近20年针灸治疗卵巢早衰的临床研究及作用机制进展

Clinical research and the effect mechanism on premature ovarian failure treated with acupuncture in recent 20 years

目的:回顾和整理近20年针灸治疗卵巢早衰(POF)的研究成果与作用机制,为临床针灸治疗POF提供参考依据。方法:通过计算机检索Pub Med、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP),收集整理自1998年1月1日至2017年3月31日针灸治疗POF的文献,从选穴规律、治疗方法等方面归纳分析,阐述潜在的作用机制。结果:最终获得针灸治疗POF的临床文献26篇,阐释作用机制的实验类文献5篇。临床治疗卵巢早衰的辨证分型及使用频次前3位的腧穴分别为少阴病证(太溪、三阴交、关元穴),太阴病证(三阴交、足三里、次髎穴),厥阴病证(太冲、神庭、关元穴),少阴、厥阴兼证(三阴交、肝俞、肾俞穴),少阴、太阴兼证(脾俞、三阴交、足三里穴),冲任失调(关元、子宫、肓俞穴)。十四经经脉腧穴使用频率前5位的穴位由高到低依次为关元、肾俞、三阴交、中极、脾俞、太溪、肝俞。经外奇穴则以局部取穴为主。按经脉腧穴使用个数排序前5位的经脉由高到低依次为:足太阳膀胱经、督脉、任脉、足太阴脾经、足少阴肾经。选穴部位多分布在胸腹部、腰背部及下肢。临床方法多样,包含毫针刺、电针疗法、灸法、穴位埋线疗法等。其机制可能是:通过调节下丘脑-垂体-卵巢轴(HPOA)的功能,恢复性激素正常水平;改善卵巢、子宫的组织学形态;影响神经-内分泌-免疫调控系统,提高机体免疫力;调节卵巢早衰相关信号通路的基因和蛋白表达水平等,达到治疗效果。结论:虽然针灸治疗卵巢早衰在临床上已取得一定疗效,但其作用机制的研究却有限。从机制上阐明针灸治疗POF,可以指导临床实践。今后应规范临床路径,探究效应机制,通过设计科学严谨的实验,选取更为客观合理的评价体系,进行深入系统地研究。

Objective To review and collect the study achievements and the effect mechanism of acupuncture in the treatment of premature ovarian failure（POF） in recent 20 years so as to provide more references for the clinical treatment of POF with acupuncture. Methods Through retrieving Pub Med, CNKI and VIP, the literature on acupuncture for POF was collected from January 1, 1998 through March 31, 2017 regarding the rule of acupoint selection and the therapeutic method. The potential effect mechanism was explored. Results Finally, 26 papers on the clinical treatment for POF with acupuncture and 5 ones on the laboratory mechanism were obtained. The differentiated syndromes and the top 3 acupoints for the treatment of POF included shaoyin syndrome [Taixi（KI 3）, Sanyinjiao（SP 6） and Guanyuan（CV 4）], Taiyin syndrome [Sanyinjiao（SP 6）, Zusanli（ST 36） and Ciliao（BL 32）], jueyin syndrome [Taichong（LR 3）, Shenting（GV 24）, Guanyuan（CV 4）], the mixed syndrome of shaoyin and jueyin [Sanyinjiao（SP 6）, Ganshu（BL 18） and Shenshu（BL 23）], the mixed syndrome of shaoyin and taiyin [Pishu（BL 20）, Sanyinjiao（SP 6） and Zusanli（ST 36）] and the dysfunction of the thoroughfare vessel and the conception vessel [Guanyuan（CV 4）, Zigong（EX-CA 1） and Huangshu（KI 16）]. The top 5 acupoints of the 14 meridians were Guanyuan（CV 4）, Shenshu（BL 23）, Sanyinjiao（SP 6）, Zhongji（CV 3）, Pishu（BL 20）, Taixi（KI 3） and Ganshu（BL 18）. The local extraordinary points were dominant. According to the use frequency of the acupoints, the first top 5 meridians were the bladder meridian of foot-taiyang, the governor vessel, the conception vessel, the spleen meridian of foot-taiyin and the kidney meridian of foot-shaoyin. The most acupoints were distributed in the chest, the abdomen, the lumber region and the lower limbs. Many therapeutic methods were used, such as acupuncture with filiform needle, electroacupuncture, moxibustion and the acupoint thread-embedding therapy. The effect mechanisms possibly referred to the recovery of the sexual level through regulating the hypothalamus-pituitary gland-ovarian axle（HPOA） function, the improvement of the histological morphology of the uterine, the improvement of body immunity through affecting the nerve-endocrine-immune regulation system as well as the regulation of the genetic and protein expressions of the signal pathway relevant with POF. Conclusion Even though acupuncture has achieved the therapeutic effects in the clinical treatment of POF, the research on the effect mechanism is still limited. The exploration of acupuncture for POF in terms of mechanism may guide the clinical practice. In the future study, the clinical pathway should be specified and the effect mechanism be explored through the rigorous laboratory design and more objective and rational evaluation system.