巢综合征的实验研究进展[J].中国医药导报,2016,13(12):49-52.
[20]王继红,李月梅,黎崖冰,等.赖新生通元针法临床应用探析[J].中医杂志,2016,56(1):17-19.
[21]刘春泥,廖鑫波,周莉云.中医四期疗法合达英-35治疗多囊卵巢综合征的临床研究[J].光明中医,2017,32(9):1335-1337.
[22]郑兰,潘兆兰,童娟娟,等.中药联合针灸治疗未破裂卵泡黄素化不孕患者20例[J].江西中医药,2017,48(3):50-51.
[23]叶咏菊.穿山甲联合针刺治疗多囊卵巢综合征患者卵泡黄素化的疗效观察[J].中国中医药科技,2016,23(1):87-88.