电针治疗乳腺增生疗效及对黄体期E2、P、RLI水平的影响

Therapeutic Efficacy of Electroacupuncture for Hyperplasia of Mammary Glands and Its Effect on E2, P and PRL in Luteal Phase

目的观察电针治疗乳腺增生的临床疗效及对黄体期雌二醇(E2)、孕酮(P)、泌乳素(PRL)含量的影响。方法将符合诊断的乳腺增生患者随机分为观察组、对照组,每组72例。观察组主穴取膺窗,肝郁气滞型加内关、行间,冲任失调型加关元、三阴交,痰凝血瘀型加膻中、丰隆。对照组采用“规划教材”方法。两组均加用电针。于治疗前(月经周期的22~23 d)和末次治疗后(与治疗前月经日相同)每组随机抽取20例患者,空腹肘静脉采血取血清,应用放免法检测E2、P、PRL含量。结果两组治疗后乳痛、乳房肿块指数(大小、硬度、范围)和全身症状均有明显改善(P<0.01),观察组各项指标的改善均优于对照组(P<0.05);观察组近期治愈率和总有效率分别为77.7%和94.4%,对照组分别为62.5%和80.6%,观察组均明显优于对照组(P<0.05);两组患者治疗后血清E2含量均明显下降(P<0.01,P<0.05),P水平显著升高(P<0.01,P<0.05),观察组均优于对照组(P<0.05);治疗前肝郁气滞型和痰凝血瘀型患者血清E2含量均异常升高,冲任失调型低于正常,治疗后3个证型均呈现良性调整作用(P<0.05);治疗前3型患者血清P浓度均较正常值偏低,治疗后肝郁气滞型和冲任失调型升高明显(P<0.05,P<0.01),冲任失调型升高更为显著,痰凝血瘀型治疗后变化不明显;治疗前3型PRL水平均偏高,治疗后均显著降低(P<0.05),组间比较差异无统计学意义(P>0.05);治疗过程中未见不良反应及并发症。结论电针治疗乳腺增生疗效显著,无不良反应,其治疗机制与电针降低患者黄体期血清E2和PRL含量、升高P水平有关。

Objective To observe the clinical efficacy of electroacupuncture in treating hyperplasia of mammary glands and its effect on the contents of estradiol(E2),progesterone(P)and prolactin(PRL)in luteal phase.Method Patients conforming to the diagnosis of hyperplasia of mammary glands were randomized into an observation group and a control group,with 72 cases in each group.For the observation group,Yingchuang(ST16)was selected as the major acupoint,with Neiguan(PC6)and Xingjian(LR2)added for the syndrome of qi stagnation due to liver depression,Guanyuan(CV4)and Sanyinjiao(SP6)for the syndrome of dysfunction of the Thoroughfare and Conception Vessels,and Danzhong(CV17)and Fenglong(ST40)for the syndrome of phlegm accumulation and blood stagnation.The control group was intervened following the textbook.Electroacupuncture was used for both groups.Twenty patients were randomly chosen from each group for the detection of serum E2,P and PRL contents using radioimmunoassay prior to treatment(the 22nd-23rd day of a menstrual cycle)and after the last treatment(the same menstrual day as the pre-treatment test).Result The two groups showed notable improvements in breast pain,breast lump index(size,firmness and extent)and general symptoms(P<0.01),and the improvements in the observation group were more significant(P<0.05).The short-term cured rate and total effective rate were respectively 77.7%and 94.4%in the observation group,versus 62.5%and 80.6%in the control group,and the observation group was significantly superior to the control group(P<0.05).The serum E2 content decreased significantly(P<0.01,P<0.05)and the level of P increased significantly(P<0.01,P<0.05)in the two groups after treatment,and the observation group was superior to the control group(P<0.05).Before treatment,the serum E2 content was higher than normal range in patients with syndromes of qi stagnation due to liver depression and phlegm accumulation and blood stagnation,while the content was lower than the normal range in patients with syndrome of dysfunction of Thoroughfare and Conception Vessels.After treatment,the 3 types of patients all showed a positive reaction(P<0.05).Before treatment,an abnormally low serum P content was found in all 3 types of patients.After treatment,the P level increased significantly in patients with syndromes of qi stagnation due to liver depression and dysfunction of Thoroughfare and Conception Vessels(P<0.05,P<0.01),and a more significant increase was found in the latter type,while the change in patients with the syndrome of phlegm accumulation and blood stagnation was insignificant.The level of PRL was abnormally high in all 3 types of patients before treatment,and it decreased significantly after treatment(P<0.05),and there were no significant inter-group differences(P>0.05).There were no adverse reactions or complications during the whole intervention process.Conclusion Electroacupuncture can produce significant efficacy in treating hyperplasia of mammary glands,without causing adverse reactions.Its mechanism is associated with the down-regulation of serum E2 and PRL and the up-regulation of serum P in luteal phase.