本文選題：經(jīng)皮穴位電刺激 + 體外受精-胚胎移植　； 參考：《山東大學(xué)》2016年博士論文

【摘要】：目的卵巢儲(chǔ)備功能通常包括卵巢內(nèi)儲(chǔ)存的竇卵泡數(shù)量和卵子的質(zhì)量兩個(gè)方面,臨床上往往將卵巢儲(chǔ)備功能作為反映女性生育能力的一項(xiàng)重要指標(biāo)。隨著體外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)及其衍生技術(shù)的不斷發(fā)展,許多不孕癥夫婦需要通過輔助生殖技術(shù)妊娠,但目前輔助生殖技術(shù)仍面臨著一系列的挑戰(zhàn),其中提高卵巢儲(chǔ)備功能下降患者的臨床療效及妊娠率仍缺乏安全、有效的方法,是困擾臨床醫(yī)生的一個(gè)難題。近年來有研究發(fā)現(xiàn)采用經(jīng)皮穴位電刺激(transcutaneous electrical acupoint stimulation,TEAS)對體外受精-胚胎移植的患者進(jìn)行治療,可以改善卵子質(zhì)量,提高妊娠率。經(jīng)皮穴位電刺激是一種新的穴位刺激方法,與傳統(tǒng)手捻針灸不同,治療時(shí)以電刺激信號代替機(jī)械刺激,避免了針刺帶來的疼痛和局部皮膚組織損傷,更易于被患者接受,并且治療的刺激時(shí)間和強(qiáng)度是可以定量控制的,目前已在臨床治療和科學(xué)研究中廣泛應(yīng)用。本研究主要觀察經(jīng)皮穴位電刺激治療對接受體外受精-胚胎移植助孕治療的卵巢儲(chǔ)備下降的患者卵巢功能的影響,希望為這類患者尋求一種安全、有效的治療方法。方法1、研究對象本研究選擇接受體外受精-胚胎移植治療的符合卵巢儲(chǔ)備下降標(biāo)準(zhǔn)的患者,年齡為26-47歲,平均36.69±4.95歲,不孕年限1-15年,平均4.89±2.89年,不孕原因均為輸卵管因素導(dǎo)致的配子運(yùn)輸障礙。治療組患者180例,順序編號,隨機(jī)分為3組,人工周期治療組(A組)60例、安慰型經(jīng)皮穴位電刺激組(B組)60例和經(jīng)皮穴位電刺激治療組(C組)60例。同時(shí)選取同期不愿接受人工周期或經(jīng)皮穴位電刺激治療的患者60例作為空白對照組(D組)。試驗(yàn)設(shè)計(jì)經(jīng)醫(yī)院倫理委員會(huì)討論批準(zhǔn),入組患者均知情同意并簽署試驗(yàn)知情同意書。2、入組標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)2.1入組標(biāo)準(zhǔn)目前卵巢儲(chǔ)備功能下降尚無統(tǒng)一的標(biāo)準(zhǔn),我們根據(jù)文獻(xiàn)報(bào)道,采用以下卵巢儲(chǔ)備下降的預(yù)測方法,同時(shí)具備以下(1)、(2)項(xiàng)和(3)、(4)項(xiàng)其中之一者,考慮其卵巢儲(chǔ)備下降,納入我們的研究范圍：(1)至少兩次基礎(chǔ)FSH水平≥10IU/L者,或FSH/LH≥3.6者;(2)雙側(cè)卵巢竇卵泡數(shù)目≤5個(gè)者；(3)有盆腔手術(shù)史者(曾經(jīng)進(jìn)行卵巢囊腫手術(shù)或卵巢部分切除手術(shù))；(4)年齡≥35歲者。(5)選擇不孕原因?yàn)檩斅压芤蛩貙?dǎo)致的配子運(yùn)輸障礙,超促排卵方案采用常規(guī)短方案的患者,以避免不同不孕原因及超促排卵方案對臨床妊娠率的影響。2.2排除標(biāo)準(zhǔn)由于觀察指標(biāo)中有獲卵數(shù)、受精率、卵裂率、優(yōu)胚率、臨床妊娠率及早期流產(chǎn)率的比較,為避免其他因素對這些指標(biāo)的影響,入組的患者需排除子宮內(nèi)膜異位癥和進(jìn)行卵胞漿內(nèi)單精子注射(intracytoplasmic sperm injection,ICSI)的患者。(1)子宮內(nèi)膜異位癥的診斷標(biāo)準(zhǔn)1)臨床癥狀和體征：繼發(fā)性痛經(jīng)進(jìn)行性加重；月經(jīng)改變；其他異位病灶的改變；婦科檢查典型的體征是宮骶韌帶痛性結(jié)節(jié)以及附件粘連包塊。2)影像學(xué)檢查：超聲、CT、MRI檢查發(fā)現(xiàn)卵巢子宮內(nèi)膜異位囊腫或深部病變。3)腹腔鏡檢查：腹腔鏡中病理診斷為子宮內(nèi)膜異位癥。4)伴或不伴血清CA125水平的升高。(2)進(jìn)行卵胞漿內(nèi)單精子注射(ICSI)的患者：由于男性因素導(dǎo)致無法自然受精,需要進(jìn)行卵胞漿內(nèi)單精子注射輔助受精的患者。3、治療方法3.1人工周期治療方案人工周期治療組患者從月經(jīng)周期的第5天開始每日口服戊酸雌二醇片(補(bǔ)佳樂,1mg/片,拜耳醫(yī)藥公司)2mg/d,連用21天,最后10天加用地屈孕酮片(達(dá)芙通,10mg/片,Abbott Healthcare products B. V.),20 mg/d,連用3個(gè)周期。3.2經(jīng)皮穴位電刺激治療方案經(jīng)皮穴位電刺激治療組患者給予經(jīng)皮穴位電刺激治療的時(shí)間是在月經(jīng)干凈后,采用北京大學(xué)神經(jīng)研究所的韓氏穴位神經(jīng)刺激儀(HANS),選擇治療強(qiáng)度20-25mA,頻率為2Hz,每日一次,每次30分鐘,直到下次月經(jīng)來潮前結(jié)束,這樣就完成一個(gè)療程的治療。在進(jìn)入超促排卵周期前共治療3個(gè)療程,在超促排卵的當(dāng)個(gè)周期,經(jīng)皮穴位電刺激治療于月經(jīng)干凈后繼續(xù)進(jìn)行,方法與前述相同,直至取卵日。3.3安慰型經(jīng)皮穴位電刺激治療方案采用安慰型韓氏穴位神經(jīng)刺激儀(假HANS),這是一種科研用儀器,儀器外觀與韓氏穴位神經(jīng)刺激儀(真HANS)完全相同,但無論儀器顯示的電流強(qiáng)度是多少,通電時(shí)間為接通3秒,停頓7秒,實(shí)際輸出電流強(qiáng)度均為5mA,可以引起穴位酥麻的感覺,但沒有治療作用,僅起到安慰劑的作用,儀器的安慰劑作用已在研究中得到證實(shí)。治療時(shí)間、療程及操作方法均和經(jīng)皮穴位電刺激治療方案相同。4、主要檢測指標(biāo)4.1超聲檢查指標(biāo)于治療前患者月經(jīng)第二天測定竇卵泡數(shù)、卵巢動(dòng)脈血流搏動(dòng)指數(shù)(ovarian artery pulsatility index, PI)、卵巢動(dòng)脈血流阻力指數(shù)(ovarian artery resistance index,RI)、收縮期/舒張期血流速度比值(systolic/diastolic flow velocity ratio,S/D),治療3個(gè)周期后重復(fù)測定以上各參數(shù)。