| ObjectivePolycystic ovarian syndrome(PCOS)is the most common endocrine disorder with complex pathogenic factors and diversified clinical manifestations in women of childbearing age.At present,Western medicine is the first choice for the treatment of PCOS patients with clinical symptoms and medical needs.Ovulation-promoting drugswhichis the first choice for medical treatment for the clinical symptoms and medical needs of PCOS patients are the most widely used.Since drug treatments cannot avoid side effects such as premature ovarian failure,dizziness,and vomiting,clinical research has been exploring a more efficient,safe,easy to promote treatment.Acupuncture is ancharacteristic diagnosis and treatment method in traditional Chinese medicine in China.There are so many scholars had been attracted the attention by its special treatment method and high safety,and it has been continuously treating PCOS patients with Western medicine.Forensic medicine is an important subject that seeks clinical research evidence mainly through systematic reviews and meta-analysis.Its evidence level belongs to the highest level of medicine,and it is fully persuasive and authoritative.In this study,Meta-analysis was used to systematically and comprehensively retrieve the evidence of the therapy which is acupuncture combined with ovulation-promoting drugs applied to treat the PCOS patients,and the author analyzes the effective rate,insulin resistance rate,miscarriage rate,pregnancy rate,cycle ovulation rate,acupuncture point usage,etc,as well as project implementation and research design.Deficiencies,provide follow-up clinical research for medical evidence and practical reference.MethodsAccording to the requirements of evidence-based medicine for literature search,the author conducts data sorting,analysis and evaluation,and result discussion on the included materials that meet the standards,including the following contents.Literature search:The author uses a computer to search data in EBSCOhost Research Databases(EBSCOhost),Pub Med of National Center for Biotechnology Information(Pub Med),CNKI,Wiley Online Library,Springer Link,Wan Fang DATA,Science Direct and other databases,and collect the literature about acupuncture combined with ovulation promoting therapy for polycystic ovary syndrome published in domestic and foreign from January 1999 to January 2020.The search strategy adopts the combination of subject words and free words,screens the documents that meet the inclusion and exclusion criteria one by one,and supplements the leak search with manual search.The search terms are Acupuncture Therapy?Acupuncture Treatment?polycystic ovary?Acupotomy?electroacupuncture?letrozole?Ovulation induction drugs?polycystic ovary syndrome.Data extraction and analysis:The author organized two staff to evaluate the included literature according to the research requirements,and extract the literature information by reading the full text and matching the literature entry criteria one by one.If you encounter documents that cannot be judged or are controversial,they will be submitted to the third staff for comprehensive evaluation.The modified Jadad score scale recommended by the Cochrane collaborative organization was used to assess the risk bias of the generation of random sequences.R3.4 software was used for meta-analysis of the data.The analysis results of measurement data and enumeration data are expressed by relative ratio(RR)and mean difference(MD)respectively.The author uses the Q test and I~2 test to evaluate the heterogeneity of the included literature,and uses the Egger's test to quantitatively evaluate the publication bias of the research results,and uses the funnel plot to macro-evaluate its publication bias.The analysis indicators include the main indicators and secondary indicators,the main indicators are the effectiveness of clinical symptoms changes,pregnancy rate,insulin resistance index,etc.The secondary indicators are body mass index,incidence of adverse reactions,acupoints included in the literature Frequency of use,etc.Results(1)A total of 34 studies were included this time,including 2 studies abroad.The subjects included in the study were all patients with PCOS,including 24 patients with normal PCOS(70.59%),5 patients with obese PCOS(14.71%),2 patients with clomiphene PCOS(5.88%),and 2 patients with kidney deficiency PCOS(5.88%)%),1patient with phlegm-dampness PCOS(2.94%).There were 6 electroacupuncture methods(17.65%)and 28 general acupuncture methods(82.35%)in the treatment group.The sample size included in the study was between 25-500.A total of 3399 subjects were included in this study,including 1711(50.34%)in the treatment group and1688(49.66%)in the control group.In terms of total bias risk assessment,64.71%had a total score of greater than 3 in the risk of bias assessment,and 35.29%had a total score of less than or equal to 3 points.(2)In terms of frequency of acupuncture points more than 10 times are Sanyinjiao30(8.62%),Guanyuan 26(7.47%),Zhongji 26(7.47%),Uterus 24(6.90%),etc,and with acupoint frequency between 5 and 10 times are Zhongwan 9(2.59%),Ganshu 9(2.59%),Tianshu 9(2.59%),Guilai 8(2.30%).(3)In terms of efficiency,the effective RR of acupuncture combined with ovulation in the treatment of PCOS patients is 1.35(95%CI:1.24?1.48).Subgroup analysis of different intervention types had been found that the effective RR of the electroacupuncture group was 1.28(95%CI:1.12?1.46);the effective RR of the ordinary acupuncture group was 1.39(95%CI:1.24?1.56).