任丽娜;郭丽红;马文珠;张瑞;

• 1:北京中医药大学针灸推拿学院

摘要(Abstract)：

目的:运用循证医学系统综述方法评价针刺治疗多囊卵巢综合征(PCOS)的疗效和安全性。方法:计算机检索CNKI、VIP、CBM、Wanfang、PubMed和Cochrane Library数据库,并对论文后的参考文献做补充检索。时间从建库(刊)到2013年11月。收集单纯针刺(或+药物/其它针灸疗法)对比阳性药物(或安慰剂/空白对照)治疗PCOS的随机对照试验(RCT)。对临床异质性较小的文献采用RevMan 5.2进行Meta分析,否则进行定性分析。结果:共纳入31项研究,合计2 321例PCOS患者。2个Meta分析结果显示:①单纯针刺组的有效率与西药组相当;②针刺结合中药组的有效率明显高于西药组。定性描述结果:单纯针刺(或+药物)治疗PCOS,在提高有效率、排卵率,降低黄体生成素/卵泡刺激素值、胰岛素抵抗水平、睾酮、体质量指数方面,优于或等效于对照组疗效。局限性:由于语种条件限制,存在文献检索选择偏倚;阳性结果易于发表使纳入研究存在潜在发表偏倚;无随访及报告结局时点不一致而存在时间效应偏倚;未对针刺的具体操作进行分类,致使本次研究有潜在的信息偏倚。结论:现有的研究证据对针刺治疗PCOS疗效还不能得出肯定的结论,针刺可能可以促进PCOS患者排卵。

关键词(KeyWords)： 多囊卵巢综合征;针刺干预;随机对照试验;系统综述;Meta分析

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 任丽娜;郭丽红;马文珠;张瑞;

Email:

参考文献(References)：

• [1]曹泽毅.中华妇产科学(临床版)[M].北京:人民卫生出版社,2010:501-507.Cao Z Y.Chinese Obstetrics and Gynecology:Clinical Edition[M](Chin).Beijing:People’s Medical Publishing House,2010:501-507.
• [2]罗辉,刘建平.从系统综述看中国随机对照试验的质量[J].中西医结合学报,2011,9(7):697-701.Luo H,Liu J P.Quality and validity of randomized controlled trials in China from the perspective of systematic reviews[J].Zhong Xi Yi Jie He Xue Bao(J Chin Integr Med,Chin),2011,9(7):697-701.
• [3]Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group.Revised 2003consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-47.
• [4]Higgins J P T,Green S.Cochrane Handbook for Systematic Reviews of Interventions[S].Version 5.0.2,2009.
• [5]Vickers A,Goyal N,Harland R,et al.Do certain countries produce only positive results?A systematic review of controlled trials[J].Control Clin Trials,1998,19(2):159-166.
• [6]Egger M,Smith G D,Schneider M.Bias in meta-analysis detected by a simple,graphical test[J].BMJ,1997,315(7109):629-634.
• [7]Johansson J,Redman L,Veldhuis P P,et al.Acupuncture for ovulation induction in polycystic ovary syndrome:a randomized controlled trial[J].Am J Physiol Endocrinol Metab,2013,304(9):E 934-943.
• [8]Rashidi B H,Tehrani E S,Hamedani N A,et al.Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome[J].Acupunct Med,2013,31(2):151-156.
• [9]Pastore L M,Williams C D,Jenkins J,et al.True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome[J].J Clin Endocrinol Metab,2011,96(10):3143-3150.
• [10]杨越红,洪建云,魏达友,等.针刺治疗多囊卵巢综合征所致不孕的临床观察[J].广东医学院学报,2005,23(4):377-378.Yang Y H,Hong J Y,Wei D Y,et al.Acupuncture on polycystic ovarian syndrome-induced infertility[J].Guangdong Yi Xue Yuan Xue Bao(J Guangdong Med Coll,Chin),2005,23(4):377-378.
• [11]胡智海,王毅.针刺对非胰岛素抵抗型多囊卵巢综合征作用机理的研究[J].上海针灸杂志,2009,28(4):197-198.Hu Z H,Wang Y.Study of the mechanism of acupuncture action on polycystic ovary syndrome of non-insulin resistance type[J].Shanghai Zhen Jiu Za Zhi(Shanghai J Acu-moxi,Chin),2009,28(4):197-198.
• [12]佀雪平,丛惠芳,王晓滨.针药并用治疗多囊卵巢综合征排卵障碍的疗效观察[J].针灸临床杂志,2007,23(8):35-36.Si X P,Cong H F,Wang X B.Observation on therapeutic effect of acupuncture combined with drug therapy on anovulatory polycystic ovarian syndrome[J].Zhen Jiu Lin Chuang Za Zhi(J Clin Acu-moxi,Chin),2007,23(8):35-36.
• [13]林炳钦,张泽玫,林敉祥,等.阴道彩色多普勒监测温针合二陈汤加减治疗多囊卵巢综合征患者排卵的价值[J].国际医药卫生导报,2013,19(4):452-454.Lin B Q,Zhang Z M,Lin M X,et al.Transvaginal color Doppler monitoring the ovulation value of warm acupuncture combined with Erchen soup treatment in patients with polycystic ovary syndrome[J].Guo Ji Yi Yao Wei Sheng Dao Bao(Int Med Health Guid News,Chin),2013,19(4):452-454.
• [14]马仁海,冀萍,沙桂娥,等.针灸治疗多囊卵巢综合征98例临床观察[J].中国针灸,1996,16(11):18-19.Ma R H,Ji P,Sha G E,et al.Observation on clinical effect of acupuncture intervention for 98cases of polycystic ovarian syndrome[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),1996,16(11):18-19.
• [15]黄道兰,许峰,温雅兰,等.针药并用治疗多囊卵巢综合征所致不孕30例疗效观察[J].新中医,2011,43(8):85-86.Huang D L,Xu F,Wen Y L,et al.Efficacy of acupuncture combined with drugs for 30cases of infertility due to polycystic ovarian syndrome[J].Xin Zhong Yi(J New Chin Med,Chin),2011,43(8):85-86.
• [16]胡智海,王毅,沈鸿斌.针刺“气海”与“三阴交”对胰岛素抵抗型多囊卵巢综合征内分泌调整作用的对比研究[J].针灸临床杂志,2009,25(4):1-2.Hu Z H,Wang Y,Shen H B.Study on impact of inserting Qihai and Sanyinjiao point on the endocrine changes in insulin resisting PCOS[J].Zhen Jiu Lin Chuang Za Zhi(J Clin Acumoxi,Chin),2009,25(4):1-2.
• [17]陈栋,陈恕仁,石晓兰,等.针挑治疗多囊卵巢综合征临床观察[J].中国针灸,2007,27(2):99-102.Chen D,Chen S R,Shi X L,et al.Clinical study on needle pricking therapy for treatment of polycystic ovarial syndrome[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),2007,27(2):99-102.
• [18]许雪梅.中药针灸结合治疗87例多囊卵巢综合征合并不孕的疗效分析[J].中国卫生产业,2013(3):177.Xu X M.Analysis on therapeutic effect of acupuncture combined with Chinese herbal medicines in the treatment of 87cases of infertility induced by polycystic ovarian syndrome[J].Zhongguo Wei Sheng Chan Ye(Chin Health Industry,Chin),2013(3):177.
