Objective: To compare the clinical effect of the combined treatment of acupuncture, moxibustion, Chinese herbal medicine and western medication and simple western medication on polycystic ovary syndrome (PCOS) of kidney deficiency and blood stagnation pattern and explore the effect on endometrial receptivity and the expression of serum homeobox gene A10 (HOXA10).
Methods: A total of 60 patients with PCOS of kidney deficiency and blood stagnation pattern were randomized into a combined treatment group and a western medication group, 30 cases in each one. In the western medication group, on the fifth day of menstruation, clomiphene citrate tablets were taken orally, 50 mg each time, once daily, consecutively for 5 days. On the day when the follicle diameter was ≥ 18 mm, chorionic gonadotrophin for muscular injection, a dose of 10 000 U was given. Before sleep, the aspirin enteric-coated tablets were taken orally, 50 mg (except during menstruation). In the combined treatment group, on the base of the treatment as the western medication group, acupuncture and moxibustion were adopted and the Chinese herbal for tonifying the kidney and activating blood circulation was taken orally. The acupoints were Guanyuan (CV 4), Qihai (CV 6), Zusanli (ST 36), Sanyinjiao (SP 6), Zigong (EX-CA 1), etc. Acupuncture was remained for 30 min each time, once every two days and discontinued during menstruation. Chinese herbal was given from the 3rd day of menstruation till the onset of the next menstruation, one dose each day. After consecutive treatment for 3 menstrual cycles in the two groups, the real-time polymerase chain reaction (RT-PCR) method was adopted to determine the expression of serum HOXA10 before and after treatment in the patients of the two groups. The endometrial thickness at ovulatory phase, uterine arterial flow 7 days after ovulation [including uterine arterial pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV)/end diastolic velocity (EDV), meaning S/D], pregnancy rate and the score of Chinese medicine symptoms before and after treatment were compared in the patients between the two groups.
Results: ① After treatment, the expression of serum HOXA10 was higher than that before treatment in the patients of the two groups (P<0.01). The increase range in the combined treatment group was larger than the western medication group (P<0.01). ② After treatment, the endometrial thickness at the ovulatory phase was increased in the patients of the two groups (P<0.01). The increase range of the endometrial thickness in the combined treatment group was larger than the western medication group (P<0.01). ③ The pregnancy rate was 46.7% (14/30) in the combined treatment group, higher than 26.7% (8/30) in the western medication group (P<0.05). ④ After treatment, the bilateral uterine arterial PI, RI and S/D values, as well as TCM symptom score were all lower than those before treatment in the patients of the two groups (P<0.01). The decrease range of each index in the combined treatment group was greater than the western medication group (P<0.01, P<0.05).
Conclusion: The combined treatment with acupuncture, moxibustion and medication effectively improves endometrial receptivity and uterine arterial flow in the patients with PCOS of kidney deficiency and blood stagnation pattern and increases pregnancy rate. The therapeutic effect is better than the simple western medication and its mechanism is probably related to the regulation of serum HOXA10 expression.
目的：比较针灸、中药联合西药治疗与单纯西药治疗肾虚血瘀型多囊卵巢综合征患者的临床疗效，并探讨其对子宫内膜容受性及血清同源框基因A10（HOXA10）表达的影响。方法：将60例肾虚血瘀型多囊卵巢综合征患者随机分为针药结合组和西药组，每组30例。西药组于月经第5天口服枸橼酸氯米芬片，每次50 mg，每日1次，连续5 d，当卵泡直径≥18 mm时，当日予肌内注射绒促性素10 000 U；睡前口服阿司匹林肠溶片50 mg（经期除外）。在西药组治疗基础上，针药结合组采用针灸与口服中药补肾活血方治疗，穴取关元、气海、足三里、三阴交、子宫穴等，针灸每次30 min，隔日1次，经期停用；中药均于月经第3天开始，服用至下次月经来潮前，每日1剂。两组均连续治疗3个月经周期。采用实时定量聚合酶链式反应（real-time PCR）检测两组患者治疗前后血清HOXA10基因表达，比较两组患者排卵期子宫内膜厚度、排卵后7 d子宫动脉血流情况[包括子宫动脉搏动指数（PI）、阻力指数（RI），收缩期峰值流速（PSV）/舒张末期流速(EDV)，即S/D比值]、妊娠率及治疗前后中医症状评分。结果：①治疗后两组患者血清HOXA10基因表达均高于治疗前（P<0.01），且针药结合组升高幅度大于西药组（P<0.01）；②治疗后，两组患者排卵期子宫内膜增厚（P<0.01），针药结合组增厚 幅度大于西药组（P<0.01）；③针药结合组妊娠率为46.7%（14/30），高于西药组的26.7%（8/30，P<0.05）；④治疗后，两组患者双侧子宫动脉PI、RI、S/D比值及中医症状评分均低于治疗前（P<0.01），针药结合组各项指标降低幅度均大于西药组（P<0.01，P<0.05）。结论：针药结合治疗能有效改善肾虚血瘀型多囊卵巢综合征患者子宫内膜的容受性和子宫动脉血流，提高妊娠率，疗效优于单纯西药治疗，其机制可能与调节血清中HOXA10的表达有关。.
Keywords: acupuncture and moxibustion; endometrial receptivity; herbal medicine; homeobox gene A10 (HOXA10); polycystic ovary syndrome.