针刺改善体外受精-胚胎移植患者临床妊娠结局及其机制的研究  

Study of Acupuncture Improving Clinical Pregnancy Outcome and Its Mechanisms in IVF-ET Patients

作　　者：金志春[1] 郑洁[1] 夏敏[1] 孙虹[1] 刘杰[1] 杨青 张明子 胡兴文[1] 雷亚兰[1] 文晓凤[1] 王维鹏[1] 张纯[1] 吴璇 何联[1] 姚娟[1] 张倩 艾华 JIN Zhi-chun;ZHENG Jie;XlA Min;SUN Hong;LIU Jie;YANG Qing;ZHANG Ming-zi;HU Xing-wen;LEI Ya-lan;WEN Xiao-feng;WANG Wei-peng;ZHANG Chun;WU Xuan;HE Lian;YAO Juan;ZHANG Qian;AI Hua(Hubei Maternal and Child Health Care Hospital,Wuhan 43007)

机构地区：[1]湖北省妇幼保健院,武汉430070

出　　处：《中国中西医结合杂志》2018年第10期1174-1179,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：湖北省自然科学基金重点项目(No.2009CDA065)

摘　　要：目的通过针刺介入体外受精-胚胎移植(IVF-ET)过程,观察针刺改善IVF-ET临床妊娠结局的作用效果,并以血清和卵泡液相关生殖激素、细胞因子和子宫内膜状态为指标探索针刺改善IVF-ET临床妊娠结局的作用机制。方法将193例符合研究标准的病例随机分为针刺组(96例)与对照组(97例)。两组病例均采用短效Gn RH-a长方案降调节垂体功能,垂体降调节后采用Gn促排卵,针刺组自Gn启动日开始针刺,每日1次,至移植后7天。观察两组患者不同时期血清和卵泡液内FSH、LH、E2、P、T、PRL等生殖内分泌激素和IGF-2、IL-1β、IL-6、LIF、TGF-β1、VEGF、TNF-α相关因子水平,以及子宫内膜状态和临床妊娠情况。结果针刺组着床率、临床妊娠率分别为42. 70%(79/185)、61. 70%(58/94),对照组分别为32. 04%(58/181)、44. 68%(42/94),针刺组优于对照组(P <0. 05);与对照组比较,血清中针刺组h CG注射日E2、P、T水平降低,OPU日E2、P及ET日E2水平降低(P <0. 05),卵泡液中E2含量升高而P含量降低(P <0. 05);与对照组比较,针刺组OPU日血清及卵泡液中TNF-α水平降低,IGF-2、IL-1β、IL-6、LIF、TGF-β1、VEGF水平升高(P <0. 05,P <0. 01),ET日血清TNF-α水平降低,IGF-2、IL-1β、IL-6、LIF、TGF-β1、VEGF水平升高(P <0. 05);与对照组比较,针刺组子宫内膜形态显著改善(P <0. 05)。结论针刺可显著改善IVF-ET临床妊娠结局,其机制可能与针刺可以调节血清和卵泡液相关生殖激素(E2、P、T)、细胞因子(IGF-2、IL-1β、IL-6、LIF、TGF-β1、VEGF和TNF-α)和子宫内膜形态有关。Objective To investigate whether acupuncture could improve the clinical pregnancy outcome of patients who received IVF-ET,and to explore the possible mechanisms from the reproductive hormones and cytokines in the serums and follicular fluidand endometrial status. Methods According to their order of admission,193 female patients were randomly divided into acupuncture group（ 96 cases） and control group（ 97 cases）. The patients in the two groups were treated with the long-program of short-effect Gn RH-a to down-regulate the hypophysis,and than Gn were used to control ovarian hyperstimulation. The acupuncture began from the Gn start-up date to 7 days after the embryo transplant,once a day in the acupuncture group. The reproductive endocrine hormones such as FSH,LH,E2,P,T,PRL,and related factors such as IGF-2,IL-1β,IL-6,LIF,TGF-β1,VEGF,TNF-α in the different periods serum and follicular fluid were measured,and also the status of endometria and clinical pregnancy were observed. Results The implantation rate and the clinical pregnancy rate were respectively 42. 70%（ 79/185）and 61. 70 %（ 58/94） in the acupuncture group,and 32. 04 %（ 58/181） and 44. 68 %（ 42/94） in the controlgroup,and that were superior in the acupuncture group to in the control group（ P〈0. 05）. Compared with the control group,in the acupuncture group,the levels of E2,P,T on the h CG-injection day,the levels of E,P on the OPU day,and the level of E2 on the ET day,all decreased in the serums（ P〈0. 05）,the content of E2 increased while the content of P decreased in follicular fluid（ P〈0. 05）. Compared with the control group,in the acupuncture group,the levels of TNF-α decreased on the OPU day in the serums and follicular fluid,while the levels of IGF-2,IL-1β,IL-6,LIF,TGF-β1,VEGF increased（ P〈0. 05,P〈0. 01）,at the same time,the level of TNF-α decreased in the serums on the ET day,and the levels of IGF-2,IL-1β,IL-6,LIF,TGF-β1,VEGF increased（ P〈0. 05）. Compared with the control group,the endomet

关 键 词：针刺 体外受精-胚胎移植 临床妊娠 生殖内分泌 激素 细胞因子 

分 类 号：R714.8[医药卫生—妇产科学]