补肾疏肝中药联合针刺对体外受精-胚胎移植患者焦虑抑郁情绪及手术结局的影响

Effects of Acupuncture Combined Chinese Materia Medica for Tonifying Shen and Soothing Gan on the Anxiety and Depression of Patients with in vitro Fertilization and Embryo Transplantation and on the Treatment Outcomes

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中文关键词: 补肾疏肝中药针刺体外受精-胚胎移植焦虑抑郁临床妊娠率

英文关键词:Chinese materia medica for tonifying Shen and soothing Gan acupuncture in vitro fertilization and embryo transplantation anxiety depression clinical pregnancy rate

基金项目:国家自然科学基金资助项目(No.30901920);山东省自然科学基金资助项目(No.Q2008C17);山东省中医药科技发展计划项目(No.2009-038)

作者	单位
孙振高	山东中医药大学附属医院生殖中心
连方	山东中医药大学附属医院生殖中心
张建伟	山东中医药大学临床学院
郭琼	山东中医药大学临床学院
孙金龙	山东中医药大学附属医院生殖中心
郭颖	山东中医药大学附属医院生殖中心
薛明玥	山东中医药大学附属医院生殖中心
张宁	山东中医药大学临床学院
孟茜	山东中医药大学附属医院生殖中心
李婷婷	山东中医药大学临床学院

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中文摘要:

目的评价补肾疏肝中药联合针刺疗法对行体外受精-胚胎移植(IVF-ET)患者焦虑、抑郁情绪的有效性,并对手术结局进行观察。方法将97例IVF-ET患者随机分为中药联合针刺组(51例)和单纯西药组(46例),两组均采用黄体中期长方案进行IVF-ET,中药联合针刺组在超排卵过程中联合应用补肾疏肝中药(二至天癸颗粒和逍遥丸颗粒)及针刺治疗,单纯西药组只按IVF-ET进行常规操作。观察两组治疗前后肾虚肝郁证候改善情况及焦虑自评量表(self-rating anxiety scale,SAS)、贝克抑郁自评量表(Beck depression inventory,BDI)评分变化;两组注射绒毛膜促性腺激素(HCG)当日子宫内膜厚度、分型及卵泡膜血流阻力指数(RI),两组取卵数、优卵率、受精率、优胚率及临床妊娠率。结果肾虚肝郁证候、SAS、BDI评分的改善,中药联合针刺组优于单纯西药组,差异有统计学意义(P<0.01);HCG日子宫内膜厚度,两组比较差异无统计学意义(P>0.05);A型内膜所占比例中药联合针刺组为74.5%(38/51),单纯西药组为45.7%(21/46),两组比较差异有统计学意义(P<0.01);注射HCG当日卵泡膜血流RI中药联合针刺组(0.48±0.03)明显低于单纯西药组(0.52±0.06),差异有统计学意义(P<0.01);两组患者取卵数、受精率比较差异无统计学意义(P>0.05);优卵率、优质胚胎率及临床妊娠率中药联合针刺组较单纯西药组均显著提高,差异有统计学意义(P<0.05)。结论补肾疏肝中药联合针刺治疗可明显缓解IVF-ET患者焦虑、抑郁等不良情绪,有效地改善手术结局,其作用可能与降低交感神经系统兴奋性,提高卵细胞质量和改善子宫内膜容受性有关。

英文摘要:

Objective To assess the effects of acupuncture combined Chinese materia medica for tonifying Shen and soothing Gan ( CMMTSSG) on the anxiety and depression of patients with in vitro fertilization and embryo transplantation ( IVF-ET) ,and to observe the treatment outcomes. Methods Totally 97 IVF-ET patients were randomly assigned to two groups,the acupuncture combined CMMTSSG ( Group A,51 cases) and the Western medicine treatment group ( Group B,46 cases) . The long protocol of IVF-ET in a mid luteal phase was performed in all patients. Patients in Group A received acupuncture and CMMTSSG ( Erzhi Tiangui Granule and Xiaoyao Granule) during the process of ovarian hyperstimulation,while those in Group B only received the routines of IVF-ET. The improvement of Shen deficiency Gan depression syndrome ( SDGDS) between after and before treatment were observed in the two groups. The changes of self-rating anxiety scale ( SAS) and Beck depression inventory ( BDI) score were observed. The endometrial thickness,typing,and endometrial blood flow resistance index ( RI) on the day of injecting HCG,the number of retrieved oocytes,the rate of high quality oocytes,the fertilization rate,the rate of high quality embryos,and the clinical pregnancy rate were respectivelycompared between the two groups. Results The scores of SDGDS,SAS,and BDI were improved more obviously in Group A than in Group B,showing statistical difference ( P <0. 01) . There was no statistical difference in the endometrial thickness on the day of injecting HCG between the two groups ( P >0. 05) . The proportion of type A endometrium was 74. 5% ( 38 /51 cases) in Group A and 45. 7% ( 21 /46 cases) in Group B,showing statistical difference between the two groups ( P <0. 01) . The RI was significantly lower in Group A ( 0. 48 ±0. 03) than in Group B on the day of injecting HCG ( 0. 52 ±0. 06,P <0. 01) . There was no statistical difference in the number of retrieved oocytes and the fertilization rate between the two groups ( P > 0. 05) . The rate of high quality oocyte,the rate of high quality embryos,and the clinical pregnancy rate were all improved more significantly in Group A than in Group B,showing statistical difference between the two groups ( P < 0. 05) . Conclusions Acupuncture combined CMMTSSG could obviously alleviate unfavorable emotions as anxiety and depression in patients with IVF-ET,effectively improve the treatment outcomes. Its effects might be correlated with lowering the excitability of the sympathetic nervous system,elevating the quality of oocytes,and improving the endometrial receptivity.

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