穴位埋线联合芬吗通治疗早发性卵巢功能不全的临床疗效及对子宫容受性的影响

Clinical Efficacy of Acupoint Catgut Embedding Combined with Femoston in the Treatment of Premature Ovarian Insufficiency and its Influence on Uterine Receptivity

目的:在西医常规治疗的基础上,评价穴位埋线合用芬吗通治疗早发性卵巢功能不全的临床疗效及对子宫内膜容受性的影响,探讨其作用机制。方法:选取符合标准的早发性卵巢功能不全患者60例,采用随机抽样方法分成观察组及对照组,每组各30例。对照组单纯给予戊酸雌二醇-地屈孕酮片(芬吗通)口服以雌孕激素替代疗法,观察组在对照组的基础上联合采用穴位埋线治疗,穴取气海、关元、天枢(双侧)、子宫(双侧)、卵巢(双侧)、肾俞(双侧)、次髎(双)、足三里(双侧)、三阴交(双侧),每两周1次,6次为1疗程,2组均治疗12周后观察疗效。记录比较患者治疗前后中医症候积分变化的情况,比较2组治疗前后的月经情况、血清促卵泡生成素(FSH)水平、雌二醇(E2)水平,并以Kupperman自评量表积分评估患者临床症状改变,治疗前后OVD、AFC、RI水平和子宫内膜容受性改善情况。结果:治疗后观察组中医证候评分低于对照组,且观察组降低幅度更大(均P<0.01);治疗后2组临床综合疗效比较,观察组优于对照组(P<0.01);治疗后激素水平两两比较,2组血清FSH、LH下降,E2水平较前有所升高,差异有统计学意义(P<0.01,P<0.05),其中观察组FSH下降,E2升高较对照组明显,差异有统计学意义(P<0.01),治疗前后血清AMH水平较前有所升高,差异有统计学意义(P<0.01,P<0.05),且观察组上升幅度更大(P<0.01);治疗后2组Kupperman自评量表积分比较,埋线组优于对照组(均P<0.01),研究组治疗后AFC水平高于对照组,RI水平低于对照组(P<0.05),LIF、αVβ3和gly-codelin水平高于对照组(P<0.05)。结论:穴位埋线联合芬吗通治疗早发性卵巢功能不全可有效改善血清激素水平,恢复月经周期,增加卵巢血流量,提高卵巢储备功能和子宫内膜容受性,同时有助于临床症状的缓解,与芬吗通具有较好的协同作用。

Objective:Based on the conventional treatment of western medicine,the clinical efficacy of acupoint-embedded thread combined with Femoston in the treatment of early-onset ovarian insufficiency and its effect on endometrial receptivity were evaluated,and its mechanism of action was discussed.Methods:Sixty patients with early-onset ovarian insufficiency that met the criteria were selected and divided into an observation group and a control group by random sampling,with 30 cases in each group.The control group was simply given estradiol valerate didroxyprogesterone tablets(fenmoton)orally with estrogen and progestin replacement therapy.The observation group based on the control group was combined with acupoint-embedding,acupuncture at Qihai and Guanyuan,Tianshu(bilateral),uterus(bilateral),ovary(bilateral),Shenshu(bilateral),Jiyu(double),Zusanli(bilateral),Sanyinjiao(bilateral),1 every two weeks 6 times is 1 course of treatment,and the curative effect is observed in both groups after 12 weeks of treatment.Changes in TCM symptom scores before and after treatment were recorded and compared.Menstrual conditions,serum follicle stimulating hormone(FSH),and estradiol(E2)levels were compared between the two groups before and after treatment.Symptoms changed,OVD,AFC,RI levels and endometrial receptivity improved before and after treatment.Results:The score of TCM syndromes in the observation group after treatment was lower than that in the control group,and the reduction was greater in the observation group(P<0.01).The comparison of the clinical efficacy of the two groups after treatment was better in the observation group than in the control group(P<0.01);Comparison of hormone levels after treatment,serum FSH and LH in the two groups decreased,and E2 levels increased compared with the previous ones,the difference was statistically significant(P<0.01,P<0.05),in which the FSH in the observation group decreased and E2 increased The control group was obvious,and the difference was statistically significant(P<0.01).Serum AMH levels were increased before and after treatment,and the difference was statistically significant(P<0.01,P<0.05),and the increase in the observation group was greater(P<0.01);Comparison of Kupperman self-assessment scores between the two groups after treatment.The buried thread group was better than the control group(P<0.01).The levels of LIF,αVβ3 and gly-codelin were higher than those in the control group(P<0.05).Conclusion:Acupoint-embedding combined with fenmorphone can effectively improve serum hormone levels,restore menstrual cycle,increase ovarian blood flow,improve ovarian reserve function and endometrial receptivity,and help clinical symptoms Relief,has a better synergy with fenmorphone.