摘要
目的:观察在西药基础上针灸联合中药人工周期疗法与单纯西药治疗痰湿型多囊卵巢综合征(PCOS)胰岛素抵抗患者的临床疗效差异,并探讨其部分作用机制。方法:将60例患者随机分为观察组和对照组,每组30例。对照组于月经第3天开始口服来曲唑和二甲双胍。观察组在对照组基础上予以针灸配合中药治疗。主穴取关元、气海及双侧子宫、卵巢、丰隆、阴陵泉、足三里、三阴交,卵泡期配合大赫穴,并于关元和气海穴行温针灸;排卵期配合中极、血海穴,并于气海和中极穴、血海和阴陵泉穴接2组电针,选择2 Hz连续波;黄体期取以上主穴,并艾灸关元和气海穴,每次30 min,隔日1次;月经期间停止治疗。中药以补肾养血、健脾化痰为主。两组均连续治疗3个月经周期。观察两组治疗前后血清中血清微小核糖核酸-29(mi R-29)表达水平、中医症状积分、内分泌激素值[促卵泡生成素(FSH)、促黄体生成素(LH)、睾酮(T)、催乳素(PRL)、LH/FSH值]、胰岛素(INS)和血糖含量及胰岛素抵抗(HOMA-IR)指数,并比较两组治疗后妊娠情况。结果:两组治疗后mi R-29基因表达及中医症状积分均低于治疗前(P<0.01,P<0.05),且观察组改善情况优于对照组(P<0.01,P<0.05)。观察组治疗后LH、LH/FSH及T值均低于治疗前(P<0.01,P<0.05),对照组治疗后T值低于治疗前(P<0.05),观察组LH、LH/FSH改善情况优于对照组(均P<0.05)。两组治疗后INS、血糖含量、HOMA-IR指数均低于治疗前(P<0.05,P<0.01),且观察组INS、HOMA-IR指数改善情况优于对照组(均P<0.05)。观察组妊娠率为56.7%(17/30),明显高于对照组的30.0%(9/30,P<0.05)。结论:针药人工周期疗法能改善痰湿型PCOS患者的内分泌和胰岛素抵抗情况,同时能显著提高患者的妊娠率,从分子生物学角度,有可能通过mi R-29表达的改变来作用于多囊卵巢综合征胰岛素抵抗。
Objective To explore the effect difference between acupuncture combined with Chinese medicine of artificial cycle therapy on the basis of western medication and simple western medication for polycystic ovarian syndrome（PCOS） of phlegm damp type with insulin resistance, and to explore its mechanism. Methods Sixty patients were randomly assigned into an observation group and a control group, 30 cases in each group. Patients of the control group began to take letrozole and metformin orally on the third menstrual day. Patients of the observation group were treated with acupuncture combined with Chinese medicine of artificial cycle therapy on the basis of the treatment of the control group. The main acupoints were Guanyuan（CV 4）, Qihai（CV 6） and bilateral Zigong（EX-CA 1）, Luanchao（Extra）,Fenglong（ST 40）, Yinlingquan（SP 9）, Zusanli（ST 36）, Sanyinjiao（SP 6）. Dahe（KI 12） was matched in the follicular phase, and warm acupuncture was applied at Guanyuan（CV 4） and Qihai（CV 6）; Zhongji（CV 3） and Xuehai（SP 10） were matched in the ovulatory phase, and electroacupuncture were used at Qihai（CV 6） and Zhongji（CV 3）, Xuehai（SP 10） and Yinlingquan（SP 9）, 2 Hz and continuous wave; The acupoints in the luteal phase were the above main acupoints, atthe same time, moxibustion was used at Guanyuan（CV 4） and Qihai（CV 6）, the treatment was given once every other day,30 min a time. There was no treatment in the menstrual phase. Chinese medicine was applied for tonifying kidney and nourishing blood, strengthening spleen and eliminating phlegm. The patients of the two groups were treated for continuous three menstrual cycles. The indexes before and after treatment were detected, including serum micro RNA-29（mi R-29）expression, TCM symptom score, insulin（INS）, blood-sugar content and homeostasis model assessment-insulin resistance（HOMA-IR） index, the endocrine hormone values of follicle stimulating hormone（FSH）, luteinizing hormone（LH）,testosterone（T）, LH/FSH ratio, prolactin（PRL）. The pregnancy rates of the two groups were compared. Results After treatment the expressions of mi R-29 and TCM symptom scores of the two groups were lower than those before treatment（P0.01, P0.05）, with better results in the observation group（P0.01, P0.05）. The levels of LH LH/FSH and T of the observation group were lower than those before treatment（P0.01, P0.05）, and the T value in the control group decreased after treatment（P0.05）. The changes of LH and LH/FSH in the observation group were better than those in the control group（both P0.05）. After treatment, The INS, blood-sugar content and HOMA-IR were lower than those before treatment in the two groups（P0.05, P0.01）, with better results for INS and HOMA-IR improvements in the observation group（both P0.05）. The pregnancy rate in the observation group was 56.7%（17/30）, which was significantly higher than 30.0%（9/30） in the control group（P0.05）. Conclusion Acupuncture combined with Chinese medicine of artificial cycle therapy can improve the endocrine levels and insulin resistance of PCOS with phlegm damp type. At the same time, the pregnancy rate is improved. By the view of molecular biology, there may be a pathway trough changing serum miR-29 expression.
出处
《中国针灸》
CAS
CSCD
北大核心
2017年第11期1163-1168,共6页
Chinese Acupuncture & Moxibustion
基金
国家自然科学基金资助项目:81302998
福建省科学技术厅科技计划项目:2015Y0002
福建省中医药科研项目:wzfg201304
福建省卫生计生委青年科研课题:2014-1-20
关键词
多囊卵巢综合征
痰湿型
胰岛素抵抗
针灸
中药
随机对照试验
polycystic ovary syndrome, phlegm damp type
insulin resistance
acupuncture
Chinese medicine
randomized controlled trial （RCT）
作者简介
许金榜（1980-），男，副主任医师。研究方向：妇科内分泌病证研究。E-mail：xujinbang1980@126．com
