针药联合治疗来曲唑诱导排卵的多囊卵巢综合征不孕患者临床疗效观察  

Clinical therapeutic effects of acupuncture combined with Chinese herbal medicine on infertility of polycystic ovary syndrome in the patients with ovulation induction with letrozole

作　　者：尹燕[1] 张迎春[1] 张花[1] 姜朵生[1] 郭桂荣[2] 

机构地区：[1]湖北省妇幼保健院中医科,武汉430070 [2]湖北中医药大学针灸教研室

出　　处：《中国针灸》2018年第1期27-32,共6页Chinese Acupuncture & Moxibustion

基　　金：湖北省科技厅自然科学基金项目:2013 cfc 095;湖北省妇幼保健院院内项目:220936014

摘　　要：目的:评价电针联合调经祛痰方治疗来曲唑(LE)诱导排卵的多囊卵巢综合征(PCOS)不孕患者的临床疗效及安全性。方法:将120例PCOS不孕患者随机分为3组,每组40例。A组口服达英-35(月经第5天起,每日1片,连服21 d)治疗1个疗程(3个月)后,再给予来曲唑(月经第5天起,每日1片,连服5 d)促排卵1个疗程(3个月)。B组在A组治疗基础上于月经第5天起配合使用中药调经祛痰方,每天1剂,经期停药;C组在B组治疗基础上于月经第5天加用电针,穴取关元、足三里、丰隆等穴,隔日1次,经期停针。均治疗3个月为一疗程,连续治疗2个疗程。观察各组患者治疗前后月经改善情况、体质量、体质量指数(BMI)、血清性激素[黄体生成激素(LH)、卵泡刺激素(FSH)、LH/FSH比值、总睾酮(T)、雌二醇(E2)];采用酶联免疫吸附法测定血清抗苗勒氏管激素(AMH)及抑制素B(IHNB)含量;比较各组疗效与安全性、排卵率及妊娠率。结果:(1)3组总有效率、排卵率、妊娠率比较差异均有统计学意义(均P<0.05),均为C组最优,B组次之。(2)3组治疗后月经周期明显缩短(均P<0.05),且C组优于A组(P<0.05);治疗后B、C组体质量均减轻(均P<0.05),且C组优于A组(P<0.05);BMI各组治疗前后及组间比较差异均无统计学意义(均P>0.05)。(3)3组治疗后血清LH、LH/FSH比值均明显下降(均P<0.05),组间比较差异均无统计学意义(均P>0.05)。B、C组治疗后血清T、AMH值明显下降(均P<0.05),其中T值C组低于A、B组,B组低于A组(均P<0.05);AMH值C组低于A组(P<0.05)。FSH、E2、IHNB各组治疗前后及各组间比较差异均无统计学意义(均P>0.05)。(4)C组未发生黄素化卵泡不破裂综合征(LUFS),B组发生LUFS 3例(7.5%),A组发生LUFS 5例(12.5%)。结论:对于来曲唑诱导排卵的PCOS不孕患者,通过调经祛痰方联合电针治疗,能明显改善患者月经周期,减轻体质量,降低血清LH、LH/FSH、T及AMH水平,提高排卵率及妊娠率,未见不良反Objective To evaluate the clinical therapeutic effects and safety on infertility of polycystic ovary syndrome （PCOS） in the patients with ovulation induction with letrozole in the treatment with the formula for regulating menstruation and removing phlegm and electroacupuncture （EA）. Methods A total of 120 patients of PCOS infertility were randomized into 3 groups, 40 cases in each one. In the group A, diane-35 was prescribed for oral administration （one tablet a day since the 5th day of menstruation, continuously for 21 days）. After 1 course of treatment （3 months）, letrozole was used （one tablet a day since the 5th day of menstruation, continuously for 5 days） for ovulation induction for another 1 course （3 months）. In the group B, on the basis of the treatment as the group A, since the 5th day of menstruation, the Chinese herbal formula was combined to regulate menstruation and remove phlegm, one dose a day and discontinued during menstruation. In the group C, on the basis of the treatment as the group B, EA was added since the 5th day of menstruation. The main acupoints were Guanyuan （CV 4）, Zusanli （ST 36） and Fenglong （ST 40）, etc. EA was applied once every 2 days and discontinued during menstruation. In all of the 3 groups, the treatment for 3 months was as 1 course and the 2 courses were required continuously. Before and after treatment, the menstruation improvements, body weight, body mass index （BMI）, serum sex hormones [luteal production hormone （LH）, follicle stimulating hormone （FSH）, LH/FSH, total testosterone （T） and estradiol （E2）] were observed in the patients of each group. The enzyme linked immunosorbent assay was adopted to determine the content of anti-mullerian hormone （AMH） and inhibin B （IHNB）. The therapeutic effects, safety, ovulation rate and pregnancy rate were compared among the 3 groups. Results （1） The differences were significant statistically in the total effective rate, ovulation rate and pregnancy rate in compari

关 键 词：多囊卵巢综合征 不孕 电针 调经祛痰方 来曲唑 

分 类 号：R246.3[医药卫生—针灸推拿学]