温针灸对IVF-ET肾阳虚型反复移植失败患者子宫内膜容受性及妊娠结局的影响

Effect of Warm Needling on Endometrial Receptivity and Pregnancy Outcome in Kidney-yang Deficient Patients with Repeated Implantation Failure in IVF-ET

目的观察温针灸干预体外受精-胚胎移植(IVF-ET)肾阳虚型反复移植失败(RIF)患者子宫内膜容受性及妊娠结局的影响。方法选取60例肾阳虚型RIF、拟再行冻融胚胎移植(FET)患者,随机分为治疗组和对照组,每组30例。对照组予常规激素替代方案治疗,治疗组在此基础上,于月经第2天行温针灸治疗,针刺取关元、归来、气海、子宫、足三里、三阴交、地机、太冲,其中关元、足三里予温针灸治疗,每日1次。观察两组患者临床妊娠率及种植率、子宫内膜厚度、内膜血流及内膜形态分型、子宫动脉搏动指数(PI)、子宫动脉血流阻力指数(RI)、治疗前后肾阳虚症状体征积分。结果治疗组临床妊娠率及种植率均高于对照组(P<0.05);治疗组子宫内膜厚度与对照组比较差异有统计学意义(P<0.05);治疗组子宫内膜形态及血流分型较治疗前有明显改善(P<0.05),与对照组比较差异有统计学意义(P<0.05);移植日治疗组子宫内膜血流指数PI、RI明显低于对照组(P<0.05,P<0.01);治疗组治疗后肾阳虚症状积分较治疗前明显降低(P<0.05),与对照组比较差异有统计学意义(P<0.05)。结论温针灸和常规激素替代方案可能通过改善子宫内膜厚度、形态及内膜血流参数,改善肾阳虚症状,从而在一定程度上改善RIF患者子宫内膜容受性,提高胚胎种植率及临床妊娠率。

Objective To observe the effect of warm needling on endometrial receptivity and pregnancy outcome in kidney-yang deficient patients with repeated implantation failure （RIF） in IVF-ET （in vitro fertilization and embryo transfer）. Method Sixty kidney-yang deficient patients with RIF who were going to receive frozen-thawed embryo transfer （FET） were randomized into a treatment group and a control group, with 30 cases in each group. The control group was intervened by routine hormone replacement therapy; based on which, the treatment group was additionally given warm needling treatment which started from the second day of menstruation. Guanyuan （CV4）, Guilai （ST29）, Qihai （CV6）, Zigong （EX-CA1）, Zusanli （ST36）, Sanyinjiao （SP6）, Diji （SP8） and Taichong （LR3） were selected to receive acupuncture, among which, Guanyuan and Zusanli were treated with warm needling, once every day. The clinical pregnancy rate, implantation rate, endometrial thickness, endometrial blood flow and intima level in the two groups were observed, as well as the uterine artery pulse index （PI）, uterine artery blood flow resistance index （RI）, andkidney-yang deficiency symptom and sign score. Result The clinical pregnancy rate and implantation rate in the treatment group were higher than those in the control group （P〈0.05）; there was a significant difference in the endometrial thickness between the two groups （P〈0.05）; the endometrial property and blood flow were significantly improved after the intervention in the treatment group （P〈0.05）, and were significantly different from those in the control group （P〈0.05）; on the implantation day, the endometrial PI and RI in the treatment group were significantly lower than those in the control group （P〈0.05, P〈0.01）; the kidney-yang deficiency symptom and sign score markedly declined in the treatment group after the intervention （P〈0.05）, and it was significantly different from that in the control group （P〈0.05）. Conclusion Warm needling plus routine hormone replacement therapy can improve the endometrial receptivity to a certain extent and increase embryo implantation and clinical pregnancy rates, which is possibly through the amelioration of endometrial thickness, property and blood flow parameters and the improvement of kidney-yang deficiency symptoms.