摘要
目的:系统评价行体外受精-胚胎移植过程中针灸对卵巢低反应(POR)患者妊娠结局和卵巢功能有效性的疗效。方法:计算机检索国家知识基础设施数据库(CNKI)、中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、中国学术期刊数据库(CSPD)、PubMed、Cochrane Library数据库,检索针灸治疗POR的随机对照试验(RCT),检索时限为建库至2021年8月31日。采用RevMan 5.4软件对纳入研究进行偏倚风险评价和数据分析,并进行GRADE证据质量评价。结果:共纳入8个RCT,包括537例患者。Meta分析结果显示:与体外受精-胚胎移植(IVF-ET)组比较,针灸+IVF-ET组可提高POR患者临床妊娠率(RR=1.58,95%CI为1.03~2.42,P=0.04),增加获卵数(MD=1.16,95%CI为0.47~1.85,P=0.001)和窦卵泡数(MD=0.93,95%CI为0.06~1.8,P=0.04),降低促卵泡素(FSH)水平(SMD=-0.29,95%CI为-0.50~-0.08,P=0.007),但2组在提高受精率、优胚率、降低促黄体素(LH)水平、提高抗米勒管激素(AMH)水平、降低促性腺激素(Gn)用量上差异均无统计学意义。结论:现有证据表明,针灸可提高接受IVF-ET助孕的POR患者临床妊娠率,增加获卵数和窦卵泡数,降低POR患者的FSH水平。由于纳入研究数量较少且存在一定的偏倚风险,本研究结论后续仍需要高质量研究进行验证。
Objective:To systematically evaluate the effectiveness of acupuncture and moxibustion in pregnancy outcome and ovarian function of patients with poor ovarian response(POR).Methods:China National Knowledge Infrastructure(CNKI),Chinese Citation Database(CCD),Chinese Biomedical Literature Database(CBM),China Science Periodical Database(CSPD),PubMed and Cochrane Library were electronically searched to collect randomized controlled trials(RCTs) on the effectiveness of acupuncture and moxibustion in pregnancy outcome and ovarian function of POR patients from the inception of the databases to August 31,2021.RevMan 5.4 was used to perform risk of bias assessment and data analysis among the included articles,and GRADE was used for quality assessment.Results:Eight RCTs were included,involving 537 patients.The Meta-analysis indicated that compared with in vitro fertilization-embryo transfer(IVF-ET) alone,acupuncture combined with IVF-ET increased the clinical pregnancy rate(RR=1.58,95%CI 1.03 to 2.42,P=0.04),the number of retrieved oocytes(MD=1.16,95%CI 0.47 to 1.85,P=0.001) and antral follicle count(MD=0.93,95%CI 0.06 to 1.8,P=0.04),and reduced level of follicle-stimulating hormone(FSH)(SMD=-0.29,95%CI-0.50 to-0.08,P=0.007).There was no statistical difference between the two groups in elevating fertilization rate,excellent embryo rate,and level of anti-Müllerian hormone(AMH) as well as in decreasing level of luteinizing hormone(LH) and dosage of gonadotropins(GN).Conclusion:Acupuncture and moxibustion can improve the clinical pregnancy rate,the number of retrieved oocytes,and the number of antral follicle count,and lower the level of FSH in POR patients receiving IVF-ET.Due to limited quantity of the included studies and certain risk of bias,high-quality studies are required to verify the above conclusions in the future.
作者
丰逸轩
杨会生
勾明会
刘思雨
范素
房繄恭
FENG Yixuan;YANG Huisheng;GOU Minghui;LIU Siyu;FAN Su;FANG Yigong(Institute of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700,China;Clinic of Premature Ovarian Failure,Hospital of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700,China)
出处
《世界中医药》
CAS
2023年第4期491-495,共5页
World Chinese Medicine
基金
国家重点研发计划项目(2017YFC1703600)——针灸优势病种疗效评价国际合作研究资助。
关键词
针灸
体外受精-胚胎移植
卵巢低反应
妊娠结局
卵巢功能
有效性
Meta分析
随机对照试验
Acupuncture and moxibustion
In vitro fertilization-embryo transfer
Poor ovarian response
Pregnancy outcome
Ovarian function
Effectiveness
Meta-analysis
Randomized controlled trial
作者简介
丰逸轩(1995.06-),女,博士研究生在读,研究方向:针灸治疗生殖内分泌疾病的临床和作用机制研究,E-mail:18771940803@163.com;通信作者:房繄恭(1968.09-),男,博士,主任医师,研究方向:针灸治疗生殖内分泌疾病的临床和作用机制研究,E-mail:fangyigong@163.com。
