针灸埋线法联合礞石滚痰汤治疗痰湿内阻型多囊卵巢综合征的临床疗效

徐道芬; 胡欣欣; 高楚楚; 陈蕾蕾; 马大正; 孙云

doi:10.16766/j.cnki.issn.1674-4152.003348

针灸埋线法联合礞石滚痰汤治疗痰湿内阻型多囊卵巢综合征的临床疗效

doi: 10.16766/j.cnki.issn.1674-4152.003348

温州市中医院妇科，浙江温州 325000

基金项目:

浙江省中医药科技计划项目 2019ZB121

温州市基础性医疗卫生科技项目 Y2020196

温州市重大科技创新攻关项目 ZY2022014

浙江中医药大学附属医院科研项目 2022FSYYZZ28

详细信息

通讯作者:
徐道芬，E-mail：wzxudaofen@126.com

中图分类号: R711.75 R245
计量
- 文章访问数: 178
- HTML全文浏览量: 87
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-14
- 网络出版日期: 2024-03-09

Clinical efficacy of acupuncture catgut embedding combined with Hushi Guntan decoction in treating polycystic ovary syndrome with phlegm-dampness internal resistance

Department of Gynecology, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的分析针灸埋线法及礞石滚痰汤联合来曲唑在痰湿内阻型多囊卵巢综合患者中的应用价值。方法采用随机数字表法将2021年10月—2022年10月于温州市中医院接受治疗的115例痰湿内阻型多囊卵巢综合征患者分为2组，对照组57例，采用来曲唑治疗，治疗组58例，在对照组的基础上采用针灸埋线法联合礞石滚痰汤治疗。对比2组患者的性激素、糖脂代谢指标、卵巢多囊样改变等。结果治疗组的促黄体生成素[(8.76±2.08)U/L]等性激素水平低于对照组[(10.28±2.29)U/L，t=3.724，P < 0.05]；治疗组的糖化血红蛋白[(4.91±0.91)%]等糖脂代谢指标低于对照组[(5.29±0.87)%，t= 2.289，P < 0.05]；治疗组的卵巢体积[(6.52±0.95)cm³]小于对照组[(7.66±1.02)cm³，t=6.200，P < 0.05]；治疗组的排卵(86.21%，50/58)和妊娠(60.34%，35/58)比例均高于对照组[68.42%(39/57)、38.60%(22/57)，χ²=5.197、5.439，P < 0.05]。结论针灸埋线法联合礞石滚痰汤可以降低痰湿内阻型多囊卵巢综合征患者的BMI和腰臀比，改善性激素、糖脂代谢水平及卵巢多囊样改变，恢复正常排卵以提高妊娠率。
- 多囊卵巢综合征 /
- 针灸埋线 /
- 痰湿内阻 /
- 礞石滚痰汤 /
- 内分泌
Abstract: Objective The purpose of this study is to analyze the application value of acupuncture and catgut embedding and Hushi Guntan Decoction combined with letrozole in patients with polycystic ovary syndrome with phlegm-dampness internal resistance. Methods According to the random number table method, 115 patients with polycystic ovary syndrome with phlegm-dampness internal resistance who were treated in Wenzhou Traditional Chinese Medicine Hospital from October 2021 to October 2022 were divided into two groups. A total of 57 cases in the control group were treated with letrozole, and 58 cases in the treatment group were treated with acupuncture and catgut embedding combined with Hushi Guntan Decoction on the basis of the control group. The levels of sex hormones, glucose and lipid metabolism indexes and polycystic ovarian changes were compared between the two groups. Results The levels of LH [(8.76±2.08) U/L] and other sex hormones in the treatment group were lower than those in the control group [(10.28±2.29) U/L, t=3.724, P < 0.05]. Glycolipid metabolism levels such as HbA1c [(4.91±0.91)%] in the treatment group were lower than those in the control group [(5.29±0.87)%, t= 2.289, P < 0.05]. The ovarian volume in the treatment group [(6.52±0.95) cm³] was smaller than that in the control group [(7.66±1.02) cm³, t=6.200, P < 0.05]. The rates of ovulation (86.21%, 50/58) and pregnancy (60.34%, 35/58) in the treatment group were higher than those in the control group [68.42% (39/57), 38.60% (22/57), χ²=5.197, 5.439, P < 0.05]. Conclusion Acupuncture and catgut embedding combined with Hushi Guntan Decoction can reduce BMI and waist-to-hip ratio, improve the levels of sex hormones, glucose and lipid metabolism and polycystic ovarian changes, restore normal ovulation and increase pregnancy rate.
- Polycystic ovary syndrome /
- Acupuncture catgut embedding /
- Internal resistance of phlegm-dampness /
- Hushi Guntan Decoction /
- Internal secretion

