Objective: To observe the effect of acupuncture combined with medication on the pregnancy outcome of kidney deficiency and blood stasis type recurrent implantation failure (RIF) in prethrombotic infertility patients.
Methods: A total of 70 RIF patients of kidney deficiency and blood stasis type who were to undergo freeze-thaw embryo transplantation were randomly divided into control and treatment groups, with 35 cases in each group. Patients in the control group were given the basic treatment of artificial periodic freeze-thaw embryo transfer and oral aspirin enteric-coated tablet, 25 mg each time, twice a day, for 3 consecutive menstrual cycles. Patients in the treatment group were treated with acupuncture on the basis of the control group, 30 min each time, 3 times a week, for 3 consecutive menstrual cycles. The clinical pregnancy rate, embryo implantation rate and live birth rate of the two groups were compared. Before treatment and 1 day before transplantation, the scores of kidney deficiency and blood stasis symptom were compared. The blood flow pulse index (PI) and resistance index (RI) of the uterus spiral artery were detected by Doppler ultrasound before treatment and 1 day before transplantation. The endometrial thickness was detected 1 day before transplantation. The contents of plasma D-dimer, serum homocysteine (Hcy) and serum thromboxane B2 (TXB2) were detected.
Results: The clinical pregnancy rate, embryo implantation rate and live birth rate in the treatment group were higher than those in the control group (P<0.05). After treatment, the scores of kidney deficiency and blood stasis symptom, the levels of plasma D-dimer, serum Hcy and TXB2, the PI and RI value in both groups were decreased (P<0.05) compared with those before treatment, and the indexes in the treatment group were decreased (P<0.05) more than those in the control group. There was no significant difference in endometrial thickness between the two groups. In the course of treatments, 7 patients in the control group underwent gastric distension pain, poor appetite, constipation, nausea and other gastrointestinal reactions, while only 2 patients in the treatment group had the above discomfort reactions.
Conclusion: On the basis of medication, acupuncture can reduce the serum TXB2 content in RIF patients in prethrombotic state, improve vascular endothelial function, enhance endometrial tolerance, alleviate the symptoms of kidney deficiency and blood stasis, reduce drug adverse reactions, and ultimately improve the pregnancy outcome and increase the rate of embryo implantation.
目的：观察针刺联合西药对肾虚血瘀型反复种植失败（RIF）血栓前状态不孕患者妊娠结局的影响。方法：将70例拟行冻融胚胎移植的肾虚血瘀型反复种植失败血栓前状态患者随机分为对照组35例，治疗组35例。对照组予人工周期冻融胚胎移植基础治疗和口服阿司匹林肠溶片25 mg/片，一次1片，每日2次，连续治疗3个月经周期。治疗组在对照组的基础上加用针刺治疗，每次30 min，一周3次，连续治疗3个月经周期。比较两组患者临床妊娠率、胚胎种植率、活产率；于治疗前及移植前1 d，比较两组患者肾虚血瘀症状评分；于治疗前及移植前1 d采用多普勒超声检测患者子宫螺旋动脉血流搏动指数（PI值）、阻力指数（RI值），于移植前1 d比较两组子宫内膜厚度；检测患者血浆D-二聚体、血清同型半胱氨酸（Hcy）及血栓素B2（TXB2）含量。结果：治疗组临床妊娠率、胚胎种植率、活产率均高于对照组（P<0.05）。治疗后两组的肾虚血瘀型症状评分、血浆D-二聚体含量、血清Hcy和TXB2含量、PI和RI值均较治疗前降低（P<0.05），且治疗组低于对照组（P<0.05）。治疗过程中对照组7例患者在一定程度上出现胃脘胀痛、纳差、便秘、欲呕等胃肠的不适反应，而治疗组仅2例出现上述不适反应。结论：针刺能在西药治疗基础上降低肾虚血瘀型血栓前状态RIF患者的血清TXB2含量而改善血管内皮功能，提高子宫内膜容受性，可缓解患者的肾虚血瘀症状，减少药物不良反应，最终改善患者妊娠结局，提高胚胎种植率。.
Keywords: Acupuncture; Endometrial receptivity; Pregnancy rate; Prethrombotic state; Repeated planting failure; Thromboxane B2.