4.2內(nèi)分泌激素的檢測于治療前患者月經(jīng)第二天測定基礎(chǔ)雌二醇(estradiol, E2)值、基礎(chǔ)卵泡刺激素(follicle-stimulating hormone, FSH)值、基礎(chǔ)黃體生成素(luteinizing hormone, LH)值、抗苗勒氏管激素(Anti-Mtillerian hormone, AMH)值、基礎(chǔ)卵泡刺激素／黃體生成素(FSH/LH)比值,治療3個(gè)周期后重復(fù)測定以上各參數(shù)。4.3臨床指標(biāo)的收集超促排卵過程中統(tǒng)計(jì)促性腺激素用量、促性腺激素使用天數(shù)。取卵后統(tǒng)計(jì)四組患者的獲卵數(shù)、卵泡顆粒細(xì)胞卵泡刺激素受體(follicle stimulating hormone receptor,FSHR)、受精率、卵裂率、優(yōu)胚數(shù)、臨床妊娠率及早期流產(chǎn)率。結(jié)果1、各組患者基礎(chǔ)情況的比較治療過程中人工周期治療組有6例患者由于終斷服藥或間斷服藥脫落,經(jīng)皮穴位電刺激治療組及安慰型經(jīng)皮穴位電刺激組均有4例患者中斷治療脫落。排除脫落患者后人工周期治療組(A組)54例,安慰型經(jīng)皮穴位電刺激組(B組)56例,經(jīng)皮穴位電刺激治療組(C組)56例。四組患者的一般情況如患者年齡、身高、體重、體重指數(shù)差異無統(tǒng)計(jì)學(xué)意義(P0.05)。四組患者按不孕的病因及不同類型卵巢手術(shù)病史統(tǒng)計(jì),差異無統(tǒng)計(jì)學(xué)意義(P0.05)。四組患者治療前超聲檢測指標(biāo)如竇卵泡數(shù)、卵巢血流RI、PI、S/D比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。四組患者治療前基礎(chǔ)內(nèi)分泌激素如E2、FSH、LH、T、AMH比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。因此,四組患者的一般情況和基礎(chǔ)指標(biāo)比較均無明顯差異(P0.05),具有可比性。2、治療組各組患者治療效果的比較2.1 三組治療組患者治療前后超聲檢測指標(biāo)的比較經(jīng)皮穴位電刺激治療組患者治療后較治療前竇卵泡數(shù)明顯增多,差異有顯著意義(P0.05)。經(jīng)皮穴位電刺激治療組與安慰型經(jīng)皮穴位電刺激治療組相比治療后竇卵泡個(gè)數(shù)及治療前后差值明顯增多,差異有顯著意義(P0.05)。人工周期治療組患者治療后較治療前竇卵泡數(shù)明顯增多,差異有顯著意義(P0.05)。安慰型經(jīng)皮穴位電刺激治療組患者治療前后竇卵泡數(shù)無明顯變化(P0.05)三組患者治療前后卵巢動(dòng)脈血流阻力指數(shù)(RI)、卵巢動(dòng)脈血流搏動(dòng)指數(shù)(PI)以及收縮期／舒張期血流速度比值(S/D)差異無顯著性意義(P0.05)。2.2三組治療組患者治療前后及組間基礎(chǔ)內(nèi)分泌激素的比較經(jīng)皮穴位電刺激治療組患者治療后較治療前AMH值明顯提高,差異有顯著性意義(P0.05)。經(jīng)皮穴位電刺激治療組與安慰型經(jīng)皮穴位電刺激治療組相比治療后AMH值明顯增多,差異有顯著意義(P0.05)。人工周期治療組患者治療后較治療前AMH值明顯提高,差異有顯著性意義(P0.05)。安慰型經(jīng)皮穴位電刺激治療組患者治療前后AMH值無明顯變化(P0.05)。經(jīng)皮穴位電刺激治療組患者治療后較治療前基礎(chǔ)E2值、基礎(chǔ)FSH/LH值、基礎(chǔ)FSH值降低,差異均有顯著性意義(P0.05)。經(jīng)皮穴位電刺激治療組與安慰型經(jīng)皮穴位電刺激治療組相比治療后上述激素水平明顯降低,前后差值明顯增高,差異均有顯著意義(P0.05)。人工周期治療組患者治療后較治療前上述激素均有降低,差異有顯著性意義(P0.05)。安慰型經(jīng)皮穴位電刺激治療組患者治療前后上述激素?zé)o明顯變化(P0.05)。2.3 四組患者各項(xiàng)臨床指標(biāo)的比較經(jīng)皮穴位電刺激治療組患者與安慰型經(jīng)皮穴位電刺激治療組及對照組相比Gn用量、Gn天數(shù)明顯降低,差異有顯著性意義(P0.05)。人工周期治療組與對照組相比Gn用量、Gn天數(shù)明顯降低,差異有顯著性意義(P0.05)。經(jīng)皮穴位電刺激治療組患者與人工周期治療組相比Gn用量、Gn天數(shù)降低,差異有顯著性意義(P0.05)。經(jīng)皮穴位電刺激治療組患者獲卵數(shù)、優(yōu)質(zhì)胚胎數(shù)與安慰型經(jīng)皮穴位電刺激治療組及對照組相比明顯增加,差異有顯著性意義(P0.05)。人工周期治療組獲卵數(shù)、優(yōu)質(zhì)胚胎數(shù)與對照組相比明顯增加,差異有顯著性意義(P0.05)。經(jīng)皮穴位電刺激治療組患者獲卵數(shù)、優(yōu)質(zhì)胚胎數(shù)多于于人工周期治療組,差異有顯著性意義(P0.05)。四組患者受精率、卵裂率無明顯差異(P0.05)。經(jīng)皮穴位電刺激治療組患者臨床妊娠率與人工周期組、安慰型經(jīng)皮穴位電刺激治療組及對照組相比均明顯增加,差異有顯著性意義(P0.05)。人工周期治療組臨床妊娠率與安慰型經(jīng)皮穴位電刺激治療組及對照組相比明顯增加,差異有顯著性意義(P0.05)。四組患者早期流產(chǎn)率率無明顯差異(P0.05)。3.四組患者卵泡顆粒細(xì)胞FSHR蛋白表達(dá)的比較經(jīng)皮穴位電刺激治療組患者與安慰型經(jīng)皮穴位電刺激治療組及對照組患者相比卵泡顆粒細(xì)胞FSHR蛋白表達(dá)量高,差異有顯著性意義(P0.05)。人工周期治療組患者與安慰型經(jīng)皮穴位電刺激治療組及對照組患者相比卵泡顆粒細(xì)胞FSHR蛋白表達(dá)量高,差異有顯著性意義(P0.05)。經(jīng)皮穴位電刺激治療組患者與人工周期治療組患者相比卵泡顆粒細(xì)胞FSHR蛋白表達(dá)量高,差異有顯著性意義(P0.05)。結(jié)論1、經(jīng)皮穴位電刺激治療可以增加卵巢儲(chǔ)備功能下降患者的竇卵泡數(shù),提高患者AMH水平,降低患者基礎(chǔ)E2水平、基礎(chǔ)FSH水平及基礎(chǔ)FSH/LH比值,從而改善卵巢儲(chǔ)備下降患者的卵巢功能。2、經(jīng)皮穴位電刺激治療可以減少IVF過程中促性腺激素的使用劑量和使用時(shí)間,增加患者的獲卵數(shù)及優(yōu)質(zhì)胚胎數(shù),從而減少了患者的經(jīng)濟(jì)負(fù)擔(dān),改善了IVF的治療效果。3、經(jīng)皮穴位電刺激治療的作用可能與經(jīng)皮穴位電刺激治療可以上調(diào)FSHR表達(dá),使卵泡對于外源性FSH的刺激更為敏感有關(guān)。4、經(jīng)皮穴位電刺激與傳統(tǒng)的針刺相比,避免了皮膚損傷、感染、暈針等不良反應(yīng),且刺激持續(xù)、定量,易操作,無痛苦,易于被患者接受。作為一種無明顯不良反應(yīng)的治療方法,經(jīng)皮穴位電刺激可以提高卵巢儲(chǔ)備功能,改善IVF治療效果,在IVF卵巢儲(chǔ)備下降患者中有很好的應(yīng)用價(jià)值。