HTML全文

表 1 2组痰湿内阻型多囊卵巢综合征患者BMI、WHR比较(x±s)

Table 1. Comparison of BMI and WHR between two groups of polycystic ovary syndrome patients with phlegm-dampness internal resistance(x±s)

组别	例数	BMI		WHR
组别	例数	治疗前	3个月后	治疗前	3个月后
对照组	57	27.55±2.11	25.16±1.78^a	0.88±0.07	0.85±0.04^a
治疗组	58	28.07±1.85	23.87±2.02^a	0.87±0.06	0.82±0.06^a
t值		1.404	3.635	0.822	3.160
P值		0.163	< 0.001	0.413	0.002
注：与同组治疗前比较，^aP < 0.05。

下载: 导出CSV

表 2 2组痰湿内阻型多囊卵巢综合征患者性激素比较(x±s)

Table 2. Comparison of sex hormone levels between two groups of polycystic ovary syndrome patients with phlegm-dampness internal resistance(x±s)

组别	例数	LH(U/L)		LH/FSH		T(μg/L)
组别	例数	治疗前	3个月后	治疗前	3个月后	治疗前	3个月后
对照组	57	13.49±2.19	10.28±2.29^a	1.70±0.61	0.99±0.31^a	58.31±6.79	53.26±5.37^a
治疗组	58	14.05±2.44	8.76±2.08^a	1.72±0.58	0.81±0.24^a	59.15±7.31	50.17±5.84^a
t值		1.296	3.724	0.180	3.478	0.639	2.954
P值		0.198	< 0.001	0.857	0.001	0.524	0.004
注：与同组治疗前比较，^aP < 0.05。

下载: 导出CSV

表 3 2组痰湿内阻型多囊卵巢综合征患者糖脂代谢指标比较(x±s)

Table 3. Comparison of glucose and lipid metabolism between two groups of polycystic ovary syndrome patients with phlegm-dampness resistance(x±s)

组别	例数	HbA1c(%)		FINS(nmol/L)		HOMA-IR		TC(mmol/L)		TG(mmol/L)
组别	例数	治疗前	3个月后	治疗前	3个月后	治疗前	3个月后	治疗前	3个月后	治疗前	3个月后
对照组	57	5.82±1.09	5.29±0.87^a	23.26±4.18	14.26±2.48^a	5.44±0.88	3.46±0.71^a	5.42±1.37	4.69±1.05^a	2.44±0.48	1.94±0.26^a
治疗组	58	5.79±1.12	4.91±0.91^a	22.65±5.03	9.14±1.53^a	5.37±0.94	2.01±0.56^a	5.56±1.42	4.18±0.97^a	2.39±0.45	1.29±0.19^a
t值		0.146	2.289	0.708	13.297	0.412	12.146	0.538	2.704	0.576	15.285
P值		0.885	0.024	0.481	< 0.001	0.681	< 0.001	0.592	0.008	0.566	< 0.001
注：与同组治疗前比较，^aP < 0.05。

下载: 导出CSV

表 4 2组痰湿内阻型多囊卵巢综合征患者卵巢多囊样改变及子宫内膜厚度比较(x±s)

Table 4. Comparison of polycystic ovary changes and endometrial thickness between two groups of polycystic ovary syndrome patients with phlegm-dampness internal resistance(x±s)

组别	例数	卵巢体积(cm³)		卵泡数目(个)		子宫内膜厚度(mm)
组别	例数	治疗前	3个月后	治疗前	3个月后	治疗前	3个月后
对照组	57	9.84±1.31	7.66±1.02^a	13.06±3.11	9.38±1.83^a	6.19±0.66	8.17±1.03^a
治疗组	58	9.77±1.45	6.52±0.95^a	12.87±2.94	7.41±1.37^a	6.51±0.73	9.73±1.16^a
t值		0.272	6.200	0.337	6.526	1.720	7.629
P值		0.786	< 0.001	0.369	< 0.001	0.088	< 0.001
注：与同组治疗前比较，^aP < 0.05。

下载: 导出CSV

表 5 2组痰湿内阻型多囊卵巢综合征患者排卵及妊娠情况比较[例(%)]

Table 5. Comparison of ovulation and pregnancy between two groups of polycystic ovary syndrome patientswith phlegm-dampness resistance[cases (%)]

组别	例数	排卵	妊娠
对照组	57	39(68.42)	22(38.60)
治疗组	58	50(86.21)	35(60.34)
χ²值		5.197	5.439
P值		0.023	0.020

下载: 导出CSV

参考文献(21)

