经脉排刺治疗阴阳两虚型卵巢储备功能下降的临床研究

目的:观察经脉排刺法对阴阳两虚型卵巢储备功能下降患者的临床疗效,并探讨其作用机制。方法:阴阳两虚型卵巢储备功能下降患者96例,随机分为针刺组与西药组,每组48例。针刺组排刺任脉、肾经、脾经、膀胱经,月经周期的第10天开始针刺,10d为一疗程,共治疗6个疗程;西药组予以口服克龄蒙(戊酸雌二醇片/雌二醇环丙孕酮片)治疗,月经周期第5天开始口服,21d为一疗程,共治疗6个疗程。观察治疗前、治疗6个月、治疗结束后6个月的两组中医临床症状积分及月经情况,检测血清促卵泡生成素(FSH)、雌二醇(E2)、促黄体生成素(LH)。结果:针刺组总有效率为87.5%(42/48),西药组为89.6%(43/48),两组间总有效率比较差异无统计学意义(P0.05)。两组治疗后临床症状积分较治疗前均有明显降低(P0.05);治疗结束后6个月,针刺组较治疗前和西药组明显下降(P0.05)。两组血清FSH、LH及E2治疗后较治疗前明显下降(P0.05),治疗结束后6个月,针刺组较治疗前和西药组明显下降(P0.05)。两组治疗后月经周期均较治疗前明显缩短,月经天数明显延长(P0.05),治疗结束6个月后针刺组月经周期较治疗前及西药组明显缩短,月经天数明显延长(P0.05)。结论:运用经脉排刺治疗阴阳两虚型卵巢储备功能下降患者取得较好的疗效,其机制可能是通过调节下丘脑-垂体-卵巢轴的功能,改善卵巢功能,降低血清FSH、LH以及E2的水平,改善临床症状,调整月经周期,且远期疗效稳定。

Acupuncture Stimulation of Acupoints of Multiple Meridians for Patients with Diminished Ovarian Reserve of Both Yin and Yang Deficiency

Objective To observe the effect of acupuncture stimulation of acupoints of the Conception Vessel,Kidney Meridian,Spleen Meridian,and Bladder Meridian on menstrual cycles and duration,and serum follicle-stimulating hormone(FSH),luteinizing hormone(LH)and estrogen 2(E2)levels in patients with diminished ovarian reserve(DOR).Methods A total of 96 patients with DOR of both yin and yang deficiency were randomly divided into medication group and acupuncture group(n=48cases in each group).Patients of the medication group were treated by Estradiol Valerate tablets,2mg/d on the first 10 days,and Estradiol Cyproterone,3mg/d from day 11 to 21,followed by 5-7days' rest,and the next therapeutic course,continuously for 6months.For patients of the acupuncture group,filiform acupuncture needles were separately inserted into every 5points of the Conceptional Vessel,Kidney,Spleen and Bladder Meridians,manipulated with uniform reinforcing and reducing methods till Deqi,and retained for 40 min.The treatment was conducted once daily for consecutive 10 days in one menstrual cycle,beginning from the 10 th day on after menstruation,which was repeated for 6months.The integrative scores(normal=0,mild=2,moderate=4and severe=6points)of menstrual cycle,menstrual duration,amount,color,qualityblood blot or amenia,symptoms of traditional Chinese medicine(TCM)]were assessed according to"Guiding Principles for Clinical Trials of New Drugs of Chinese Materia Medica".Serum FSH,LH and E2 contents were detected by Roche's electrochemical luminescence method.Results After the treatment,of the two 48 cases in the medication and acupuncture groups,12(25.0%)and 20(41.7%)were cured,11(22.9%)and 12(25.0%)experienced marked improvement in their symptoms,20(41.7%)and 10(20.8%)were effective,and 5(10.4%)and 6(12.5%)failed,with the effective rate being 89.6% and 87.5%,respectively.The integral score of TCM symptoms,menstrual cycle,serum FSH,LH and E2 contents were considerably diminished in both groups after 6months of treatment(P<0.05),and the TCM symptom score,menstrual cycle,and serum FSH,LH and E2 levels were significantly lower in the acupuncture group than in the medication group 6months after cease of the treatment(P<0.05),while the menstrual duration in each cycle was notably longer in both groups after the treatment,and evidently longer in the acupuncture group than in the medication group 6months after cease of the treatment(P<0.05).No significant differences were found between the two groups in the effective rate,score of TCM symptoms,menstrual cycle and duration,and serum FSH,LH and E2 contents following the treatment(P>0.05).Conclusion Acupuncture stimulation of acupoints of the Conception Vessel,Kidney,Spleen,and Bladder Meridians is effective in improving clinical symptoms of DOR patients with deficiency of both yin and yang,and has a longer effect,which may be closely associated with its functions in lowering serum FSH,LH and E2 levels through regulating the hypothalamic-pituitary-ovarian axis.