电针肝经腧穴治疗肝郁型卵巢储备功能减退:随机对照试验

Electroacupuncture at acupoints of liver meridian for diminished ovarian reserve of liver depression:a randomized controlled trial

目的:观察电针肝经腧穴治疗肝郁型卵巢储备功能减退(DOR)的临床疗效。方法:将62例肝郁型DOR患者随机分为电针组(31例,中止1例)和西药组(31例,剔除1例)。电针组予电针双侧太冲、蠡沟、曲泉、急脉,连续波,频率2 Hz,电流0.5~1.0 mA,每次30 min,隔日1次,每周治疗3次。西药组口服芬吗通,前14 d口服雌二醇片,后14 d口服雌二醇/地屈孕酮复合片,每天1片。两组均连续治疗3个月经周期。分别于治疗前后观察两组患者中医证候、焦虑自评量表(SAS)、抑郁自评量表(SDS)评分,检测血清卵泡刺激素(FSH)、抗缪勒管激素(AMH)含量,采用彩色多普勒超声测量两组窦卵泡计数(AFC)、卵巢动脉收缩期峰值流速(PSV)和阻力指数(RI),并于治疗后评定两组临床疗效。结果:治疗后,两组患者中医证候主症、次症评分及总分均较治疗前降低(P<0.01),SAS、SDS评分及血清FSH含量、卵巢动脉RI均较治疗前降低(P<0.01),血清AMH含量、AFC、卵巢动脉PSV均较治疗前升高(P<0.05,P<0.01);电针组患者中医证候主症评分高于西药组(P<0.01),中医证候次症、SAS和SDS评分低于西药组(P<0.05,P<0.01)。电针组总有效率为70.0%(21/30),西药组总有效率为73.3%(22/30),两组总有效率比较差异无统计学意义(P>0.05)。结论:电针肝经腧穴可有效改善肝郁型DOR患者中医临床症状及焦虑、抑郁状态,调节血清性激素水平,增加AFC,改善卵巢血供。

Objective To observe the therapeutic effect of electroacupuncture at acupoints of liver meridian in patients with diminished ovarian reserve(DOR)of liver depression.Methods A total of 62 patients with DOR of liver depression were randomly divided into an electroacupuncture group(31 cases,1 case discontinued)and a western medication group(31 cases,1 case was eliminated).Electroacupuncture was applied at bilateral Taichong(LR 3),Ligou(LR 5),Ququan(LR 8),Jimai(LR 12)in the electroacupuncture group,with continuous wave,in frequency of 2 Hz and current of 0.5-1.0 mA,30 min each time,once every other day,3 times a week.Femoston was taken orally in the western medication group,oral estradiol tablets were taken for the first 14 days,followed by oral estradiol/progesterone complex tablets for the rest 14 days,1 tablet a day.Both groups were treated for 3 consecutive menstrual cycles.Before and after treatment,the scores of TCM syndrome,self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were observed,serum levels of follicle stimulating hormone(FSH)and anti-Müllerian hormone(AMH)were detected,and antral follicle count(AFC),peak systolic velocity(PSV)and resistance index(RI)of ovarian artery were measured by color Doppler ultrasound in the two groups,and the clinical efficacy was evaluated after treatment.Results After treatment,the scores of primary symptom and secondary symptom,as well as the total scores of TCM syndrome were decreased compared with those before treatment(P<0.01),the scores of SAS and SDS,as well as the serum FSH levels and RI of ovarian artery were decreased compared with those before treatment(P<0.01),while the serum AMH levels,AFC and PSV of ovarian artery were increased compared with those before treatment(P<0.05,P<0.01)in the two groups.After treatment,in the electroacupuncture group,the primary symptom score of TCM syndrome was higher than that in the western medication group(P<0.01),the secondary symptom score of TCM syndrome and the scores of SAS and SDS were lower than those in the western medication group(P<0.05,P<0.01).The total effective rate was 70.0%(21/30)in the electroacupuncture group and 73.3%(22/30)in the western medication group respectively,there was no significant difference in the total effective rate between the two groups(P>0.05).Conclusion Electroacupuncture at acupoints of liver meridian can effectively improve the clinical symptoms,anxiety and depression,regulate the serum sex hormone levels,increase AFC and improve ovarian blood supply in DOR patients of liver depression.