• [19]王轶蓉,李春日.针灸治疗多囊卵巢综合症的临床观察[J].中国保健营养,2013,4(8):2112.Wang Y R,Li C R.Clinical observation on acupuncture treatment of polycystic ovarian syndrome[J].Zhongguo Bao Jian Ying Yang(Chin Health Care Nutrit,Chin),2013,4(8):2112.
• [20]李晨,张松柏.针刺治疗多囊卵巢综合征30例临床观察[J].北京中医药,2011,30(2):128-130.Li C,Zhang S B.Clinical observation on treatment of 30cases of polycystic ovarian syndrome[J].Beijing Zhong Yi Yao(Beijing J Trad Chin Med,Chin),2011,30(2):128-130.
• [21]李锦鸣,苗晓玲,封淑青,等.分时段针刺导气法治疗多囊卵巢综合征临床研究[J].辽宁中医杂志,2013,40(7):1444-1446.Li J M,Miao X L,Feng S Q,et al.Efficacy of acupuncture using Daoqi manipulation and different therapy in different time on polycystic ovarian syndrome[J].Liaoning Zhong Yi Za Zhi(Liaoning J Trad Chin Med,Chin),2013,40(7):1444-1446.
• [22]崔英,熊斌,周娅.针刺对多囊卵巢综合征性激素及细胞因子的影响[J].华南国防医学杂志,2012,26(6):547-549.Cui Y,Xiong B,Zhou Y.Effect of acupuncture on sex hormone and cytokines in treatment of polycystic ovarian syndrome[J].Hua Nan Guo Fang Yi Xue Za Zhi(Milit Med J South Chin,Chin),2012,26(6):547-549.
• [23]桑海莉.补肾加针刺治疗多囊卵巢综合征35例临床观察[J].中医杂志,2000,41(7):412-413.Sang H L.Clinical observation on 35cases of polycystic ovary syndrome treated with tonifying the kidney plus acupuncture[J].Zhong Yi Za Zhi(J Trad Chin Med,Chin),2000,41(7):412-413.
• [24]周建华,王东建,王治洁.针药并用对多囊卵巢综合征患者胰岛素抵抗的影响[J].上海针灸杂志,2012,31(6):380-382.Zhou J H,Wang D J,Wang Z J.Effect of acupuncture plus medication on insulin resistance in patients with polycystic ovary syndrome[J].Shanghai Zhen Jiu Za Zhi(Shanghai J Acu-moxi,Chin),2012,31(6):380-382.
• [25]吴凯恩.针药结合治疗PCOS的前瞻性随机对照研究[D].广州:广州中医药大学,2011:16-29.Wu K E.Prospective randomized controlled clinical trials for treatment of polycystic ovarian syndrome with acupuncture combined with medicines[D](Chin).Guangzhou:Guangzhou University of Chinese Medicne,2011:16-29.
• [26]施茵,冯慧钧,刘慧荣,等.针药结合治疗肾虚痰瘀型多囊卵巢综合征疗效观察[J].中国针灸,2009,29(2):99-102.Shi Y,Feng H J,Liu H R,et al.Observation on therapeutic effect of acupuncture combined with Chinese herbs on polycystic ovary syndrome of kidney deficiency and phlegm stasis type[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),2009,29(2):99-102.
• [27]徐德伟.中西医结合加针刺治疗多囊卵巢综合征不孕症临床疗效观察[J].四川中医,2010,28(1):93-94.Xu D W.Observation on clinical efficacy of combined treatment of polycystic ovarian syndrome induced sterility with Chinese herbal medicines,western medicines and acupuncture[J].Sichuan Zhong Yi(J Sichuan Trad Chin Med,Chin),2010,28(1):93-94.
• [28]柳青.活血化瘀法联合针刺治疗对多囊卵巢综合征早期诱发卵巢过度刺激的干预研究[D].南京:南京中医药大学,2011:13-20.Liu Q.Intervention of polycystic ovarian syndrome induced ovarian hyperstimulation at the early stage by blood circulation promotion to remove blood stasis method combined with acupuncture therapy[D](Chin).Nanjing:Nanjing University of Chinese Medicine,2011:13-20.
• [29]苏健,李亚敏,田李军,等.补肾化痰通络法加针刺治疗肥胖型多囊卵巢综合征的临床研究[J].天津中医药,2013,30(5):274-276.Su J,Li Y M,Tian L J,et al.Treating polycystic ovary syndrome with obesity by acupuncture combined with tonifying kidney,reducing phlegm and dredging collateral[J].Tianjin Zhong Yi Yao(Tianjin J Trad Chin Med,Chin),2013,30(5):274-276.
• [30]赵琰,胡丽莎,王长华,等.针灸联合二甲双胍对多囊卵巢综合征患者应用克罗米酚促排卵疗效观察[J].江西医药,2007,42(12):1089-1092.Zhao Y,Hu L S,Wang C H,et al.The study of treatment with compound acupuncture-metformin on the outcome of ovulation induction with chloramiphene in the patients with polycystic ovarian syndrome[J].Jiangxi Yi Yao(J Jiangxi Med,Chin),2007,42(12):1089-1092.
• [31]高天旸,王瑾,王洁,等.针灸联合宫内人工授精(IUI)治疗多囊卵巢综合征所致不孕——65例疗效观察[J].生殖与避孕,2009,29(10):680-682.Gao T Y,Wang J,Wang J,et al.Effect of acupuncture assist IUI treatment on the outcome of infertility patients with polycystic ovarian syndrome[J].Sheng Zhi Yu Bi Yun(Reprod Contracep,Chin),2009,29(10):680-682.