[1]	SZCZUKO M, KIKUT J, SZCZUKO U, et al. Nutrition strategy and life style in polycystic ovary syndrome-narrative review[J]. Nutrients, 2021, 13(7): 2452. doi: 10.3390/nu13072452
[2]	ZHANG Y, CAI M, DILIMULATI D, et al. Correlation between serum uric acid and body fat distribution in patients with polycystic ovary syndrome[J]. Front Endocrinol(Lausanne), 2021, 12: 782808. DOI: 10.3389/fendo.2021.782808.
[3]	PENG Q, CHEN X, LIANG X, et al. Metformin improves polycystic ovary syndrome in mice by inhibiting ovarian ferroptosis[J]. Front Endocrinol(Lausanne), 2023, 14: 1070264. DOI: 10.3389/fendo.2023.1070264.
[4]	MOINI JAZANI A, NASIMI DOOST AZGOMI H, NASIMI DOOST AZGOMI A, et al. A comprehensive review of clinical studies with herbal medicine on polycystic ovary syndrome (PCOS)[J]. Daru, 2019, 27(2): 863-877. doi: 10.1007/s40199-019-00312-0
[5]	毛新, 孙淼, 孟小钰, 等. 多囊卵巢综合征合并痤疮患者333例体质类型及在不同中医证型中分布规律和临床特点[J]. 中华中医药杂志, 2020, 35(6): 3081-3084. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202006106.htm MAO X, SUN M, MENG X Y, et al. Study on constitution type, distribution rule and clinical characteristics of 333 polycystic ovary syndrome with acne[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2020, 35(6): 3081-3084. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202006106.htm
[6]	陈锦明, 张芬, 邓姣, 等. 中医体质类型与多囊卵巢综合征相关性的meta分析[J]. 中华全科医学, 2022, 20(4): 691-695. doi: 10.16766/j.cnki.issn.1674-4152.002432 CHEN J M, ZHANG F, DENG J, et al. Correlation between TCM constitution and polycystic ovary syndrome: a meta-analysis[J]. Chinese Journal of General Practice, 2022, 20(4): 691-695. doi: 10.16766/j.cnki.issn.1674-4152.002432
[7]	LI Y, WU H, GUO Y, et al. Cangfu Daotan Wan alleviates polycystic ovary syndrome with phlegm-dampness syndrome via disruption of the PKP3/ERCC1/MAPK axis[J]. J Ovarian Res, 2023, 16(1): 134. doi: 10.1186/s13048-023-01200-7
[8]	潘紫萌, 侯丽辉, 孙淼, 等. 肥胖与代谢综合征对多囊卵巢综合征患者中医体质分布及代谢的影响[J]. 中华中医药杂志, 2022, 37(3): 1656-1661. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202203104.htm PAN Z M, HOU L H, SUN M, et al. Effects of obesity and metabolic syndrome on distribution and metabolism of traditional Chinese medicine constitution in PCOS patients[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2022, 37(3): 1656-1661. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202203104.htm
[9]	张吉华, 崔寒尽, 王杨, 等. 礞石滚痰汤辅助治疗颅脑损伤后躁狂型精神障碍痰火扰神证19例临床观察[J]. 中医杂志, 2019, 60(5): 400-404. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201905010.htm ZHANG J H, CUI H J, WANG Y, et al. Clinical Observation on Mengshi Guntan Decoction in the Adujuctive Treatment of 19 Cases of Manic Agitation with Phlegm-Fire Disturbing Mind Syndrome after Traumatic Brain Injury[J]. Journal of Traditional Chinese Medicine, 2019, 60(5): 400-404. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201905010.htm
[10]	中华医学会妇产科学分会内分泌学组及指南专家组. 多囊卵巢综合征中国诊疗指南[J]. 中华妇产科杂志, 2018, 53(1): 2-6. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201810010.htm Endocrinology Group and Guideline Expert Group of Obstetrics and Gynecology Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of polycystic ovary syndrome in China[J]. Chinese Journal of Obstetrics and Gynecology, 2018, 53(1): 2-6. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201810010.htm
[11]	国家中医药管理局. 中医病证诊断疗效标准[S]. 南京: 南京大学出版社, 1994: 233-234. 标准编码: ZY/T001.1-94. State administration of traditional chinese medicine. Diagnostic criteria of TCM diseases and syndromes[S]. Nanjing: Nanjing University Press, 1994: 233-234.
[12]	高敬书, 朱梦一, 马红丽, 等. 伴或不伴卵巢多囊样改变的多囊卵巢综合征痰湿阻滞型患者临床特征比较[J]. 中医杂志, 2021, 62(5): 428-432. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202105019.htm GAO J S, ZHU Y M, MA H L, et al. Comparison of Clinical Characteristics between Polycystic Ovary Syndrome Patients of Phlegm-Damp Obstruction Pattern with or without Polycystic Ovarian Morphology[J]. Journal of Traditional Chinese Medicine, 2021, 62(5): 428-432. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202105019.htm