[Abstract]:Objective ovarian reserve functions usually include the number of ovum vesicles stored in the ovary and the quality of the egg. In clinical practice, ovarian reserve function is often used as an important indicator to reflect the fertility of women. With the continuous fertilization and embryo transfer (in vitro fertilization and embryo transfer, IVF-ET) and its derivative technology Development, many infertility couples need assisted reproductive technology, but at present, assisted reproductive technology is still facing a series of challenges, of which the clinical efficacy and pregnancy rate of patients with decreasing ovarian reserve function are still lack of safety. Effective methods are a difficult problem for clinicians. Acupoint electrical stimulation (transcutaneous electrical acupoint stimulation, TEAS) can improve the quality of ovum and improve the pregnancy rate. The percutaneous point electrical stimulation is a new method of acupoint stimulation, which is different from the traditional hand twisting acupuncture and moxibustion, and the electrical stimulation signal is replaced by the electrical stimulation signal in place of the mechanical stimulation. The pain and local skin tissue injury caused by acupuncture are easier to be accepted by the patient, and the time and intensity of the treatment can be controlled quantitatively. It is now widely used in clinical and scientific research. This study mainly observed the ovarian reserve of the percutaneous acupoint electrical stimulation therapy for the treatment of in vitro fertilization and embryo transfer. The effect of ovarian function in the decreased patients was expected to seek a safe and effective treatment for these patients. Method 1, the study selected patients who were treated with in vitro fertilization and embryo transfer for the standard of ovarian reserve reduction. The age was 26-47 years old, the average age of 36.69 + 4.95 years, the infertile years 1-15 years, the average of 4.89 + 2.89 years, infertility. All the causes were tubal factors caused by gamete transport disorder. 180 patients in the treatment group were numbered, randomly divided into 3 groups, 60 cases of artificial periodic treatment group (group A), 60 cases of consolation percutaneous acupoint electrical stimulation group (group B) and 60 cases (group C) with percutaneous acupoint electrical stimulation (Group). At the same time, they were not willing to accept manual or percutaneous point electrical stimulation at the same time. 60 patients were treated as the blank control group (group D). The experimental design was approved by the hospital ethics committee. The patients were all informed consent and signed informed consent.2. There was no uniform standard for the decline of ovarian reserve function at the standard of entry group and the standard of exclusion standard 2.1. We reported using the following ovarian reserve according to the literature. The descent prediction method, with one of the following (1), (2) and (3), (4) items, considered the decline in the ovarian reserve, and included the scope of our study: (1) at least two basal FSH levels