电针联合克罗米芬干预多囊卵巢综合征促排卵助孕的疗效研究

Therapeutic effects on ovulation and reproduction promotion with acupuncture and clomiphene in polycystic ovary syndrome

目的:比较电针联合克罗米芬与单纯克罗米芬治疗多囊卵巢综合征(PCOS)排卵障碍的疗效差异,并探讨其作用机制。方法:将80例PCOS患者随机分为针药组(40例)与药物组(40例)。药物组,于月经或撤药性出血第5天口服克罗米芬,连续服用5 d。针药组,口服用药同药物组,同时行电针(连续波,2 Hz)治疗,取气海、关元、子宫、大赫、三阴交、中极、地机、肾俞、三焦俞、次髎等为主穴,自月经或撤药性出血第5天开始治疗,留针30 min,隔日1次,1周治疗3次,1个月经周期或1个月为一疗程。两组治疗周期均为3个月。比较两组治疗后血清雌二醇(E_2)、孕酮(P)水平,子宫内膜厚度及形态分型、排卵率及临床妊娠率,并比较两组临床疗效。结果:针药组有2例因同时服用中药而被剔除,药物组有3例因胃肠道不良反应而要求停止治疗。针药组总有效率为86.8%(33/38),优于药物组的64.9%(24/37,P<0.05);针药组排卵率高于药物组(86.8%(33/38)vs 64.9%(24/37),P<0.05);针药组妊娠率有高于药物组的趋势,但差异无统计学意义(21.1%(8/38)vs 16.2%(6/37),P>0.05);针药组治疗后子宫内膜厚度、子宫内膜形态(A型率)优于药物组(P<0.01,P<0.05);治疗后着床窗口期血清E_2、P水平,针药组明显高于药物组(均P<0.01)。结论:电针联合克罗米芬治疗多囊卵巢综合征促排卵助孕疗效确切,其血清E_2、P水平明显增高,子宫内膜增厚,A型率增加,其疗效明显优于单纯使用克罗米芬,且安全、不良反应可以耐受。其机制可能与改善其雌激素、孕激素水平,提高子宫内膜容受性有关。

Objective To compare the difference in the therapeutic effects on ovulation disorder in polycystic ovary syndrome（PCOS） between the combined therapy of electroacupuncture and clomiphene and the single medication of clomiphene and to explore the effect mechanism. Methods A total of 80 patients of PCOS were randomized into an acupuncture plus medication group（40 cases） and a medication group（40 cases）. In the medication group, since the 5 th day of menstruation or medicine-withdrawal bleeding, clomiphene was prescribed for oral administration, continuously for 5 days. In the acupuncture plus medication group, the medication was the same as the medication group. Additionally, 30 min electroacupuncture（continuous wave, 2 Hz） was applied to Qihai（CV 6）, Guanyuan（CV 4）, Zigong（EX-CA 1）, Dahe（KI 12）, Sanyinjiao（SP 6）, Zhongji（CV 3）, Diji（SP 8）, Shenshu（BL 23）, Sanjiaoshu（BL 22） and Ciliao（BL 32）, etc. The treatment started on the 5 th day of menstruation or medicine-withdrawal bleeding, once every two days, 3 times a week. One cycle of menstruation or 1 month was taken as one course. The treatment cycles were 3 months in the two groups. The level of estradiol（E2） and progesterone（P） in the serum, the endometrial thickness and morphology, ovulation rate and clinical pregnancy rate, as well as the clinical therapeutic effects were compared after treatment in the two groups. Results Two cases were dropped out because the herbal medicine was taken simultaneously in the acupuncture plus medication group. In the medication group, the medication was discontinued in 3 cases due to gastrointestinal adverse reactions. The total effective rate was 86.8%（33/38）in the acupuncture plus medication group, better than 64.9%（24/37） in the medication group（P〈0.05）. The ovulation rate in the acupuncture plus medication group was higher than that in the medication group [（86.8%, 33/38） vs（64.9% 24/37）, P〈0.05]. The pregnancy rate in the acupuncture plus medication group was higher than the medication group in tendency, without significant difference [21.1%（8/38） vs 16.2%（6/37）, P〈0.05]. After treatment, the results of endometrial thickness and morphology（A-type rate） in the acupuncture plus medication group were better than those in the medication group（P〈0.01, P〈0.05）. After treatment, regarding the levels of E2 and P in the serum in the window period of implantation, the results in the acupuncture plus medication group were higher remarkably than those in the medication group（both P〈0.01）. Conclusion The combined intervention of electroacupuncture and clomiphene achieves the definite effects of ovulation and pregnancy promotion in PCOS. It remarkably increases the levels of E2 and P in the serum, the endometrial thickness and A-type rate. The therapeutic effects of the combined intervention are remarkably better than those of the simple application of clomiphene. This combined intervention is safe and tolerable for the adverse reactions. The effect mechanisms may be related to the improvements of estrogen, progestin and endometrial receptivity.