电针对提高肾虚型不孕患者卵细胞质量的研究

Improvement of the oocyte quality with electroacupuncture in infertility patients of kidney deficiency pattern

目的：探讨电针对肾虚型不孕患者卵细胞质量的影响及可能的作用机制。方法：临床选取年龄35~42岁辨证属肾虚型、行体外受精-胚胎移植（IVF-ET）妇女66例,随机分为观察组和对照组,每组33例。两组患者均采用促性腺激素释放激素激动剂长方案行IVF-ET治疗。观察组于体外受精（IVF）周期的月经第5天开始进行电针治疗,穴取三阴交、子宫、中极、关元,对照组选取相同穴位行假针刺,均隔日1次,每次30min,至取卵日。观察两组患者肾虚证候积分变化、优质卵率、优质胚胎率及临床妊娠率;比较两组患者取卵日卵泡液胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子-2（IGF-2）及血清β-内啡肽（β-EP）的含量差异及与卵细胞质量的相关性。结果：1观察组患者治疗后肾虚证候积分较治疗前明显降低（P〈0.05）,且治疗后较对照组降低更明显（P〈0.05）;2优质卵率、优质胚胎率均高于对照组[81.3%（161/198）vs 57.6%（98/170）,59.8%（58/97）vs 37.7%（26/69）,均P〈0.05],两组临床妊娠率相当（42.4%（14/33）vs 24.2%（8/33）,P〉0.05）;3观察组相比对照组患者取卵当日卵泡液中IGF-1与IGF-2及血清β-内啡肽含量均有明显增高（均P〈0.05）;4两组患者卵泡液中IGF-1、IGF-2及血清β-内啡肽的含量与优质卵率均呈直线正相关。结论：电针可有效提高肾虚型不孕患者卵泡液内IGF因子和血清β-EP的表达,提高患者优质卵率、优质胚胎率,改善肾虚症状。

Objective To explore the impact and effect mechanism of eleetroacupuneture （EA） on oocyte quali- ty in the patients with infertility of kidney deficiency pattern. Methods Sixty-six cases differentiated as kidney deficiency and with in vitro fertilization-embryo transplantation （IVF-ET）, aged from 35 to 42 years were rando- mized into an observation group and a control group, 33 cases in each one. The IVF-ET therapy of the long protocol with gonadotrophin releasing hormone agonist was adopted in the two groups. In the observation group, on the 5th day of menstruation in IVF cycle, EA was applied to Sanyinjiao （SP 6）, Zigong （EX-CA 1）, Zhongji （CV 3） and Guanyuan （CV 4）. In the control group, the sham-acupuncture was applied to the same acupoints. The treat- ment was given once every two days till the date of egg collection and the needles were retained for 30 rain each time. The change in the score of kidney deficiency syndrome, the high-quality ooeyte rate, the high-quality embryo rate and clinical pregnant rate were observed in the two groups. The levels of insulin-like growth factor-1 （IGF-1） and IGF-2 in follicular fluid and the serum β-endorphin （β-EP） on the date of egg collection and the correlation with oocyte quality were compared between the two groups. Results 1） In the observation group, the kidney deficiency syndrome score after treatment was reduced apparently as compared with that before treatment （P〈0.05）, the score after treatment in the observation group was reduced much more apparently as compared with the control group （P〈0.05）. 2） The high-quality egg rate and the high quality embryo rate in the observation group were both higher than those in the control group [81.3% （161/198） vs 57.6% （98/170）, 59.8% （58/97） vs 37.7% （26/ 69）, both P〈0.05]. 3） Compared with the control group, the levels of IGF-1 and IGF-2 in follicular fluid and se- rum β- EP on the day of egg collection were all increased obviously in the observation group （all P〈0.05）. 4） The levels of IGF-1 and IGtr-2 in follicular fluid and serum β-EP presented the linear positive correlation with the high-quality egg rate. Conclusion EA effectively improves the expressions of IGF in follicular ftuid and serum β-EP, increases the high-quality egg rate and high-quality embryo rate and relieves the symptoms of kidney deficiency.