针刺治疗卵巢储备功能减退的临床疗效：随机对照试验的系统评价和荟萃分析。

Clinical efficacy of acupuncture for diminished ovarian reserve: a systematic review and meta-analysis of randomized controlled trials.

机构信息

Department of Gynecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

出版信息

Front Endocrinol (Lausanne). 2023 Aug 2;14:1136121. doi: 10.3389/fendo.2023.1136121. eCollection 2023.

OBJECTIVE

To evaluate the clinical efficacy of acupuncture for the treatment of diminished ovarian reserve (DOR) based on the existing randomized controlled trials (RCTs).

METHODS

Nine databases from their inception to December 6th, 2022, were comprehensively searched to retrieve RCTs related to the clinical efficacy of acupuncture for the treatment of DOR. The outcomes of interest were sex hormones level and antral follicle count (AFC). Risk of Bias (RoB) was adopted to assess the quality of the included trials.

RESULTS

A total of 13 RCTs involving 787 patients were included in this meta-analysis. The review of available evidence revealed acupuncture produced a significant efficacy in decreasing follicle-stimulating hormone (FSH) levels (SMD = -1.07, 95%CI [-1.79, -0.36], = 0.003), FSH/LH ratio (MD = -0.31, 95%CI [-0.54, -0.09], = 0.006) and increasing anti-Müllerian hormone (AMH) levels (SMD = 0.25, 95%CI [-0.00, 0.49], = 0.05), along with AFC (MD = 1.87, 95%CI [0.96, 2.79], < 0.0001) compared to controls. Compared with electro-acupuncture treatment, manual acupuncture was superior in reducing FSH levels, FSH/LH ratio, and increasing AMH levels and AFC ( < 0.05). A notable association was also seen when acupuncture was combined with traditional Chinese medicine therapy for improving FSH levels, FSH/LH ratio, and AFC ( < 0.05). Besides, a high dose of acupuncture (≥10 acupoints) was more conducive to ameliorating FSH levels, FSH/LH ratio, and AFC ( < 0.05) than a low dose of acupuncture (<10 acupoints). Substantial heterogeneity existed among studies.

CONCLUSION

Acupuncture may have significant clinical potential for patients with DOR in terms of improving sex hormones level and increasing AFC, although the evidence is drawn with high heterogeneity. This finding suggests that more rigorous trials conducted in diverse regions worldwide are necessary to identify the efficacy of acupuncture for patients diagnosed with DOR.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk, identifier CRD42023402336.

目的

基于现有随机对照试验（RCT）评估针灸治疗卵巢储备功能降低（DOR）的临床疗效。

方法

全面检索从建库至 2022 年 12 月 6 日的 9 个数据库，以获取与针灸治疗 DOR 的临床疗效相关的 RCT。主要结局指标为性激素水平和窦卵泡计数（AFC）。采用偏倚风险（RoB）评估纳入试验的质量。

结果

本荟萃分析共纳入 13 项 RCT，共计 787 例患者。现有证据表明，针灸在降低卵泡刺激素（FSH）水平[SMD=-1.07，95%CI（-1.79，-0.36）， =0.003]、FSH/LH 比值[MD=-0.31，95%CI（-0.54，-0.09）， =0.006]和增加抗苗勒管激素（AMH）水平[SMD=0.25，95%CI（-0.00，0.49）， =0.05]方面具有显著疗效，同时也能提高 AFC（MD=1.87，95%CI[0.96，2.79]， < 0.0001）。与对照组相比，与电针治疗相比，手针在降低 FSH 水平、FSH/LH 比值、增加 AMH 水平和 AFC 方面更具优势（ < 0.05）。当针灸与中药疗法联合使用时，也可以改善 FSH 水平、FSH/LH 比值和 AFC（ < 0.05）。此外，高剂量（≥10 个穴位）的针灸比低剂量（<10 个穴位）更有利于改善 FSH 水平、FSH/LH 比值和 AFC（ < 0.05）。研究之间存在显著的异质性。