or more than 10IU/L, or FSH/LH > 3.6; (2) the number of bilateral ovarian follicles was less than 5; (3) patients with pelvic surgery (once ovarian cysts were performed) Or ovarian partial resection); (4) (4) the age of 35 years old. (5) the choice of infertility due to the tubal factors caused by the gamete transport disorder, the superovulation scheme using conventional short program patients, to avoid different infertility causes and superovulation schemes for the clinical pregnancy rate of the effect of exclusion criteria due to the number of eggs in the observation index, fertilization, fertilization. Rate, cleavage rate, optimal embryo rate, clinical pregnancy rate and early abortion rate, in order to avoid the influence of other factors on these indicators, patients in the group need to exclude endometriosis and patients with intracytoplasmic sperm injection, ICSI. (1) diagnostic criteria for endometriosis 1) clinical symptoms and Signs: secondary dysmenorrhea progressively aggravated; menstrual changes; other ectopic lesions; the typical signs of gynecologic examination were uterosacral ligamentous nodules and adnexal mass.2) imaging examination: ultrasound, CT, MRI examination found ovarian endometriosis cysts or deep lesions.3) laparoscopy: pathological diagnosis in celiac mirror Patients with endometriosis.4) with or without elevated serum CA125 levels. (2) patients with intracytoplasmic sperm injection (ICSI): a patient with intracytoplasmic sperm injection assisted fertilization (.3) due to male factors resulting in insemination, and the treatment of artificial cycle treatment group 3.1 The fifth day of the menstrual cycle began to take Estradiol Valerate Tablets (bout, 1mg/, Bayer pharmaceutical company) 2mg/d daily for 21 days, and the last 10 days were added to Dydrogesterone Tablets (Duff, 10mg/, Abbott Healthcare products B. V.), 20 mg/d, with 3 cycles of the percutaneous acupoint electrical stimulation therapy for the 3 cycles of the percutaneous acupoint electrical stimulation treatment group The time for the treatment of the percutaneous acupoint electrical stimulation is to use the Han's acupoint nerve stimulator (HANS) of the Peking University neuroresearch Institute to select the treatment intensity of 20-25mA, the frequency of 2Hz, once a day, 30 minutes each time, until the next period of menstruation, so as to complete a course of treatment. A total of 3 courses of treatment, in the period of superovulation, the treatment of meridian acupoint electric stimulation continued after menstruation. The method is the same as the foregoing, until the egg day.3.3 consolation meridian acupoint electrical stimulation therapy is adopted by the comfort type Han's acupoint nerve stimulator (false HANS). This is a kind of scientific research instrument, the appearance of the instrument and Han's point The position nerve stimulator (true HANS) is exactly the same, but no matter how much the current intensity is shown by the instrument, the time is 3 seconds and a pause is 7 seconds. The actual output current is 5mA, which can cause the feeling of acupoint numb, but there is no therapeutic effect. The