针灸改善子宫内膜容受性的临床研究特点分析
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摘要
目的:分析针灸改善子宫内膜容受性(endometrial receptivity,ER)的临床研究特点。方法:通过检索中国知网截至2017年12月公开发表的有关针灸改善ER的临床研究及现状研究的文献资料,对针灸改善ER临床研究文献的分布年限、文献构成、诊断标准、选穴特点、治疗方法、治疗周期、介入时机、疗效评价标准等规律和特点进行分析和总结。结果:①针灸改善ER的治疗方式多样,包括艾灸、穴位埋线、耳穴、穴位电刺激、电针、温针、毫针等。其中毫针针刺使用频率最高,为11次,占34.38%;穴位电刺激/电针疗法的使用频率也较高,为9次,占28.13%;针刺配合温针、中药等频率为8次,占25%;耳穴2次,占6.25%;穴位埋线、单纯艾灸较少,各1次,各占3.12%;②针灸改善ER的选穴主要分布于任脉、督脉、足阳明胃经、足太阴脾经、足少阴肾经、足太阳膀胱经、手阳明大肠经、足厥阴肝经、足少阳胆经、手厥阴心包经,其外还有经外奇穴;③针灸改善ER的治疗周期以治疗1个月经周期、3个月经周期为多;④针灸调和气血的作用显著,月经期的病理变化多为气血不和,为针灸介入的良好时机分别。结论:针灸对ER具有积极的改善作用,但研究中存在一些不足:①缺乏大样本多中心随机对照研究,临床推广受限;②研究多停留在临床疗效观察,对针灸作用的效应机制研究甚少,缺乏回顾性研究与分析;③诊断标准有待统一;④因联合其他疗法较多,针灸的疗效不易突显;⑤应将子宫内膜、卵巢的分泌周期纳入考虑,在应用中坚持辨证论治;⑥治疗后评价指标的选择争议较大,需积极寻找特异性评价指标,减少检测资源的浪费。
Objective: To analyze the clinical research characteristics of acupuncture in improving endometrial receptivity.Methods:By retrieving the literature published by CNKI until December 2017 on clinical research and current research on acupuncture in improving ER, this paper analyzed and summarized the regularities and characteristics of the literature on acupuncture in improving ER, such as distribution years, literature composition, diagnostic criteria, characteristics of acupoint selection, treatment methods, treatment cycle, timing of intervention, evaluation criteria of curative effect, etc.Results:①Acupuncture can improve ER in a variety of ways, including moxibustion, acupoint catgut embedding, ear acupoint, acupoint electrical stimulation, electro-acupuncture, warm needle, filiform needle, etc.Among them, filiform needle acupuncture has the highest frequency of use, which is 11 times,accounting for 34.38%; the frequency of acupoint electrical stimulation/electro-acupuncture therapy is also high, which is 9 times, accounting for 28.13%; acupuncture with warm needle, Chinese medicine and other frequencies are 8 times, accounting for 25%; ear acupoints is 2 times, accounting for 6.25%; acupoint catgut embedding and simple moxibustion are less, 1 time each, each accounting for 3.12%;②Acupuncture are mainly used to improve ER in Ren Meridian, Du Meridian, Foot Yangming Stomach Meridian, Foot Taiyin Spleen Meridian, Foot Shaoyin Kidney Meridian, Foot Taiyang Bladder Meridian, Hand Yangming Large Intestine Meridian, Foot Jueyin Liver Meridian, Foot Shaoyang Gallbladder Meridian, Hand Jueyin Pericardial Meridian, and there are also external Qi Points.③Acupuncture can improve ER treatment cycle mainly for treating 1 menstrual cycle and 3 menstrual cycle. ④Acupuncture can harmonize qi and blood remarkably. The pathological changes of menstruation are mostly the disharmony between qi and blood, which is the good time for the intervention of acupuncture.Conclusion: Acupuncture can improve ER positively, but there are some deficiencies in the research: ①Large sample multicenter randomized controlled trials are lacking with limited clinical application; ②the research mostly stays in the observation of clinical curative effect, the research on the mechanism of the effect of acupuncture is very little, and the retrospective research and analysis are lacking; ③diagnostic criteria needs to be unified; ④because of the combination of other therapies, the curative effect of acupuncture is not easy to highlight; ⑤the secretory cycle of endometrium and ovary should be taken into account, and syndrome differentiation and treatment should be adhered to in application; ⑥After treatment, the selection of evaluation indicators is controversial. It is necessary to actively find specific evaluation indicators to reduce the waste of detection resources.
