针灸辅助胞浆内单精子注射人工受精的临床疗效观察
【摘要】：
引言：针灸是一种至少可以追溯到3000年前的治疗方法,是传统中医的重要组成部分。针灸疗法已被成功地应用于治疗男性不育和女性不孕症,并且逐渐作为一种有效治疗手段受到世界各地的高度关注。既往研究表明,经低频电针疗法治疗,超过三分之一的多囊卵巢综合症患者可以实现正常排卵,而且内分泌和神经内分泌参数也变得正常,且未见任何副作用。
目的：观察针灸辅助治疗已接受经胞浆内单精子注射人工受精治疗的不孕症患者的临床疗效。
方法：
以接受经胞浆内单精子注射治疗的120例无病理体征的不孕症妇女(不育症原因不明或由男方因素造成)为观察对象,将她们随机分为两组：针灸组60例,接受电针和灸法治疗3个月(每周2次)；对照组60例患者仅接受ICSI(胞浆内单精子注射)治疗。观察指标包括卵泡率、卵母细胞、由ICSI介导的胚胎及胚胎质量,同时怀孕率和流产百分比也被纳入研究中。
结果：
针灸疗效对患者卵泡数的影响：针刺组卵泡数略高于对照组(P＜0.05),因为针刺组除了接受ICSI治疗外,还接受针刺治疗。
针灸疗效对患者卵母细胞数的影响：针刺组和对照组间存在显著差异,P=0.007(P＜0.01)。
针灸疗效对患者胚胎数的影响：P值小于0.001(p＜0.01)表明两组间的差异有显著意义。基于P值和-3.417的均差,可以得出,针刺可以增加在接受ICSI治疗患者的胚胎数。
针灸对患者一级胚胎的影响：对照组一级胚胎平均值为2.13±370.1，针刺组为4.07±0.331。可见,针刺组一级胚胎平均值多于对照组。两组间存在显著差异(P＜0.01)。基于P值和-1.943的均差,可以推断,针刺促使了一级胚胎的增长。
针灸对患者二级胚胎的影响：对照组二级胚胎平均值为1.65±0.209,针刺组为2.71±0.352。统计结果显示,针刺组二级胚胎平均值多于对照组(P＜0.05)。
针灸疗效对成功怀孕的影响：接受了针灸治疗的成功怀孕的患者远比仅接受ICSI治疗的患者多。结果令人难以置信,从25%上升至61.7%。流产百分比表明针刺组合对照组之间存在显著差异。而且,差异表明针刺可以成功地降低流产几率。针刺组流产百分比是16.21%,对照组是26.6%。
结论：
结果表明,针刺对卵泡率、卵母细胞、胚胎和胚胎质量有积极作用。而且,患者中接受针刺治疗的怀孕率较高,且针刺组中的流产率也降低。
【关键词】：不孕症 针刺 怀孕率 胚胎质量 流产 【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R246.3
【目录】：
- Content5-8
- Abbreviation8-9
- Abstract9-11
- 中文摘要11-13
- Preface13-15
- 1. Chapter 1: Introduction15-64
- 1.1: Definition15
- 1.2: Basis of acupuncture in Chinese medicine15-17
- 1.3: Meridians17-36
- 1.3.1: The Lung Meridian of Hand-Taiyin (LU)17
- 1.3.2: The Large Intestine Meridian of Hand-Yangming (LI)17-19
- 1.3.3: The Stomach Meridian of Foot-Yangming (ST)19-21
- 1.3.4: The Spleen Meridian of Foot-Taiyin (SP)21-22
- 1.3.5: The Heart Meridian of Hand-Shaoyin(HT)22
- 1.3.6: The Small Intestine Meridian of Hand-Taiyang (SI)22-23
- 1.3.7: The Bladder Meridian of Foot-Taiyang (BL)23-26
- 1.3.8: The Kidney Meridian of Foot-Shaoyin (KI)26-27
- 1.3.9: The Pericardium Meridian of Hand-Jueyin (PC)27-28
- 1.3.10: The Sanjiao (Triple Energizer) Meridian of Hand-Shaoyang (SJ)28-29
- 1.3.11: The Gallbladder Meridian of Foot-Shaoyang (GB)29-31
- 1.3.12: The Liver Meridian of Foot-Jueyin (LR)31-32
- 1.3.13: The Ren Meridian (Conception Vessel) (RN)32-33
- 1.3.14: The Du Meridian (Du)33-35
- 1.3.15: Ear acupuncture35-36
- 1.4: What is the physiological basis for acupuncture?36-38
- 1.5: What Causes Infertility?38-45
- 1.5.1: Why Does A Woman Become Infertile?39-43
- 1.5.2: Why Does A Man Become Infertile?43-44
- 1.5.3: What causes male autoimmunity?44-45
- 1.6: What is ICSI?45-57
- 1.6.1: Ovarian Stimulation Protocols for IVF46-47
- 1.6.2: What is the goal of a good IVF ovarian stimulation?47-50
- 1.6.3: How is the monitoring of the IVF stimulation done?50-52
- 1.6.4: IVF success rates are very low with less than 3 mature follicles.52-56
- 1.6.5: Embryo transfer56-57
- 1.7: How does acupuncture work in women with reproductive dysfunction?57-59
- 1.8: What evidence exists for use of acupuncture in reproductive dysfunction?59-64
- 1.8.1: Effects on ovulation60-61
- 1.8.2: Effects on the CNS61-62
- 1.8.3: Effects on the sympathetic nervous system62-64
- 2. Chapter 2: Review of the literature64-74
- 3. Chapter 3: Methodology74-81
- 3.1: Objective74-75
- 3.2: Method of executing project75
- 3.3: Method of doing acupuncture75-77
- 3.4: Variables and Data analysis method77-80
- 3.5: Questionnaire interview80
- 3.6: Time of project80-81
- 4. Chapter 4: Result81-90
- 4.1: Acupuncture's efficacy on the number of the patients' follicles81-82
- 4.2: Acupuncture's efficacy on the number of patient's oocyte82-83
- 4.3: Acupuncture's efficacy on the number of patient's Embryo83-84
- 4.4: The acupuncture's efficacy on grade Ⅰ of Embryo84-86
- 4.5: The acupuncture's efficacy on grade Ⅱ of Embryo86-87
- 4.6: Acupuncture's efficacy on successful pregnancy87-89
- 4.7: Comparison of miscarriage in understudying groups89-90
- 5. Chapter 5: Discussion90-95
- 6. Chapter 6: Conclusion95-96
- 7. Chapter 7: References96-108
- 8. Chapter 8: Appendix108-115
- 9. Chapter 9: Acknowledgment and CV115-119
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