针灸联合克罗米芬治疗多囊卵巢综合征不孕的临床效果

单利娜 林丽霞 陈义娇 陈思达 刘步平

摘要 目的：比較针灸联合克罗米芬（CC）治疗多囊卵巢综合征（PCOS）不孕的效果。方法：2016年11月1日电子检索中国期刊全文数据库、维普中文科技期刊全文数据库、万方医药期刊数据库建库至检索日的针灸联合克罗米芬治疗多囊卵巢综合征性不孕文献，用Jadad量表和Cochrane协作网系统综述手册5.0评价文献质量、RevMan 5.3进行Meta分析。结果：最终纳入文献9篇共769例（观察组398例、对照组380例），针灸联合其他中医与单用CC、针灸联合其他中医与CC联合其他西医的总有效率均是前者高于后者（P<0.05），单用针灸与CC联合其他西医治疗的总有效率差异无统计学意义（P>0.05），单用针灸与CC联合其他西医、针灸联合其他中医治疗与单用CC的妊娠率均是前者高于后者（P<0.05），针灸联合其他中医改善FSH、LH、T的效果均明显优于单用CC（P<0.05）。结论：针灸联合其他中医治疗PCOS性不孕在提高总有效率、妊娠率方面比单用CC或CC联合其他西医治疗有优势，在改善FSH、LH、T方面比单用CC有优势。

关键词 多囊卵巢综合征;不孕;针灸;克罗米芬;Meta分析;系统评价

Meta-analysis on Acupuncture and Clomiphene Citrate Therapy for Polycystic Ovary Syndrome Induced Infertility

Shan Lina， Lin Lixia， Chen Yijiao， Chen Sida， Liu Buping

（Guangzhou University of Chinese Medicine， Guangzhou 510006， China）

Abstract Objective：To evaluate the efficacy of acupuncture and clomiphene citrate （CC） treatment for Polycystic Ovary Syndrome （PCOS）-induced infertility. Methods：China National Knowledge Infrastructure， Wanfang Data， VIP China Science and Technology Journal Database covering the period of 1979-2016 were searched. Two reviewers assessed the methodological quality according to Jadad scale and Cochrane Systematic Review independently. Meta-analysis was performed by using the RevMan 5.3 software. Results：A total of 9 articles involving 769 patients were included .The total effective rate between acupuncture combined with other methods of traditional Chinese medicine and CC combined with other therapies， acupuncture combined with other methods of traditional Chinese medicine and CC alone was that the former was significantly higher than the latter （P<0.05）. There was no significant difference between acupuncture alone and CC combined with other therapies （P>0.05）. The gravidity rate between acupuncture alone and CC combined with other therapies， acupuncture combined with other methods of traditional Chinese medicine and CC alone was that the former was significantly higher than the latter （P<0.05）. As to the improvement of FSH and T， or the reduction of LH， acupuncture combined with other methods of traditional Chinese medicine was definitely prior to CC alone （P<0.05）. Conclusion：As to the total effective rate and the gravidity rate， the treatment of acupuncture combined with other methods of traditional Chinese medicine for PCOS-induced infertility was significantly prior to CC alone or CC combined with other therapies. Comparing with CC alone， acupuncture has an significant advantage in improving the FSH， T score， and reducing the LH score.

Key Words Polycystic Ovary Syndrome-induced Infertility; Acupuncture; Clomiphene Citrate; Meta-analysis; Systematic review

中图分类号：R245文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.03.054

多嚢卵巢綜合征（Polycystic Ovary Syndrome，PCOS）是妇女内分泌紊乱的常见疾病，在育龄期妇女中患病率在6%～15%之间，有时甚至高达20%[1-3]，占不孕的30%～40%、非排卵性不孕的50%～70%[4]，对育龄妇女生理和心理都危害巨大，严重影响家庭和谐。目前，西医多用西药、手术、辅助生殖技术等治疗PCOS性不孕取得一定效果，但疗效个体差异大，且有一定不良反应，其中以克罗米芬单用或联合使用最为常见。近年来，针灸单用或联合其他中医治疗PCOS不孕的应用报道和文献研究增加[5]，确切疗效已被证实，但与克罗米芬（CC）的疗效缺乏循证医学证据，不利PCOS性不孕治疗临床决策。为此，本研究运用Meta分析对针灸与CC治疗PCOS性不孕的效果进行了比较。

1 资料与方法

1.1 文献来源

计算机检索中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP）、万方医药期刊数据库（Wanfang），辅以文献追溯和手工检索。……