针刺疗法对反复种植失败患者子宫内膜容受性的影响  

Evaluation of acupuncture on endometrium receptivity of recurrent implantation failure

作　　者：李丽斐[1] 火明 寇志坚 赵翠[1] 张虹[3] 张学红[1] LI Li-fei;HUO Ming;KOU Zhi-jian;ZHAO Cui;ZHANG Hong;ZHANG Xue-hong(Reproductive Center,First Hospital of Lanzhou University,Lanzhou Gansu 730000;Department of Anesthesiology,Gansu Provincial Hospital,Lanzhou Gansu 730000;Department of Pathology,First Hospital of Lanzhou University,Lanzhou Gansu 730000)

机构地区：[1]兰州大学第一医院生殖中心,甘肃兰州730000 [2]甘肃省人民医院麻醉科,甘肃兰州730000 [3]兰州大学第一医院病理科,甘肃兰州730000

出　　处：《世界中西医结合杂志》2022年第2期407-411,415,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：兰州市科技计划项目(2017-4-55);兰州大学第一医院院内基金(ldyyyn2018-65)。

摘　　要：目的评价针刺治疗冻融胚胎移植周期反复种植失败患者的安全性及有效性,观察针刺对患者子宫内膜容受性的影响。方法选取2018年1月—2018年12月期间就诊于兰州大学第一医院生殖医学专科医院,采用降调节激素替代方案行冻融胚胎移植(Frozen-thawed-embryo transfer,FET)周期的反复种植失败患者96例,根据随机数字表法分为针刺组51例和对照组45例。对照组采用常规方案治疗,针刺组在常规治疗基础上给予针刺关元、三阴交、中极、子宫、足三里、肾俞、太冲,1次/d,治疗14 d,连续3个周期,共42 d。观察两组患者移植日血清性激素水平雌二醇(Estradiol,E_(2))、血清孕酮(Progesterone,P)、子宫内膜厚度、临床妊娠率、子宫内膜基底动脉情况;同时采用免疫组化技术检测子宫内膜整合素αvβ3和血管内皮生长因子(Vascular endothelial growth factor,VEGF)的表达差异。结果与对照组比较,针刺组患者在移植日血清E_(2)水平显著增加,临床妊娠率显著提高,且子宫内膜基底动脉阻力指数(RI)降低,差异有统计学意义(P<0.05)。两组流产率、子宫内膜厚度及血清孕酮(P)水平、子宫内膜基底动脉搏动指数(PI)比较,差异无统计学意义(P>0.05)。子宫内膜免疫组化检测可见整合素αvβ3和VEGF在针刺组子宫内膜腺上皮细胞胞质内均呈阳性表达,且针刺组显著高于对照组(P<0.05)。结论针刺疗法可明显改善反复种植失败患者降调节期间临床症状,提高血清E_(2)水平及妊娠率;其机制可能与增强子宫内膜容受性相关分子表达水平密切相关。Objective To evaluate the safety and efficacy of acupuncture in the treatment of patients with repeated implantation failure in frozen-thawed embryo transfer cycles,and to observe the effect of acupuncture on endometrial receptivity.Methods 96 women with recurrent implantation failure who were treated in the Reproductive center of the First Hospital of Lanzhou University from January 2018 to December 2018 and underwent Freezing-embryo transfer(FET)cycle with a downregulating hormone replacement regimen were selected.Patients were divided into an acupuncture group of 51 cases and a control group of 45 cases according to the random number table method.The control group was treated with conventional treatment,and the acupuncture group was additionally treated with acupuncture at Guanyuan,Sanyinjiao,Zhongji,Uterus,Zusanli,Shenshu,and Taichong,once a day,for 14 days,for 3 consecutive cycles,a total of 42 d.The serum sex hormone levels of estradiol(Estradiol,E_(2)),serum progesterone(Progesterone,P),endometrial thickness,clinical pregnancy rate,and endometrial basilar artery were observed in the two groups on the day of embryo tvansfer.Differential expression of endometrial integrinαvβ3 and vascular endothelial growth factor(VEGF)were observed.Results Compared with the control group,the serum E_(2)level in the acupuncture group on the day of embryo tvansfer was significantly increased,the clinical pregnancy rate was significantly increased,and the endometrial basilar artery resistance index was decreased,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in abortion rate,endometrial thickness,serum progesterone(P)level,and endometrial basilar artery pulsatilityindex(PI)between the two groups(P>0.05).Endometrial immunohistochemical detection showed that integrinαvβ3 and VEGF were both positively expressed in the cytoplasm of endometrial gland epithelial cells in the acupuncture group,and the acupuncture group was significantly higher than the control g

关 键 词：反复种植失败 子宫内膜容受性 针刺 

分 类 号：R245.31[医药卫生—针灸推拿学] R271.14[医药卫生—中医临床基础]