placebo effect of the instrument has been confirmed in the study. Time, course of treatment and operation methods were the same as that of the percutaneous acupoint electrical stimulation therapy (.4). The main index of the test was to determine the number of sinus follicles, the ovarian artery pulsatility index (PI), the blood flow resistance index (ovarian artery resistance index, ovarian artery), and the ovarian artery blood flow pulsation index (artery pulsatility index, PI) before the treatment. RI), the ratio of systolic / diastolic blood flow velocity (systolic/diastolic flow velocity ratio, S/D). After treatment for 3 cycles, the measurements of the above parameters,.4.2 endocrine hormone, were measured for the basal estradiol (estradiol, E2) and basal follicle stimulating hormone (follicle-stimulating hormone, FSH) values for second days before the treatment of the patients. The value of luteinizing hormone (luteinizing hormone, LH), anti lerlerian tube hormone (Anti-Mtillerian hormone, AMH), basal follicle stimulating hormone / luteinizing hormone (FSH/LH) ratio, treatment of 3 cycles and repeated measurements of the above parameters.4.3 clinical indicators for the collection of gonadotropin dosages and gonadotropin use in the process of ovulation. Count the number of acquired eggs, follicle stimulating hormone receptor (follicle stimulating hormone receptor, FSHR), fertilization rate, cleavage rate, optimal embryo number, clinical pregnancy rate and early abortion rate in four groups of patients. 6 patients in the artificial cycle treatment group of each group had a final break uniform during the comparative treatment process of each group. There were 4 cases of interruption treatment in the treatment group and the consolation percutaneous acupoint electric stimulation group, 54 cases in the artificial period treatment group (group A), the consolation percutaneous point electric stimulation group (group B) 56 cases, and the 56 cases of the percutaneous acupoint electric stimulation treatment group (group C). The general condition of the four groups was as follows. There was no significant difference between patients' age, height, weight and body mass index (P0.05). There was no statistically significant difference between the four groups according to the etiology of infertility and the history of different types of ovarian surgery (P0.05). There was no significant difference between the four groups before treatment, such as the number of sinus follicles, the ovarian blood flow RI, PI, and S/D (P0.05). The four groups of patients were not statistically significant. There was no significant difference between the basal endocrine hormones such as E2, FSH, LH, T, and AMH before treatment (P0.05). Therefore, there was no significant difference between the general and basic indexes of the four groups (P0.05), comparable to.2, and compared with the treatment group in the treatment group 2.1 and three groups of patients before and after treatment. The number of follicles in the anterior sinus was significantly increased after treatment in the acupoint electric stimulation treatment group, and the difference was