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针刺联合中药调神疏肝法对体外受精-胚胎移植患者焦虑抑郁及治疗结局的影响

[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].

作者信息

Sun Zhen-gao, Lian Fang, Zhang Jian-wei

机构信息

The Reproductive Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan.

出版信息

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2012 Aug;32(8):1023-7.

Abstract

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 respectively compared 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 CM-MTSSG 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.

摘要

目的

评估针刺联合补肾疏肝中药(CMMTSSG)对体外受精胚胎移植(IVF-ET)患者焦虑和抑郁的影响,并观察治疗效果。

方法

将97例IVF-ET患者随机分为两组,针刺联合CMMTSSG组(A组,51例)和西药治疗组(B组,46例)。所有患者均采用黄体中期IVF-ET长方案。A组患者在卵巢超刺激过程中接受针刺及CMMTSSG(二至天癸颗粒和逍遥颗粒)治疗,而B组患者仅接受IVF-ET常规治疗。观察两组治疗前后肾虚肝郁证(SDGDS)的改善情况。观察自评焦虑量表(SAS)和贝克抑郁量表(BDI)评分的变化。比较两组注射HCG当天的子宫内膜厚度、分型及子宫内膜血流阻力指数(RI),取卵数、优质卵母细胞率、受精率、优质胚胎率及临床妊娠率。

结果

A组SDGDS、SAS和BDI评分改善较B组更明显,差异有统计学意义(P<0.01)。两组注射HCG当天的子宫内膜厚度比较,差异无统计学意义(P>0.05)。A组A型子宫内膜比例为74.5%(38/51例),B组为45.7%(21/46例),两组比较差异有统计学意义(P<0.01)。注射HCG当天A组RI(0.48±0.03)明显低于B组(0.52±0.06,P<0.01)。两组取卵数和受精率比较,差异无统计学意义(P>0.05)。A组优质卵母细胞率、优质胚胎率及临床妊娠率均较B组改善更显著,两组比较差异有统计学意义(P<0.05)。

结论

针刺联合CMMTSSG能明显减轻IVF-ET患者的焦虑、抑郁等不良情绪,有效提高治疗效果其作用可能与降低交感神经系统兴奋性、提高卵母细胞质量及改善子宫内膜容受性有关。

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