针刺联合输卵管通液术治疗输卵管炎性不孕疗效观察及对血清MMP-9、TIMP-1的影响

Efficacy observation of acupuncture plus hydrotubation for infertility due to salpingitis and its effects on serum MMP-9 and TIMP-1

目的观察针刺联合输卵管通液术治疗气滞血瘀型输卵管炎性不孕的临床疗效及对血清基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、基质金属蛋白酶抑制剂-1(tissue inhibitor of metalloproteinase-1,TIMP-1)水平的影响。方法将69例气滞血瘀型输卵管炎性不孕患者随机分为针刺组(34例)和假针组(35例)。针刺组给予针刺联合输卵管通液术治疗;假针组给予输卵管通液术后针刺组穴位旁开1 cm非经非穴处进针,只刺破皮肤,不行针治疗。观察两组治疗前后中医证候和体征积分、输卵管通畅度及血清MMP-9和TIMP-1水平、MMP-9/TIMP-1比值变化,并比较两组中医证候、体征疗效及随访6个月内宫内妊娠率。结果假针组治疗后中医证候积分未见改变(P>0.05),针刺组治疗后低于治疗前和假针组(P<0.01)。两组治疗后体征积分降低(P<0.01),输卵管通畅情况呈现不同程度改善(P<0.05),血清MMP-9水平增高(P<0.01),血清TIMP-1降低(P<0.01),MMP-9/TIMP-1比值升高(P<0.01);针刺组治疗后优于假针组(P<0.01,P<0.05)。针刺组宫内妊娠率高于假针组(P<0.05)。结论针刺联合输卵管通液术治疗气滞血瘀型输卵管炎性不孕疗效显著,作用机制可能与升高MMP-9水平,降低TIMP-1水平,调节二者比值从而抑制纤维化过程有关。

Objective To observe the clinical efficacy of acupuncture plus hydrotubation in treating salpingitisinduced infertility due to Qi stagnation and blood stasis and its effects on serum levels of matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP).Method Sixty-nine patients with salpingitis-induced infertility due to Qi stagnation and blood stasis were randomized into an acupuncture group(34 cases)and a sham acupuncture group(35 cases).The acupuncture group was given acupuncture plus hydrotubation treatment.In the sham acupuncture group,needling was performed after hydrotubation 1 cm away from the acupuncture points used in the acupuncture group and only reached the subcutaneous layer without needling manipulations.Before and after the treatment,the symptoms and signs scores of traditional Chinese medicine(TCM),fallopian tube patency,and serum levels of MMP-9,TIMP-1,and MMP-9/TIMP-1 were observed in the two groups.The efficacy based on TCM symptoms and signs and the intrauterine pregnancy rate at the 6-month follow-up were compared between the two groups.Result After the treatment,the TCM symptoms score did not show a significant change in the sham acupuncture group(P>0.05),and the score dropped in the acupuncture group and was lower than in the sham acupuncture group(P<0.01).In both groups,the signs score declined(P<0.01),the fallopian patency improved to different extents(P<0.05),the serum MMP-9 level increased(P<0.01),the serum TIMP-1 level dropped(P<0.01),and MMP-9/TIMP-1 increased(P<0.01)after the intervention,and the acupuncture group was superior to the sham acupuncture group(P<0.01,P<0.05).The intrauterine pregnancy rate was higher in the acupuncture group than in the sham acupuncture group(P<0.05).Conclusion Acupuncture plus hydrotubation can produce significant efficacy in treating salpingitis-induced infertility due to Qi stagnation and blood stasis,and the mechanism may be associated with inhibiting fibrosis via increasing the MMP-9 level and reducing the TIMP-1 level to regulate their ratio.