耳穴电针治疗子宫内膜异位症痛经的随机对照研究

目的:观察耳穴电针治疗子宫内膜异位症(EMT)痛经的临床疗效,并探讨其部分作用机制。方法:将80例EMT痛经患者随机分为耳电针组和体电针组。耳电针组刺激耳穴子宫、皮质下、神门、内分泌等,体电针组刺激体穴天枢、气海、关元、三阴交、地机、子宫等,均每次留针30 min,隔天1次,10次为一疗程,每个疗程自月经干净后次日开始,共治疗3个疗程。分别于治疗前后进行痛经程度评分,并评定总体疗效,放射免疫法检测不同治疗阶段的血浆前列腺素E2(PGE2)、6-酮-前列腺素F1α(6-Keto-PGF1α)水平。结果:耳电针组痊愈2例,显效5例,有效30例,无效3例,总有效率为92.5%;体电针组痊愈1例,显效2例,有效31例,无效6例,总有效率为85.0%;两组总体疗效比较差异无统计学意义(P>0.05)。两组痛经程度评分治疗后均比治疗前降低(均P<0.01),治疗后第3次月经时,耳电针组评分低于体电针组(P<0.05)。两组治疗后第3次月经时与治疗后第1次月经时比较,血浆PGE2含量均下降(均P<0.01),血浆6-Keto-PGF1α含量均升高(均P<0.01);治疗后第3次月经时耳电针组与体电针组比较,血浆PGE2含量较低(P<0.05),血浆6-Keto-PGF1α含量较高(P<0.05)。结论:耳穴电针和体穴电针均可有效治疗EMT痛经,但耳穴电针比体穴电针具有更加持续的镇痛作用;抑制血浆PGE2分泌,减轻盆腔局部炎性反应,以及升高血浆6-Keto-PGF1α水平,抑制血管及子宫平滑肌痉挛性收缩,可能为耳穴电针和体穴电针治疗EMT痛经的部分作用机制。

Randomized Controlled Study on Ear-electroacupuncture Treatment of Endo-metriosis-induced Dysmenorrhea in Patients

Objective To observe the therapeutic effect of ear-electroacupuncture (Ear-EA) on dysmenorrhea in patients with endometriosis and to explore its underlying mechanism. Methods A total of 80 endometriosis patients were randomly and equally divided into ear-EA group and body-EA group. EA (50 Hz,0. 5 - 0. 8 mA) was applied to auricular points (Uterus, Subcortex, Shenmen, Endocrine, etc.) and body acupoints Tianshu (ST 25), Qihai (CV 6), Guanyuan (CV 4), Sanyinjiao (SP 6), Diji (SP 8), Uterus (EX-CA 1), etc. ] respectively for 30 min, once every other day for 3 months. Dysmenorrhea severity score (DSS) was assessed and plasma prostaglandin (PGE_2) and 6-Keto-PGF_(1α) levels detected by radioimmunoassay. Results Compared with pre-treatment, DSS lowered significantly during the 1~(st) and 2~(nd) menstrual cycle in body-EA group, and during the 1~(st), 2~(nd) and 3~(rd) menstruation in ear-EA group; and the DSS of ear-EA group during the 3~(rd) menstruation was evidently lower than that of body-EA group (P<0. 05). During the 3~(rd) menstrual onset after the treatment, plasma PGE_2 contents in both groups decreased obviously (P<0. 01), and plasma 6-Keto-PGF_(1α) levels increased considerably in comparison with pre-treatment (P<0. 01). Comparison between two groups during the 3~(rd) menstruation showed that plasma PGE_2 level of ear-EA group was markedly lower than that of body-EA group, and 6-Keto-PGF_(1α) level of ear-EA group was significantly higher than that of body-EA group (P<0. 05). No significant difference was found between two groups in clinical therapeutic effect (P>0. 05). Conclusion Both ear-EA and body-EA can effectively relieve endometriosis-induced dysmenorrhea, and the former is superior to the later in reducing pain severity, which may be closely related to their effects in reducing plasma PGE_2 and raising 6-Keto-PGF_(1α) level.