“调冲任、固肾元”针刺法配合益宫养泡汤治疗小卵泡排卵不孕症疗效及对下丘脑-垂体-卵巢轴功能的影响

Curative effect of acupuncture for coordinating Chong-Ren and strengthening kidney combined with Yigong Yangpao Decoction on small follicular ovulation infertility and its effect on the function of the hypothalamus-pituitary-ovarian axis

目的观察“调冲任、固肾元”针刺法配合益宫养泡汤治疗小卵泡排卵(SFO)所致不孕症的疗效及对下丘脑-垂体-卵巢轴(HPOA)功能的影响。方法将2015年12月—2019年5月柳州市工人医院诊治的64例SFO所致不孕症患者随机分为对照组与观察组,每组32例。对照组给予枸橼酸氯米芬片口服,观察组在其基础上给予“调冲任、固肾元”针刺法配合益宫养泡汤干预,疗程均为3个月经周期。观察2组干预前后最大卵泡直径、子宫内膜厚度、HPOA相关激素水平的变化,记录2组治疗后临床疗效及成熟卵泡排卵率、未破裂卵泡黄素化综合征(LUFS)发生率、妊娠率、早期自然流产率。结果治疗后2组子宫内膜厚度、最大卵泡直径及血清雌二醇(E 2)、黄体生成素(LH)水平均较治疗前明显增高(P均<0.05),血清促卵泡成熟激素(FSH)水平均较治疗前明显降低(P均<0.05),且观察组治疗后上述指标均优于对照组(P均<0.05)。治疗后观察组和对照组的治疗临床总有效率分别为84.4%(27/32)和65.6%(21/32),观察组明显高于对照组(P<0.05)。观察组早期自然流产率、LUFS发生率均明显低于对照组(P均<0.05),而成熟卵泡排卵率和妊娠率均明显高于对照组(P均<0.05)。结论“调冲任、固肾元”针刺法配合益宫养泡汤治疗SFO所致不孕症可促进卵泡发育,提高成熟卵泡排卵率和妊娠率,机制可能与调节HPOA功能有关。

Objective It is to observe the curative effect of acupuncture for coordinating Chong-Ren and strengthening kidney combined with Yigong Yangpao Decoction on infertility caused by small follicular ovulation(SFO)and its effect on the function of the hypothalamus-pituitary-ovarian axis(HPOA).Methods Sixty-four patients with infertility caused by SFO who were diagnosed and treated in Liuzhou Workers’Hospital from December 2015 to May 2019 were randomly divided into a control group and an observation group,with 32 cases in each group.The control group was given clomiphene citrate tablets orally,and the observation group was treated with acupuncture for coordinating Chong-Ren and strengthening kidney combined with Yigong Yangpao Decoction based on the control group.The course of treatment was 3 menstrual cycles.The changes of the maximum follicle diameter,endometrial thickness,HPOA-related hormones before and after intervention were observed in the two groups,the clinical efficacy was evaluated,mature follicle ovulation rate,incidence of luteinized unruptured follicle syndrome(LUFS),pregnancy rate,and early spontaneous abortion rate were observed after treatment in the two groups.Results After treatment,the endometrial thickness,maximum follicle diameter and the levels of serum estradiol(E 2)and luteinizing hormone(LH)in the two groups were significantly increased while the levels of serum follicle maturation hormone(FSH)were significantly reduced compared with before treatment(P<0.05),and the above indicators in the observation group were better than those in the control group after treatment(P<0.05).After treatment,the total clinical effective rates of the observation group and the control group were 84.4%(27/32)and 65.6%(21/32),respectively,the observation group was significantly higher than the control group(P<0.05).The early spontaneous abortion rate and LUFS rate in the observation group were significantly lower than those in the control group(P<0.05),while the mature follicle ovulation rate and pregnancy rate were significantly higher than those in the control group(P<0.05).Conclusion Acupuncture for coordinating Chong-Ren and strengthening kidney combined with Yigong Yangpao Decoction can promote follicular development and increase the ovulation rate of mature follicles and pregnancy rate in the treatment of infertility caused by SFO.The mechanism may be related to the regulation of HPOA function.