Effect of acupoint application combined with clomiphene for sterility patients with polycystic ovary syndrome differentiated as kidney deficiency and blood stasis
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摘要:目的 探讨穴位贴敷配合克罗米芬对肾虚血瘀型多囊卵巢综合征(PCOS)伴不孕患者的妊娠率及血清抗苗勒管激素(AMH)、单核细胞趋化蛋白-1(MCP-1)水平的影响。方法 选取本院肾虚血瘀型PCOS伴不孕患者130例，按照随机数字表法分为试验组与对照组，各65例。对照组采取克罗米芬治疗，试验组在对照组基础上采取穴位贴敷治疗, 2组均治疗3个月。统计2组治疗前、治疗3个月后检测卵巢窦泡数目、多毛及痤疮症状评分、血清性激素[促卵泡激素(FSH)、黄体生成素(LH)、睾酮(T)]、AMH、MCP-1水平。治疗后随访12个月统计2组妊娠率。结果 治疗3个月后, 2组左侧及右侧卵巢窦泡数目较治疗前减少，且试验组显著少于对照组(P < 0.05); 治疗3个月后, 2组多毛及痤疮症状评分较治疗前降低，且试验组显著低于对照组(P < 0.05); 治疗3个月后, 2组血清FSH、LH、T水平、血清AMH、MCP-1水平较治疗前降低，且试验组显著低于对照组(P < 0.05); 治疗后9、12个月，试验组妊娠率显著高于对照组(P < 0.05)。结论 穴位贴敷配合克罗米芬应用于肾虚血瘀型PCOS伴不孕患者可减轻临床症状，改善性激素水平，降低血清AMH、MCP-1的表达，提升预后妊娠率。Abstract:Objective To explore the effect of acupoint application combined with clomiphene on pregnancy rate, levels of serum anti-mullerian hormone (AMH) and monocyte chemotactic protein-1 (MCP-1) in sterility patients with polycystic ovary syndrome (PCOS) differentiated as kidney deficiency and blood stasis.Methods A total of 130 PCOS patients with sterility differentiated as kidney deficiency and blood stasis were selected, and were randomly divided into experimental group and control group, with 65 cases in each group. The control group was treated with clomiphene, and the experimental group was treated with acupoint application on the basis of the control group. Both groups were treated for 3 months. The number of ovarian sinus vesicles, scores of hirsutism and acne symptoms, serum sex hormones levels[follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T)], AMH and MCP-1 levels before and 3 months after treatment were detected. The pregnancy rates of the two groups were recorded after follow up for 12 months.Results After 3 months of treatment, the number of bilateral ovarian sinus vesicles in two groups decreased, and the experimental group was less than that of control group (P < 0.05); after 3 months of treatment, the scores of hairy and acne symptoms, levels of FSH, LH, AMH, MCP-1 and T in two groups were lower than before treatment, and the above indicators in the experimental group were lower than that in the control group (P < 0.05). The pregnancy rates in the experimental group were higher than those in the control group at 9 and 12 months after treatment (P < 0.05).Conclusion Acupoint application combined with clomiphene can alleviate clinical symptoms, improve sex hormone levels, reduce serum AMH, MCP-1 expression and improve prognosis pregnancy rate in sterility patients with PCOS differentiated as kidney deficiency and blood stasis.
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表 1 2组卵巢窦泡数目比较(x±s)
个 组别 n 左侧 右侧 治疗前 治疗3个月后 治疗前 治疗3个月后 试验组 65 12.35±2.04 8.01±1.51*# 12.49±1.89 7.89±1.44*# 对照组 65 12.16±1.97 8.98±1.34* 12.81±1.94 8.75±1.39* 与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。 
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表 2 2组多毛及痤疮评分比较(x±s)
分 组别 n 多毛评分 痤疮评分 治疗前 治疗3个月后 治疗前 治疗3个月后 试验组 65 9.54±2.31 7.71±1.53*# 1.21±0.53 0.51±0.25*# 对照组 65 10.01±2.15 8.80±1.34* 1.17±0.51 0.69±0.28* 与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 3 2组血清性激素指标水平比较(x±s)
组别 n FSH/(pmol/L) LH/(pmol/L) T/(nmol/L) 治疗前 治疗3个月后 治疗前 治疗3个月后 治疗前 治疗3个月后 试验组 65 11.91±2.13 5.34±0.91*# 8.34±1.09 6.41±0.76*# 2.98±0.69 2.02±0.29*# 对照组 65 12.18±2.05 6.96±1.04* 8.42±1.15 7.30±0.72* 3.02±0.71 2.44±0.32* FSH: 促卵泡激素; LH: 黄体生成素; T: 睾酮。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 4 2组血清AMH及MCP-1水平比较(x±s)
μg/L 组别 n AMH MCP-1 治疗前 治疗3个月后 治疗前 治疗3个月后 试验组 65 1.79±0.19 0.53±0.08*# 129.61±37.72 81.64±14.26*# 对照组 65 1.82±0.21 0.69±0.12* 131.50±35.94 98.21±15.34* MCP-1: 单核细胞趋化蛋白-1; AMH: 抗苗勒管激素。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 5 2组妊娠率比较[n(%)]
组别 n 治疗后6个月 治疗后9个月 治疗后12个月 试验组 65 23(35.38) 31(47.69)* 40(61.54)* 对照组 65 17(26.15) 20(30.77) 28(43.08) 与对照组比较, *P < 0.05。
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