significant (P0.05). The number of follicles in the post treatment group and the difference before and after treatment were significantly increased in the treatment group of the percutaneous acupoint electric stimulation treatment and the consolation percutaneous acupoint electric stimulation treatment group. The difference was significant (P0.05). The number of follicles in the anterior sinus was significantly increased after treatment, and the difference was significant (P0.05). There was no significant change in the number of follicular follicles in the consolation percutaneous acupoint electric stimulation group (P0.05) before and after treatment (RI), the pulsation index (PI) of the ovarian artery and the systolic / diastolic blood flow velocity before and after treatment. The difference of the ratio (S/D) was not significant (P0.05). The comparison of the basal endocrine hormone between the treatment group and the group of the three groups of the three groups was significantly higher than the pre treatment AMH value in the patients after the treatment of the percutaneous acupoint electric stimulation treatment group. The difference was significant (P0.05). The treatment group of the percutaneous acupoint electrical stimulation and the consolation percutaneous acupoint electric stimulation treatment group Compared with the treatment, the AMH value increased significantly (P0.05). The AMH value of the patients in the artificial cycle treatment group was significantly higher than that before the treatment (P0.05). The AMH value of the patients in the consolation percutaneous acupoint electric stimulation treatment group was not significantly changed (P0.05). The treatment group of the percutaneous acupoint electric stimulation group was treated after treatment. The base E2 value, base FSH/LH value, basic FSH value decreased, and the difference was significant (P0.05). The level of the above hormone levels decreased significantly after the treatment group compared with the consolation percutaneous acupoint electric stimulation treatment group, and the difference was significantly higher (P0.05). After the treatment of the artificial cycle treatment group, the patients were treated with the treatment group. The above hormones were reduced before treatment, and the difference was significant (P0.05). There was no significant change in the above hormone in the consolation percutaneous acupoint electric stimulation treatment group (P0.05) the clinical indexes of the.2.3 four groups were compared with the patients in the percutaneous acupoint electric stimulation treatment group and the comfortable percutaneous acupoint electric stimulation treatment group and the control group. Compared with the dosage of Gn, the number of Gn days decreased significantly (P0.05). Compared with the control group, the number of Gn days decreased significantly compared with the control group, the difference was significant (P0.05). The number of Gn used in the percutaneous acupoint electric stimulation treatment group was lower than that of the artificial cycle treatment group, the number of Gn days decreased, the difference was