不同针灸方法对卵巢储备功能下降的临床疗效观察

Clinical Observation of Different Acupuncture and Moxibustion Methods in Diminished Ovarian Reserve

目的探讨不同针灸方法对卵巢储备功能下降(Diminished ovarian reserve,DOR)女性的性激素及临床疗效差异,以筛选便捷有效的针灸干预方式。方法将60例DOR患者随机分为艾灸组和揿针组,取关元、肾俞、三阴交穴。艾灸组取清艾条对准施灸穴位进行温和灸,以患者感到穴位皮肤温热舒适为度,每穴10 min,隔日施灸1次,干预3个月经周期;揿针组采用清铃揿针按压在相应穴位上,24 h后取下,隔日1次,干预3个月经周期。观察其血清性激素、抗苗勒管激素(AMH)水平,并进行临床疗效、更年期指数(Kupperman indet,KI)以及健康调查简表(SF-36)评分。结果(1)干预3个月经周期后,艾灸组雌二醇(estradiol,E_(2))水平显著提高、卵泡刺激素(follicule-stimulating hormone,FSH)水平及FSH/黄体生成素(luteotrophic hormone,LH)的比值显著下降(P<0.01),抗苗勒管激素(anti miillerian hormone,AMH)水平显著提高(P<0.01);揿针组FSH水平及FSH/LH的比值显著下降(P<0.05),AMH水平显著提高(P<0.05)。艾灸组和揿针组的KI评分、临床症状评分和SF-36评分均较干预前显著改善(P<0.01)。(2)干预3个月经周期后,与揿针组相比,艾灸组FSH水平显著下降、AMH水平显著上升(P<0.01),且其临床症状积分、SF-36评分均较揿针组改善显著(P<0.05)。结论艾灸和揿针疗法均可有效调整DOR女性性激素及AMH水平,改善其临床症状,艾灸疗效更优。

Objective To compare the effects of different acupuncture and moxibustion methods on sex hormones and therapeutic results of women with diminished ovarian reserve(DOR),so as to screen convenient and effective acupuncture and moxibustion methods.Methods Sixty patients with DOR were randomly divided into moxibustion group and intradermal needling group,selecting“Guanyuan(RN4)”,“Shenshu(BL23)”and“Sanyinjiao(SP6)”.The patients in the moxibustion group received mild moxibustion with pure moxa stick above acupoints,lasting for 10 min.The patients were required to feel warm and comfortable of acupoints skin,this therapeutic method was received once the next day during three menstrual cycles.The intradermal needling group was treated with Qingling needles pressing on these acupoints and the needles were taken off after 24 h.This method was also received once the next day during three menstrual cycles.The levels of serum sex hormones and anti-mullerian hormone(AMH)were observed,and the clinical effects,the Kupperman index(KI)and the 36-Item Short Form Health Survey(SF-36)were compared.Results(1)After three menstrual cycles,in moxibustion group,the E_(2) level increased significantly,the FSH level and the FSH/LH ratio decreased significantly(P<0.01),and the AMH level increased significantly(P<0.01).In intradermal needling group,the FSH level and FSH/LH ratio decreased significantly(P<0.05),and the AMH level increased significantly(P<0.05).The KI score,clinical symptom scores and SF-36 scores were significantly improved in moxibustion and intradermal needling groups after intervention(P<0.01).(2)After the three menstrual cycles,compared with those of the intradermal needling group,the FSH level decreased significantly and AMH levels increased significantly(P<0.01)in moxibustion group,and their clinical symptom scores and SF-36 scores were improved(P<0.05).Conclusion Moxibustion and intradermal needling can effectively modulate the levels of sex hormones and AMH in DOR women and improve their clinical symptoms,and the effect of moxibustion is superior to that of the intradermal needling.