School of Nursing, Guangzhou University of Chinese Medicine, No.232 Waihuan East Road, Higher Education Mega Center, Panyu District, Guangzhou, Postal code:510006, Guangdong, China.
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China.
BMC Complement Altern Med. 2019 Mar 13;19(1):61. doi: 10.1186/s12906-019-2472-1.
This systematic review aimed at summarizing and evaluating the evidence of randomized controlled trials (RCTs) using acupuncture to improve endometrial receptivity (ER).
We searched 12 databases electronically through August 2018 without language restrictions. We included RCTs of women of infertility due to low ER, and excluded infertility caused by other reasons or non-RCTs. Two independent reviewers extracted the characteristics of studies and resolved the differences through consensus. Data were pooled and expressed as standard mean difference (SMD) or mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes, with 95% confidence interval (CI).
We found very low to moderate level of evidence that acupuncture may improve pregnancy rate (RR = 1.23 95%CI[1.13, 1.34] P < 0.00001) and embryo transfer rate (RR = 2.04 95%CI[1.13, 3.70] P = 0.02), increase trilinear endometrium (RR = 1.47 95%CI [1.27, 1.70] P < 0.00001), thicken endometrium (SMD = 0.41 95% CI [0.11, 0.72] P = 0.008), reduce resistive index (RI) (MD = -0.08 95% CI [- 0.15, - 0.02] P = 0.01), pulse index (PI) (SMD = -2.39 95% CI [- 3.85, - 0.93] P = 0.001) and peak systolic velocity/ end-diastolic blood velocity (S/D) (SMD = -0.60 95% CI [- 0.89, - 0.30] P < 0.0001), compared with medication, sham acupuncture or physiotherapy. Acupuncture was statistically significant as a treatment approach.
The efficacy and safety of acupuncture on key outcomes in women with low ER is statistically significant, but the level of most evidence was very low or low. More large-scale, long-term RCTs with rigorous methodologies are needed.
本系统评价旨在总结和评估使用针灸提高子宫内膜容受性（ER）的随机对照试验（RCT）的证据。
我们通过电子方式在 2018 年 8 月前检索了 12 个数据库，不限制语言。我们纳入了由于低 ER 导致不孕的女性的 RCT，并排除了由于其他原因或非 RCT 导致不孕的研究。两位独立的评审员提取研究特征，并通过共识解决差异。数据以均数差（SMD）或均值差（MD）表示连续性结局，以风险比（RR）表示二分类结局，并以 95%置信区间（CI）表示。
我们发现，针灸可能提高妊娠率（RR=1.23，95%CI[1.13，1.34]，P<0.00001）和胚胎移植率（RR=2.04，95%CI[1.13，3.70]，P=0.02），增加三线子宫内膜（RR=1.47，95%CI[1.27，1.70]，P<0.00001），增厚子宫内膜（SMD=0.41，95%CI[0.11，0.72]，P=0.008），降低阻力指数（RI）（MD=-0.08，95%CI[-0.15，-0.02]，P=0.01），脉动指数（PI）（SMD=-2.39，95%CI[-3.85，-0.93]，P=0.001）和收缩期峰值速度/舒张末期血流速度（S/D）（SMD=-0.60，95%CI[-0.89，-0.30]，P<0.0001），与药物、假针灸或物理治疗相比。针灸作为一种治疗方法具有统计学意义。
针灸对低 ER 女性关键结局的疗效和安全性具有统计学意义，但大多数证据的水平非常低或低。需要更多大型、长期、采用严格方法学的 RCT。