significant (P0.05). Percutaneous point (P0.05). The difference was significant (P0.05). The number of acquired eggs in the treatment group was significantly higher than that in the control group and the control group (P0.05). The number of eggs obtained in the artificial period treatment group was significantly increased compared with the control group, the difference was significant (P0.05). There were significant differences in the number of high quality embryos in the artificial cycle treatment group (P0.05). The fertilization rate and cleavage rate of the four groups were not significantly different (P0.05). The clinical pregnancy rate of the patients with the percutaneous acupoint electric stimulation treatment group was significantly increased compared with the artificial cycle group, the consolation percutaneous acupoint electric stimulation treatment group and the control group. Significant significance (P0.05). The clinical pregnancy rate in the artificial period treatment group was significantly increased compared with the consolation percutaneous acupoint electric stimulation treatment group and the control group. The difference was significant (P0.05). There was no significant difference in the rate of early abortion rate between the four groups (P0.05) the comparison of the expression of FSHR protein in the follicle granulocyte in the.3. four groups was treated by percutaneous acupoint electrical stimulation There was a significant difference in the expression of FSHR protein in the follicle granulosa cells of the patients in the treatment group and the consolation percutaneous acupoint electric stimulation treatment group and the control group (P0.05). Compared with the placebo percutaneous acupoint electric stimulation treatment group and the control group, the expression of FSHR protein in the granulosa cells was significantly higher in the artificial cycle treatment group than in the control group. The difference was significant. Significance (P0.05). The expression of FSHR protein in follicular granulosa cells was higher in patients treated with transcutaneous electrical acupoint stimulation compared with those in artificial cycle therapy group.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R714.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 ;子宮內(nèi)膜異位癥的診治指南[J];中華婦產(chǎn)科雜志;2015年03期

2 李靜;崔薇;孫偉;張琪瑤;管群;;電針干預(yù)對多囊卵巢綜合征患者紡錘體及卵子質(zhì)量的影響[J];中國中西醫(yī)結(jié)合雜志;2015年03期

3 崔薇;李靜;孫偉;張琪瑤;管群;;電針干預(yù)對多囊卵巢綜合征患者紡錘體及卵子質(zhì)量的影響[J];上海針灸雜志;2015年02期

4 李靜;崔薇;孫偉;聞姬;;電針干預(yù)對多囊卵巢綜合征患者卵子質(zhì)量及腫瘤壞死因子-α的影響（英文）[J];World Journal of Acupuncture-Moxibustion;2014年03期

5 崔薇;李靜;孫偉;聞姬;馮曉軍;;超促排卵過程中加用電針干預(yù)對體外受精—胚胎移植患者妊娠結(jié)局的影響[J];山東醫(yī)藥;2012年37期

6 崔薇;李靜;孫偉;聞姬;;電針對多囊卵巢綜合征患者體外受精-胚胎移植中卵細(xì)胞質(zhì)量及妊娠的影響(英文)[J];World Journal of Acupuncture-Moxibustion;2012年01期

7 崔薇;李靜;孫偉;聞姬;;電針對多囊卵巢綜合征患者體外受精-胚胎移植中卵細(xì)胞質(zhì)量及妊娠的影響[J];中國針灸;2011年08期

8 李杭生;何巧花;張少娣;張翠蓮;耿嘉tD;路錦;谷寶霞;郭海彬;張合龍;;體外受精-胚胎移植中卵巢低反應(yīng)的相關(guān)因素分析[J];中國優(yōu)生與遺傳雜志;2010年07期

9 陳軍;崔薇;李靜;孫偉;;電針干預(yù)對多囊卵巢綜合征患者體外受精胚胎移植的作用研究[J];中國婦幼保健;2009年30期

10 秦正玉;胡玲;夏曉紅;李夢;吳子建;;電針三陰交對圍絕經(jīng)期綜合征患者生殖內(nèi)分泌影響的隨機(jī)對照研究[J];針刺研究;2007年04期

，

本文編號：2108490