| Objective:Polycystic ovarian syndrome(PCOS)is the most common endocrine disorder which could cause ovulatory dysfunction among reproductive-aged women.Abdominal obesity is not only a common cause of PCOS,but also an aggravating factor of ovulatory dysfunction and metabolic disturbance.Our previous studies have found that regulation of Dai Meridian with acupuncture can significantly reduce visceral fat in abdominal obesity patients and improve metabolic disorders.The early continuous decline of visceral fat is directly related to the improvement of ovulation in PCOS patients.We did this research to explore the effect of regulating Dai Meridian with acupuncture on restoring ovulation in PCOS patients with abdominal obesity.This study investigated the effect and possible mechanism of regulation of Dai Meridian with acupuncture in the treatment of PCOS patients with abdominal obesity,and we wanted to optimize the therapy of this disease and provide an idea for further research.Methods:This research included two parts,the clinical trial and the animal experiment.In the clinical trial,we conducted a randomized controlled trial.The subjects were randomly divided into the control group and the treatment group according to a ratio of 1:2,and the control group received lifestyle modification,while the treatment group received lifestyle modification with acupuncture therapy.The primary outcome measure was the rate of recovered ovulation,and the secondary outcome measures included the improvement of ovulation,menstruation,clinical features,sex hormone level,ultrasonography characteristics of ovarian and the body fat parameters.In the animal experiment,the SD female rats were randomly divided into control group and PCOS model group,and the PCOS model was established by letrozole administration by gavage.After the 21 days letrozole administration,the PCOS model rats were randomly divided into model group,2Hz electroacupuncture group and 2/100 Hz electroacupuncture group.The two treatment groups received 2Hz electroacupuncture treatment and 2/100 Hz electroacupuncture respectively and the duration of treatment was 2 weeks.The morphology of ovary,the kisspeptin protein in hypothalamus and serum hormone level were detected.We did this animal experiment to explore the possible mechanism of regulating Dai Meridian with electroacupuncture in the improvement of ovulation.Results:The clinical trial results:(1)Differences were existed between the two groups in the changes from prior-treatment to posttreatment.The rate of recovered ovulation was higher in the treatment group than the control group(40.00%vs.6.67%,P<0.05),as well as the increase of ovulation frequency(0.20±0.51 vs.-0.02±0.38,P<0.05).Meanwhile the treatment group has a significant decrease in the waist(-3.23±3.44 vs.-1.25±3.45,P<0.05)and waist to height ratio(-0.02±0.02 vs.-0.01 ±0.02,P<0.05)compared with the control group.(2)Differences were existed between prior-treatment and posttreatment in each group.The GAGS score,body weight,BMI,body fat ratio and basal metabolic rate were declined when compared the post-intervention condition with the pre-intervention one in the control group(P<0.05).The GAGS score,body weight,BMI,basal metabolic rate,menstrual cycle,menstrual period,LH,LH/FSH,T,FINS,waist,hip circumference,waist-to-height ratio and waist-hip ratio were all decreased with the ovulation frequency and menstruation frequency increased,when compared the post-intervention condition with the pre-intervention one in the treatment group(P<0.05).However,there was no difference in the change of body fat rate.(3)The correlation between ovulation frequency improvement and the change of LH was found in the control group(correlation coefficient-0.309,P<0.05).Meanwhile,the correlation between ovulation frequency improvement and the change of IPAQ was found in the treatment group(correlation coefficient 0.337,P<0.05).The animal experiment results:(1)The PCOS rat model was established successfully,with the requirements of the increasing number of cystic and atretic follicle and the decreasing number of normal follicle and corpus luteum in ovaries showed by HE staining,and the necessity of the increasing expression of T level.The level of serum LH,the expression of kesspeptin protein in hypothalamus and the body weight were also increased in the model group compared with the control rats(P<0.05).(2)The level of T,LH and kisspeptin protein were significantly decreased in the two treatment groups compared with the model group(P<0.05).The number of cystic follicle and the level of FSH were increased in the 2Hz electroacupuncture treatment group(P<0.05),while the number of cystic follicle and the level of estradiol were decreased in the 2/100 Hz electroacupuncture treatment group(P<0.05).Conclusions:Regulation of Dai Meridian with acupuncture was effective in restoring ovulation,increasing the ovulation frequency and reducing the waist circumference.When combined with lifestyle modification,it was effective in improving the level of ovulation,steroid hormone,insulin and body fat parameters.Regulation of Dai Meridian with acupuncture combined with lifestyle modification was an effective therapy for PCOS patients with abdominal obesity,and the mechanism for improving ovulation may be related to the decrease of serum LH concentration.When GB26 points were stimulated with electroacupuncture,it could improve the serum hormones and the kisspeptin protein level in hypothalamus.There were differences on the ovarian morphology and serum hormone level between the 2Hz electroacupuncture and 2/100 Hz electroacupuncture treatment group.Therefore,different mechanisms may be involved in these two different electroacupuncture methods. |
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