• [32]李彦俐,连方,王瑞霞,等.针刺联合中西药治疗枸橼酸氯米芬抵抗多囊卵巢综合征30例疗效观察[J].河北中医,2011,33(2):244-246.Li Y L,Lian F,Wang R X,et al.Observation of clomiphene citrate resistant polycystic ovary syndrome treated by combination of acupuncture,Chinese and western medicine[J].Hebei Zhong Yi(Hebei J Trad Chin Med,Chin),2011,33(2):244-246.
• [33]杨令巧,张炜冉,张跃进,等.针药结合从脾胃论治多囊卵巢综合征的临床疗效观察[J].现代中西医结合杂志,2013,22(22):2451-2452.Yang L Q,Zhang W R,Zhang Y J,et al.Clinical efficacy observation on treatment of polycystic ovarian syndrome by acupuncture combined with Chinese herbal medicines from regulation of functions of the spleen and stomach functions[J].Xian Dai Zhong Xi Yi Jie He Za Zhi(Mod J Integr Trad Chin West Med,Chin),2013,22(22):2451-2452.
• [34]柳芳.针药结合治疗多囊卵巢综合征不孕症临床观察[J].湖北中医杂志,2013,35(3):66-67.Liu F.Clinical observation on treatment of polycystic ovarian syndrome induced infertility with acupuncture combined with Chinese medicinal herbs[J].Hubei Zhong Yi Za Zhi(Hubei J Trad Chin Med,Chin),2013,35(3):66-67.
• [35]吴丹.补肾健脾法配合针刺对多囊卵巢综合征患者高雄体征干预的临床研究[D].哈尔滨:黑龙江中医药大学,2012:30-43.Wu D.Clinical trials of treatment of polycystic ovarian syndrome with hyperandrogenemia by acupuncture combined with tonifying the kidney and spleen methods[D](Chin).Harbin:Heilongjiang University of Traditional Chinese Medicine,2012:30-43.
• [36]丘惠娜,徐佳.针灸耳压治疗肥胖多囊卵巢综合征46例临床观察[J].中国社区医师:综合版,2006,8(14):86-87.Qiu H N,Xu J.Clinical observation on treatment of 46cases of polycystic ovarian syndrome by acupuncture and peller pressure of points[J].Zhongguo She Qu Yi Shi:Zong He Ban(J Chin Comm Doctors:Compreh Ed,Chin),2006,8(14):86-87.
• [37]王嘉莉,张中成.针刺配合穴位埋线治疗肥胖型多囊卵巢综合征30例[J].辽宁中医杂志,2009,36(9):1574-1575.Wang J L,Zhang Z C.Observation of acupuncture and acupoint catgut-embedding therapy for PCOS patients of obesity[J].Liaoning Zhong Yi Za Zhi(Liaoning J Trad Chin Med,Chin),2009,36(9):1574-1575.
• [38]余曙光,郭义.实验针灸学(精编版)[M].上海:上海科学技术出版社,2009:501-507.Yu S G,Guo Y.Experimental Acupuncturology:Short Version[M](Chin).Shanghai:Shanghai Scientific and Technical Publishers,2009:501-507.
• [39]Schulz K F,Chalmers I,Hayes R J,et al.Empirical evidence of bias:dimensions of methodological quality associated with estimates of effects in controlled trials[J].JAMA,1995,273(5):408-412.
• [40]浦婧婧.利用数据挖掘方法探讨针灸治疗多囊卵巢综合征相关穴位的研究[D].哈尔滨:黑龙江中医药大学,2012:25.Pu J J.Discussion on acupoint recipes for treatment of polycystic ovarian syndrome by using data mining method[D](Chin).Harbin:Heilongjiang University of Traditional Chinese Medicine,2012:25.
• [41]张洁,俞超芹.中西医结合治疗多囊卵巢综合征的系统评价与meta分析[C].贵阳:全国中西医结合生殖系统炎症性疾病专题学术会议论文及摘要集,2013:13.Zhang J,Yu C Q.Systematic review and meta-analysis on collection of treatment of polycystic ovarian syndrome with integrated Chinese and western medicines[C](Chin).Papers and Abstracts of National Academic Conference Integrated Medicine on Treatment of Inflammatory Diseases of Reproductive System,2013:13.
• [42]吴捷玲,熊娟,黄小涛,等.中西医结合治疗多囊卵巢综合征不孕症的Meta分析[J].中国保健营养,2013,4(8):2141-2143.Wu J L,Xiong J,Huang X T,et al.Meta-analysis of Chinese integrative medicine on curing polycystic ovary syndrome infertility[J].Zhongguo Bao Jian Ying Yang(Chin Health Care Nutrit,Chin),2013,4(8):2141-2143.
• [43]陈丽新,侯丽辉,吴效科.中西医结合治疗多囊卵巢综合征的系统评价[J].世界中西医结合杂志,2008,13(6):340-343.Chen L X,Hou L H,Wu X K.Systematic evaluation on polycystic ovary syndrome treated with integrating Chinese and western medicine[J].Shi Jie Zhong Xi Yi Jie He Za Zhi(World J Integr Trad West Med,Chin),2008,13(6):340-343.
• [44]何殷,黎小斌,陈淑慧.中医药治疗多囊卵巢综合征的文献系统评价和Meta分析[J].现代医药卫生,2010,26(7):1022-1024.He Y,Li X B,Chen S H.Systematic review and meta-analysis on treatment of polycystic ovarian syndrome with Chinese medicine[J].Xian Dai Yi Yao Wei Sheng(Mod Med Health,Chin),2010,26(7):1022-1024.
• [45]张戈.针灸治疗多囊卵巢综合征所致不孕的荟萃分析[D].哈尔滨:黑龙江中医药大学,2011:44.Zhang G.A meta-analysis on acupuncture treatment of infertility caused by polycystic ovarian syndrome[D](Chin).Harbin:Heilongjiang University of Traditional Chinese Medicine,2011:44.