Abstract:

Objective　To analyze the influence of aconite cake-separated moxibustion combined with acupoint catgut embedding in the treatment of diminished ovarian reserve of kidney-yang deficiency type. Methods　This study was a randomized controlled trial. Totally 120 patients with diminished ovarian reserve of kidney-yang deficiency type in Affiliated Hospital of Shaanxi University of Chinese Medicine were selected from January 2021 to December 2023, and were divided into two groups by simple random grouping method, with 60 cases in each group. The age of the control group was (30.69±2.45) years old, and the disease course was (20.86±3.12) months. The age of the observation group was (30.31±2.58) years old, and the disease course was (21.04±2.93) months. The control group was treated with clomiphene: oral clomiphene was taken since the 5th day of the menstrual cycle at a dose of 50 mg/day for 5 days; if the diameter of the main follicle was ≥18 mm, the dosage should be adjusted specifically. The observation group was given aconite cake-separated moxibustion (once a day, resting for 2 days after 5 days of treatment) combined with acupoint catgut embedding (once a week) on the basis of the control group, for a total of 3 menstrual cycles. The clinical efficacy and traditional Chinese medicine (TCM) syndromes scores, ovarian reserve function related indexes [anti-Mullerian hormone (AMH), inhibin B (InhB), and antral follicle count], estrogen indexes [follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2)], and ovarian blood flow indexes [peak systolic velocity (PSV), blood flow pulsatility index (PI), and resistance index (RI)] before and after treatment were compared between the two groups. Statistical methods used were χ² test and t test. Results　The total effective rate of the observation group was 93.33% (56/60), which was higher than that of the control group [75.00% (45/60)] (χ²=6.253, P=0.012). After treatment, the scores of TCM primary syndrome and secondary syndrome and the levels of FSH and LH in the observation group were (6.57±1.35) points, (3.06±1.04) points, (20.75±3.67) mIU/ml, and (14.36±2.44) mIU/ml, which were lower than those in the control group [(8.78±1.76) points, (4.29±1.21) points, (25.04±4.36) mIU/ml, and (17.89±2.80) mIU/ml] (t=7.718, 5.971, 5.831, and 7.362, all P<0.001); the levels of AMH, InhB, antral follicle count, and E2 in the observation group were (0.99±0.26) μg/L, (38.51±4.14) ng/L, 8.82±1.75, and (52.27±12.46) ng/L, which were higher than those in the control group [(0.80±0.23) μg/L, (34.04±4.72) ng/L, 7.53±1.44, and (46.54±11.08) ng/L] (t=4.240, 5.515, 4.409, and 2.662, all P<0.05); the PSV of the observation group was (7.86±1.82) cm/s, which was higher than that of the control group [(6.92±1.70) cm/s] (t=2.924, P=0.004), and the PI and RI were 1.91±0.37 and 0.82±0.21, which were lower than those of the control group (2.57±0.51 and 0.99±0.26) (t=8.114 and 3.940, both P<0.001). Conclusion　The combination of aconite cake-separated moxibustion and acupoint catgut embedding has a good effect on kidney-yang deficiency type of diminished ovarian reserve, which can effectively alleviate the symptoms, and improve the ovarian reserve function, ovarian stromal blood flow status, and estrogen level.

Key words: Diminished ovarian reserve,  , Kidney-yang deficiency type,  , Aconite cake-separated moxibustion,  , Acupoint catgut embedding

摘要：

目的　分析隔附子饼灸联合穴位埋线治疗肾阳虚型卵巢储备功能减退的效果。方法　本研究为随机对照试验。选取2021年1月至2023年12月陕西中医药大学附属医院收治的120例肾阳虚型卵巢储备功能减退患者，以简单随机分组法分为两组，每组60例。对照组年龄（30.69±2.45）岁，病程（20.86±3.12）个月；观察组年龄（30.31±2.58）岁，病程（21.04±2.93）个月。对照组采用克罗米芬治疗，于月经周期第5天开始口服克罗米芬，50 mg/d，治疗5 d；若主卵泡直径≥18 mm，针对性调整用药剂量。观察组在对照组基础上给予隔附子饼灸（1次/d，治疗5 d后休息2 d）联合穴位埋线治疗（每周1次），共治疗3个月经周期。对比两组患者临床疗效，治疗前后中医证候积分、卵巢储备功能［抗米勒管激素（AMH）、抑制素B（InhB）、窦卵泡数］、雌激素［促卵泡生成素（FSH）、黄体生成素（LH）、雌二醇（E2）］、卵巢血流指标［收缩期峰值流速（PSV）、血流搏动指数（PI）、阻力指数（RI）］。统计学方法采用χ²检验和t检验。结果　观察组总有效率93.33%（56/60），高于对照组的75.00%（45/60）（χ²=6.253，P=0.012）。治疗后，观察组中医主证和次证积分、FSH和LH水平分别为（6.57±1.35）分、（3.06±1.04）分、（20.75±3.67）mIU/ml、（14.36±2.44）mIU/ml，均低于对照组的（8.78±1.76）分、（4.29±1.21）分、（25.04±4.36）mIU/ml、（17.89±2.80）mIU/ml（t=7.718、5.971、5.831、7.362，均P<0.001）；观察组AMH、InhB、窦卵泡数、E2水平分别为（0.99±0.26）μg/L、（38.51±4.14）ng/L、（8.82±1.75）个、（52.27±12.46）ng/L，均高于对照组的（0.80±0.23）μg/L、（34.04±4.72）ng/L、（7.53±1.44）个、（46.54±11.08）ng/L（t=4.240、5.515、4.409、2.662，均P<0.05）；观察组PSV为（7.86±1.82）cm/s，大于对照组的（6.92±1.70）cm/s（t=2.924，P=0.004），PI、RI分别为1.91±0.37、0.82±0.21，均低于对照组的2.57±0.51、0.99±0.26（t=8.114、3.940，均P<0.001）。结论　隔附子饼灸联合穴位埋线治疗肾阳虚型卵巢储备功能减退患者效果较好，可以有效减轻患者症状，改善卵巢储备功能、卵巢基质血流状态和雌激素水平。

关键词:

卵巢储备功能减退, 肾阳虚型, 隔附子饼灸, 穴位埋线