针药并用治疗卵巢早衰的疗效观察及对卵巢储备功能的影响

Observations on the efficacy of combined acupuncture and medicine for premature ovarian failure and its effect on ovarian reserve function

目的观察针药并用治疗卵巢早衰肾虚肝郁证的临床疗效及对卵巢储备功能的影响。方法将196例卵巢早衰肾虚肝郁证患者,随机分为甲组、乙组、丙组和丁组,每组49例。甲组采取常规西医疗法,乙组采取常规西医疗法联合补肾疏肝、调周养经汤治疗,丙组采取常规西医疗法联合三脏同治法针刺,丁组采取常规西医疗法联合三脏同治法针刺及补肾疏肝、调周养经汤。比较4组治疗前后中医证候积分、子宫内膜厚度、卵巢体积、血清性激素水平[卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinising hormone,LH)、雌二醇(estradial,E2)]、卵巢储备功能[窦卵泡计数(antral follicle count,AFC)、血清抗苗勒氏管激素(anti-Mullerian hormone,AMH)],并比较4组临床疗效及安全性。结果4组治疗后中医证候总积分及血清FSH、LH水平均较治疗前降低(P<0.05),乙组、丙组和丁组低于甲组(P<0.05),丁组低于乙组和丙组(P<0.05)。4组治疗后子宫内膜厚度、卵巢体积、AFC、血清E2和AMH水平均较治疗前增加(P<0.05),乙组、丙组和丁组高于甲组(P<0.05),丁组高于乙组和丙组(P<0.05);乙组治疗后各项指标与丙组比较差异无统计学意义(P>0.05)。丁组总有效率高于甲组、乙组和丙组(P<0.05)。4组总不良反应发生率比较差异无统计学意义(P>0.05)。结论在常规西医疗法治疗基础上,对卵巢早衰肾虚肝郁证患者采用三脏同治法针刺联合补肾疏肝、调周养经汤治疗,可明显改善患者临床症状与性激素水平,并可促进子宫内膜厚度增厚、卵巢体积增大及卵巢储备功能改善,疗效显著,安全性较好。

Objective To observe the clinical efficacy of combined use of acupuncture and medicine for premature ovarian failure with kidney deficiency and liver-qi stagnation syndrome and its effect on ovarian reserve function.Method One hundred and ninety-six patients suffering from premature ovarian failure with kidney deficiency and liver-qi stagnation syndrome were randomized to groups A,B,C and D,with 49 cases in each group.Group A received conventional Western medical treatment;group B,conventional Western medical treatment plus kidney-reinforcing,stagnated liver-qi dispersing,menstrual cycle-regulating and meridian-nourishing decoction;group C,conventional Western medical treatment plus simultaneous three zang-organ acupuncture therapy;group D,conventional Western medical treatment plus simultaneous three zang-organ acupuncture therapy and kidney-reinforcing,stagnated liver-qi dispersing,menstrual cycle-regulating and meridian-nourishing decoction.The TCM syndrome score,endometrial thickness,ovarian volume,serum sex hormone[follicle-stimulating hormone(FSH),luteinising hormone(LH)and estradiol(E2)levels and ovarian reserve function antral follicle count(AFC)and anti-Mullerian hormone(AMH)]were compared between the four groups before and after treatment.The clinical efficacy and safety were also compared between the four groups.Result After treatment,the TCM syndrome total score and serum FSH and LH levels decreased in the four groups compared with before(P<0.05)and were lower in groups B,C and D than in group A(P<0.05)and lower in group D than in groups B and C(P<0.05).After treatment,endometrial thickness,ovarian volume and AFC,serum E2 and AMH levels increased in the four groups compared with before(P<0.05)and were higher in groups B,C and D than in group A(P<0.05)and higher in group D than in groups B and C(P<0.05).There were no statistically significant post-treatment differences in various indicators between groups B and C(P>0.05).The total efficacy rate was higher in group D than in groups A,B and C(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions among the four groups(P>0.05).Conclusion On the basis of conventional Western medical treatment,simultaneous three Zang-organ acupuncture therapy plus kidney-reinforcing,stagnated liver-qi dispersing,menstrual cycle-regulating and meridian-nourishing decoction can markedly relieve the clinical symptoms,improve sex hormone levels and help to increase endometrial thickness,ovarian volume and ovarian reserve function in patients suffering from premature ovarian failure with kidney deficiency and liver-qi stagnation syndrome.It has a marked therapeutic effect and good safety.