针刺治疗卵巢早衰女性的临床价值：一项随机对照试验的系统评价和荟萃分析。
The clinical value of acupuncture for women with premature ovarian insufficiency: 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.
School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
出版信息
Front Endocrinol (Lausanne). 2024 Jul 11;15:1361573. doi: 10.3389/fendo.2024.1361573. eCollection 2024.
OBJECTIVE
The aim of this study was to evaluate the therapeutic implications of acupuncture on improving ovarian function in women diagnosed with premature ovarian insufficiency (POI) through the implementation of randomized clinical trials (RCTs).
METHODS
A comprehensive search of eight databases was conducted to identify RCTs up until 5 October 2023. The outcomes included the levels of sex hormones, antral follicle count (AFC), Kupperman score, and total effective rate. The risk of bias (RoB) tool was utilized to evaluate the quality of the included studies. In order to guarantee the robustness and reliability of the findings, subgroup and sensitivity analyses were performed to investigate potential sources of heterogeneity.
RESULTS
A total of 13 RCTs comprising 775 patients were included in the study. Acupuncture demonstrated significant efficacy in reducing follicle-stimulating hormone (FSH) [SMD = 0.83, 95% CI (0.27, 1.39), = 92%, = 0.004], enhancing estradiol levels (E) [SMD = 0.50, 95% CI (0.07, 0.93), = 0.02, = 87%], and increasing anti-Müllerian hormone (AMH) [SMD = 0.24, 95% CI (0.05, 0.44), = 0.01, = 8%], as well as improving the overall effective rate [RR = 1.22, 95% CI (1.10, 1.35), < 0.01, = 14%]. Subgroup analysis revealed that compared with non-acupuncture therapy, the acupuncture with Chinese herbal medicine (CHM) and hormone replacement therapy (HRT) group exhibited a substantial reduction in FSH levels [SMD = 1.02, 95% CI (0.52, 1.51), = 60%, < 0.01]. Furthermore, the acupuncture with CHM group also exhibited a substantial reduction [SMD = 4.59, 95% CI (1.53, 7.65), = 98%, < 0.01]. However, only the acupuncture with CHM and HRT group demonstrated a significant increase in E levels [SMD = 0.55, 95% CI (0.23, 0.87), = 12%, 0.01].
CONCLUSION
Acupuncture has demonstrated superiority over non-acupuncture in diminishing serum FSH levels and increasing serum E, AMH, and the overall efficacy rate in women diagnosed with POI. These research findings suggest the necessity for broader-scale research with meticulous designs to fully demonstrate the efficacy and safety of acupuncture in the treatment of women with POI.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk, identifier CRD42023467751.
目的
本研究旨在通过实施随机临床试验（RCT），评估针灸对改善卵巢早衰（POI）女性卵巢功能的治疗意义。
方法
全面检索了截至 2023 年 10 月 5 日的 8 个数据库，以识别 RCT。结果包括性激素水平、窦卵泡计数（AFC）、库珀曼评分和总有效率。采用偏倚风险（RoB）工具评估纳入研究的质量。为了保证研究结果的稳健性和可靠性，进行了亚组和敏感性分析，以探究潜在的异质性来源。
结果
共纳入 13 项 RCT，包含 775 例患者。针灸在降低卵泡刺激素（FSH）[SMD=0.83，95%CI（0.27，1.39）， =92%， =0.004]、提高雌二醇（E）水平[SMD=0.50，95%CI（0.07，0.93）， =0.02， =87%]和抗苗勒管激素（AMH）[SMD=0.24，95%CI（0.05，0.44）， =0.01， =8%]以及提高整体有效率[RR=1.22，95%CI（1.10，1.35）， <0.01， =14%]方面具有显著疗效。亚组分析显示，与非针灸疗法相比，针灸加中药（CHM）和激素替代疗法（HRT）组的 FSH 水平显著降低[SMD=1.02，95%CI（0.52，1.51）， =60%， <0.01]。此外，针灸加 CHM 组也显著降低[SMD=4.59，95%CI（1.53，7.65）， =98%， <0.01]。然而，只有针灸加 CHM 和 HRT 组的 E 水平显著升高[SMD=0.55，95%CI（0.23，0.87）， =12%， 0.01]。
结论
针灸在降低血清 FSH 水平、提高血清 E、AMH 水平和整体疗效方面优于非针灸，对 POI 患者具有治疗意义。这些研究结果表明，有必要进行更广泛的、设计更缜密的研究，以充分证实针灸治疗 POI 女性的疗效和安全性。
系统评价注册
https://www.crd.york.ac.uk，注册号 CRD42023467751。
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