针药并用对肾虚血瘀型多囊卵巢综合征不孕患者妊娠率与代谢指标的影响OA

Objective To observe the effects of Tong Yuan acupuncture combined with modified Bu Shen Tiao Jing decoction on ovulation and metabolic indicators in infertile patients with polycystic ovary syndrome(PCOS)of kidney deficiency and blood stasis pattern.Method A total of 105 infertile patients with PCOS of the kidney deficiency and blood stasis pattern were enrolled and randomly assigned,using a random number table,in a 1:1:1 ratio to group A(35 cases),group B(35 cases),and group C(35 cases).Group A received oral Letrozole tablets.Group B received modified Bu Shen Tiao Jing decoction in addition to the treatment administered to group A.Group C received Tong Yuan acupuncture in addition to the oral Western medicine and herbal medicine administered to group B.Clinical efficacy,1-year pregnancy rate,and safety were compared among the three groups.Changes before and after treatment were observed in traditional Chinese medicine(TCM)syndrome scores;ovulation-related indicators,including the number of mature follicles,maximum follicular diameter,follicular phase duration,luteinizing hormone(LH),follicle-stimulating hormone(FSH),estradiol(E2),and serum anti-Müllerian hormone(AMH);metabolism-related indicators,including the homeostasis model assessment of insulin resistance(HOMA-IR),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C);as well as inflammatory factors,including tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6).Result There were significant differences in overall response rates among the three groups(P＜0.05),with the response rate ranking from highest to lowest as group C,group B,and group A.After treatment,the scores for all individual TCM syndrome items decreased in all three groups compared with baseline(P＜0.05).The scores in group C were lower than those in the other two groups(P＜0.05),and those in group B were lower than those in group A(P＜0.05).After treatment,the number of mature follicles and maximum follicular diameter in group C were greater than those in groups A and B(P＜0.05),whereas the follicular phase duration was shorter than that in groups A and B(P＜0.05).After treatment,LH and AMH levels decreased(P＜0.05),while FSH and E2 levels increased(P＜0.05)in all three groups.Group C exhibited lower LH and AMH levels and higher FSH and E2 levels than the other two groups(P＜0.05).After treatment,HOMA-IR values ranked from lowest to highest as group C,group B,and group A,with significant differences among groups(P＜0.05).After treatment,TC,TG,LDL-C,IL-6,and TNF-α levels decreased(P＜0.05),whereas HDL-C levels increased(P＜0.05)in all three groups.Group C showed lower TC,TG,LDL-C,IL-6,and TNF-α levels and higher HDL-C levels than the other two groups(P＜0.05).There were significant differences in pregnancy rates among the three groups(P＜0.05),and the pregnancy rate in group C was higher than those in the other two groups(P＜0.05).No serious adverse reactions occurred in any group.Conclusion On the basis of oral Letrozole therapy,Tong Yuan acupuncture combined with modified Bu Shen Tiao Jing decoction demonstrated superior efficacy to modified Bu Shen Tiao Jing decoction alone in treating infertility associated with PCOS of the kidney deficiency and blood stasis pattern.The combined therapy improved both ovulatory function and metabolic parameters and increased the clinical pregnancy rate.