Objective: To analyze the clinical research characteristics of acupuncture in improving endometrial receptivity.Methods:By retrieving the literature published by CNKI until December 2017 on clinical research and current research on acupuncture in improving ER, this paper analyzed and summarized the regularities and characteristics of the literature on acupuncture in improving ER, such as distribution years, literature composition, diagnostic criteria, characteristics of acupoint selection, treatment methods, treatment cycle, timing of intervention, evaluation criteria of curative effect, etc.Results:①Acupuncture can improve ER in a variety of ways, including moxibustion, acupoint catgut embedding, ear acupoint, acupoint electrical stimulation, electro-acupuncture, warm needle, filiform needle, etc.Among them, filiform needle acupuncture has the highest frequency of use, which is 11 times,accounting for 34.38%; the frequency of acupoint electrical stimulation/electro-acupuncture therapy is also high, which is 9 times, accounting for 28.13%; acupuncture with warm needle, Chinese medicine and other frequencies are 8 times, accounting for 25%; ear acupoints is 2 times, accounting for 6.25%; acupoint catgut embedding and simple moxibustion are less, 1 time each, each accounting for 3.12%;②Acupuncture are mainly used to improve ER in Ren Meridian, Du Meridian, Foot Yangming Stomach Meridian, Foot Taiyin Spleen Meridian, Foot Shaoyin Kidney Meridian, Foot Taiyang Bladder Meridian, Hand Yangming Large Intestine Meridian, Foot Jueyin Liver Meridian, Foot Shaoyang Gallbladder Meridian, Hand Jueyin Pericardial Meridian, and there are also external Qi Points.③Acupuncture can improve ER treatment cycle mainly for treating 1 menstrual cycle and 3 menstrual cycle. ④Acupuncture can harmonize qi and blood remarkably. The pathological changes of menstruation are mostly the disharmony between qi and blood, which is the good time for the intervention of acupuncture.Conclusion: Acupuncture can improve ER positively, but there are some deficiencies in the research: ①Large sample multicenter randomized controlled trials are lacking with limited clinical application; ②the research mostly stays in the observation of clinical curative effect, the research on the mechanism of the effect of acupuncture is very little, and the retrospective research and analysis are lacking; ③diagnostic criteria needs to be unified; ④because of the combination of other therapies, the curative effect of acupuncture is not easy to highlight; ⑤the secretory cycle of endometrium and ovary should be taken into account, and syndrome differentiation and treatment should be adhered to in application; ⑥After treatment, the selection of evaluation indicators is controversial. It is necessary to actively find specific evaluation indicators to reduce the waste of detection resources.
引文
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[3]高星.补肾法、疏肝法改善子宫内膜容受性的作用及其与Sphk1/S1P通路的关系[D].石家庄:河北医科大学,2015.
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[9]胡秋兰,何渊,王丽伟,等.针灸改善子宫内膜容受性有效性meta分析[J].中医药临床杂志,2017,29(1):61-67.
[10]罗国群,苏文武,马文敏,等.温针灸预处理对冷冻胚胎移植者子宫内膜容受性的影响[J].中国针灸,2017,37(8):831-835.
[11]梁玉风.从子宫内膜蠕动角度探针药结合对肾阴虚患者子宫内膜容受性的影响[D].济南:山东中医药大学,2016.
[12]季清云,王芝敏,郭伟光,等.经皮穴位电刺激联合西药治疗子宫内膜容受性差不孕症40例[J].中医研究,2016,29(9):55-57.
[13]苏柏宇.腹针结合艾箱灸治疗排卵障碍性不孕(肾虚宫寒型)的临床观察[D].广州:广州中医药大学,2016.
[14]钟秀芳,尹萍,李凯,等.TEAS对IVF肾气虚型患者子宫内膜容受性影响[J].辽宁中医药大学学报,2016,18(10):188-191.
[15]杨万芳,王双丹.针灸对不孕患者子宫内膜容受性影响的研究进展[J].世界最新医学信息文摘,2016,16(77):33-34.
[16]李艳,施园,丁彩飞,等.穴位埋线对夫精人工授精妊娠率的影响[J].浙江中西医结合杂志,2016,26(5):464-465.
[17]邢玉,张庆,刘杰,等.针药结合对卵泡发育不良者卵泡发育情况及子宫内膜超声评分的作用研究[J].世界中西医结合杂志,2016,11(11):1489-1492,1496.
[18]高喜红,刘小玲,倪亚莉,等.输卵管积水抽吸术配合耳穴压丸对冻融胚胎移植结局的影响[J].西部中医药,2015,28(12):4-7.
[19]谢津津.针药结合对肾虚型月经过少子宫内膜容受性的影响[D].广州:广州中医药大学,2015.
[20]严红莲,何淑祯,邢彦君,等.针灸治疗在体外受精-胚胎移植技术中的临床应用研究[J].广州医药,2015,46(1):13-16.
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[25]陈林.安神补肾针灸法改善脾肾阳虚型黄体功能不全患者子宫内膜容受性的临床疗效研究[D].成都:成都中医药大学,2015.
[26]安锦霞,倪亚莉,刘小玲,等.输卵管积水抽吸术配合耳穴贴疗对体外受精-胚胎移植结局的影响[J].中国中西医结合杂志,2015,35(6):682-685.
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