[13]	ZHANG N, LI C, GUO Y, et al. Study on the intervention effect of Qi Gong Wan prescription on patients with phlegm-dampness syndrome of polycystic ovary syndrome based on intestinal flora[J]. Evid Based Complement Alternat Med, 2020, 2020: 6389034. DOI: 10.1155/2020/6389034.
[14]	甘小利, 邓文华. 任督脉灸联合穴位埋线治疗肥胖型多囊卵巢综合征临床研究[J]. 中国中医药现代远程教育, 2022, 20(18): 98-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYY202218034.htm GAN X L, DENG W H. Clinical Study on Ren and Du Meridian Moxibustion Combined with Acupoint Catgut Embedding in the Treatment of Obese Polycystic Ovary Syndrome[J]. Chinese Medicine Modern Distance Education of China, 2022, 20(18): 98-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYY202218034.htm
[15]	XIANG S, XIA M F, SONG J Y, et al. Effect of electro-acupuncture on expression of IRS-1/PI3K/GLUT4 pathway in ovarian granulosa cells of infertile patients with polycystic ovary syndrome-insulin resistance of phlegm-dampness syndrome[J]. Chin J Integr Med, 2021, 27(5): 330-335. doi: 10.1007/s11655-020-3219-z
[16]	王颖, 岳虹妤, 陈颖棋, 等. "健脾培元"穴位埋线法治疗围绝经期肥胖: 随机对照试验[J]. 中国针灸, 2023, 43(3): 294-298. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202303011.htm WANG Y, YUE H Y, CHEN Y Q, et al. Jianpi Peiyuan acupoint thread embedding therapy for perimenopausal obesity: a randomized controlled trial[J]. Chinese Acupuncture and Moxibustion, 2023, 43(3): 294-298. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202303011.htm
[17]	彭仙, 曹继刚, 肖苏. 加味苍附导痰丸联合穴位埋线治疗肥胖型多囊卵巢综合征临床研究[J]. 陕西中医, 2019, 40(11): 1570-1573. doi: 10.3969/j.issn.1000-7369.2019.11.023 PEN X, CAO J G, XIAO S. Cangfu Daotan pill combined with acupoint catgut embedding in the treatment of obesity polycystic ovary syndrome[J]. Shaanxi Journal of Traditional Chinese Medicine, 2019, 40(11): 1570-1573. doi: 10.3969/j.issn.1000-7369.2019.11.023
[18]	王佳捷, 黄伟, 韦丹, 等. 电针、埋线对单纯性肥胖患者血清瘦素、胰岛素影响的对比研究[J]. 针刺研究, 2019, 44(1): 57-61. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ201901011.htm WANG J J, HUANG W, WEI D, et al. Comparison of therapeutic effects of electroacupuncture and acupoint catgut embedding in reducing serum leptin and insulin levels in simple obesity patients[J]. Acupuncture Research, 2019, 44(1): 57-61. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ201901011.htm
[19]	桂晓凤, 吕燕, 张亚男. 苍附益坤汤加减辅助西医治疗痰湿瘀滞型多囊卵巢综合征不孕症临床效果观察[J]. 海南医学, 2023, 34(7): 970-973. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202307014.htm GUI X F, LYU Y, ZHANG Y N. Clinical effect of Cangfu Yikun decoction plus western medicine on infertility of patients with polycystic ovary syndrome of phlegm dampness stagnation type[J]. Hainan Medical Journal, 2023, 34(7): 970-973. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202307014.htm
[20]	侯玉清. 苍附益坤汤联合针刺对痰湿瘀滞型多囊卵巢综合征不孕症患者血清性激素水平及妊娠率的影响[J]. 亚太传统医药, 2019, 15(7): 127-128. https://www.cnki.com.cn/Article/CJFDTOTAL-YTCT201907042.htm HOU Y Q. Effect of Cangfu Yikun Decoction combined with acupuncture on serum sex hormone level and pregnancy rate of infertility patients with polycystic ovary syndrome of phlegm-dampness and blood stasis type[J]. Asia-Pacific Traditional Medicine, 2019, 15(7): 127-128. https://www.cnki.com.cn/Article/CJFDTOTAL-YTCT201907042.htm
[21]	陈静, 梁潇, 管凤丽, 等. 补肾调经法治疗多囊卵巢综合征不孕症有效性与安全性的系统评价[J]. 中草药, 2021, 52(10): 3037-3050. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYO202110021.htm CHEN J, LIANG X, GUAN F L, et al. Systematic review on efficacy and safety of Bushen Tiaojing therapy in treatment of polycystic ovary syndrome infertility[J]. Chinese Traditional and Herbal Drugs, 2021, 52(10): 3037-3050. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYO202110021.htm