(4)In terms of pregnancy rate,the RR of pregnancy rate of PCOS patients treated with acupuncture and ovulation inducing drugs was1.74(95%CI:1.54?1.97).It had been found that the pregnancy rate RR of the electroacupuncture group was1.71(95%CI:1.29?2.26);the pregnancy rate RR of the general acupuncture group was 1.75(95%CI:1.52?2.01).(5)The ovulation rate RR of PCOS patients was 1.34(95%CI:1.16?1.53)which was treated with acupuncture and ovulation inducing drugs.Subgroup analysis of different disease types had been found that the ovulation rate RR of the normal PCOS was 1.35(95%CI:1.10?1.65),and the ovulation rate RR of the obese PCOS group was1.58(95%CI:1.02?2.45);different subtypes of intervention Group analysis found that the ovulation rate RR of the electroacupuncture group was 1.45(95%CI:1.18?1.79);the ovulation rate RR of the ordinary acupuncture group was 1.32(95%CI:1.12?1.55).(6)In terms of insulin resistance,the insulin resistance rate of PCOS patients treated with acupuncture combined with ovulation inducing drugs was0.62(95%CI:0.41?0.93).In terms of miscarriage rate,the RR of abortion rate for PCOS patients treated with acupuncture and ovulation inducing drugs was 0.99(95%CI:0.65to 1.51),and there were not statistically significant between the acupuncture and ovulation inducing drugs group and the ovulation inducing group(P>0.05).(7)In terms of adverse reaction rate,the adverse reaction rate RR of PCOS patients treated with acupuncture and ovulation inducing drugs was 0.56(95%CI:0.37?0.84).And there was statistically significant between the acupuncture combined with ovulation inducing group and the ovulation inducing group for the adverse reaction rate(P<0.05).(8)In terms of LH/FSH,the MD of LH/FSH after treatment of PCOS patients with acupuncture combined with ovulation inducing drugs was-0.72(95%CI:-0.85?0.60)Subgroup analysis of different disease types had been found that the MD of LH/FSH after treatment in the normal PCOS group was-0.73(95%CI:-0.89?-0.57),and that in obese PCOS group after treatment was LH/The MD of FSH is-0.70(95%CI:-1.23?0.18);subgroup analysis of different intervention types found that the MD of LH/FSH after treatment with electroacupuncture group was-0.64(95%CI:-0.87?0.41)).The MD of LH/FSH after treatment in the general acupuncture group was-0.74(95%CI:-0.88?-0.60).(9)For testosterone,the MD of testosterone after treatment of PCOS patients with acupuncture combined with ovulation inducing drugs was-0.31(95%CI:-0.40?0.22).It had been found that the MD of testosterone after treatment in the normal PCOS group was-0.27(95%CI:-20.39?0.16)from subgroup analysis,and the MD of testosterone after treatment in the obese PCOS group was-0.62(95%CI:-1.04?-0.20);it had been found that the MD of testosterone after treatment with electroacupuncture group was-0.19(95%CI:-0.30?-0.09);the MD of testosterone after treatment with ordinary acupuncture group was-0.37(95%CI:-0.49-0.25).(10)In terms of BMI,the MD of BMI after treatment of PCOS patients with acupuncture combined with ovulation inducing drugs was-1.57(95%CI:-1.74-1.40).It had been found that the BMI MD of the normal PCOS group was-2.55(95%CI:-3.33-1.77)from subgroup analysis of different disease types,and the BMI MD of the obese PCOS group was-2.42(95%CI:-469-0.15);subgroup analysis of different intervention types found that the BMI MD of the electroacupuncture group after treatment was-1.32(95%CI:-2.45?-0.19);the BMI MD of the ordinary acupuncture group after treatment was-2.65(95%CI:-3.69?-1.61).(11)In terms of HOMA-IR,the MD of HOMA-IR after treatment of PCOS patients with acupuncture combined with ovulation inducing drugs was-0.44(95%CI:-0.86?-0.02).It had been found that the MD of HOMA-IR after treatment in the normal PCOS group was-0.01(95%CI:-0.61?0.64)from subgroup analysis of different disease types,and that was-0.55(95%CI:-0.73?-0.37)in the obese PCOS group after treatment.Conclusion1.A systematic review and META analysis of clinical research literature on the application of acupuncture combined with western medicine for PCOS in the past 20years,suggesting the efficacy of acupuncture combined with ovulation promoting drugs in the treatment of PCOS patients is higher than that of ovulation-stimulating drugs alone.2.The effect of acupuncture combined with ovulation promoting drugs in the treatment of non-obese PCOS patients is significantly higher than that of obese PCOS.The electroacupuncture intervention group was higher than the ordinary acupuncture group in terms of promoting ovulation efficiency,but lower than the ordinary acupuncture group in terms of pregnancy success rate.3.The frequency analysis of acupuncture points in the treatment of PCOS patients with acupuncture combined with ovulation-stimulating drugs,using Sanyinjiao,Guanyuan,Zhongji,Zigong,Qihai and Zusanli as high-frequency acupuncture points.Due to the small sample size of some studies,the low risk bias evaluation scores of some included studies,and the limitation of the depth of the article report,the lack of analysis of the amount of acupuncture stimulation during treatment cannot rule out the existence of potential publication bias and information bias.Therefore,the follow-up study can focus on the effects of different acupuncture stimuli which including acupuncture manipulation,acupuncture depth,acupuncture manipulation on the effect of PCOS combined treatment.At the same time,it can be used in Hong Kong to promote the treatment of PCOS with integrated Chinese and Western medicine,especially for treatments such as artificial insemination IUI and IVF provide new ideas for the treatment of PCOS in Chinese and Western medicine. |
PDF Full Text Request