| Background:Adenomyosis is manifested with progressive aggravation of dysmenorrhea,increased menstrual flow,prolonged menstruation,infertility and uterine enlargemen toccurring predominantly in women at reproductive stage.Its morbidity ranges from 8%to 62%and the severe dysmenorrhea is one of the problems to be solved urgently.There is no effective therapy to cure it.The drawback of surgery or western medicine treatment is high recurrence rate.Acupuncture therapy is effective for pri-mary dysmenorrhea exactly and scarcelyinhibit ovarian ovulation.Therefore,the research is aimed for the secondary dysmenorrhea caused by adenomyosis to investigate the analgesic action of acupuncture.Objective:To explore the evidence-based basis for acupuncture therapy of adenomyosis through the systematic review.To explore the analgesic effect of the acupunctu retherapy based on disease location and pathogenesis through a prospective case series study of clinical trials,to analyze of the correlation among clinical manifestations(pain,dysmenorrhea symptom,mens-trual flow),quality of life,and uterine volume,and to investgate the the-rapeutic effect of this regimen.Methods:Study I Literature study A Systematic Review of Acupuncture Therapy for AdenomyosisAccording to the inclusion and exclusion criteria,the search strategy was formulated,and the database was searched domestically and abroad.The time limit was selfbuil tuntil Nov.2017.The efficacy index of acupuncture treatment for adenomyosis was analyzed to evaluate its effectiveness.The databases searched include:4 Chinese databases CBM,CNKI,VIP,Wanfang and 3 English databases Pubmed,Embase,and Cochrane Library.The search form adopts the form of "Disease AND Therapy".The name of the disease used adenomyosis,adenomyosis,adenomyosis,etc.The therapies used acupuncture,moxib-ustion,auricular acupuncture,acupuncture and medicine.Cochrane Handbook version 5,2.0 ROB tool was used toassess to the risk of bias and Revman5.3was used to meta analysis,and then GRADE pro 3.6 was uesd to evaluate the quality of evidence.Study Ⅱ Clinical Study A Prospective Case Series Study of Acupuncture Treatment for Secondary Dysmenorrhea of AdenomyosisThis study is a basic research project for graduate students of Beijing University of Chinese Medicine and approved by the Dongzhimen Hospital of BUCM.According to the results of census concerning to treatment tendency among patients suffered from secondary dysmenorrhea of adenomyosis,it is necessary to adopt a design scheme of prospective case series study to dynamically observe the characteristics of efficacy as to explore the effective regimen of acupuncture therapy.The patients with moderate to severe dysmenorrhea,were comprehensive collected their medical records,received acupuncture treatment for continu-ous 3 menstrual cycles,repeated measured the same indicators for each cycleto focuse on the analgesic effect,and explore the efficacy changes of dysmenorrhea symptoms,quality of life.The change in size of the uterus in orderto analyze the effect of acupuncture analgesia,to explore the correlation between dysmenorrhea symptoms,menstrual flow,quality of life and uterine volume.1 Treatment regimen1.1 AcupointsBased on the basic pathogenesis of "promoting blood to remove stasis,disharmony of thorough vessel and conception vessel",and based on the perio-dic characteristics of menstruation,Renmai and Foot Taiyin spleen meridian points were selected,and different acupoint prescriptions were used during menstrual period and non-menstrual period.Non-menstrual period:Take CV4,EX-CA1,SP6 and ST36 as the main points,and empirically add SP8,LR4,deficiency syndrome plus SP10,KI3.Menstrual period:Take SP 8,SP6,BL32,EX-B8.1.1 Treatment time and course of treatmentEach treatment for 30 minutes,non-menstrual treatment twice a week,menstrual treatment once a day.The end of the first menstruation(non-menstrual period)after the enrollment was used as the starting point of treatment,followed by 3 menstrual cycles(ie 1 course of treatment).2 Observation indicators and evaluation time2.1 Main outcome indicatorsThe degree of pain(the VAS score at the time of the most painful period).2.2 Secondary outcome indicatorsDysmenorrhea symptoms scale(CMSS),menstrual volume score(PBAC),quality of life scale(EHP-5),uterine volume.2.3 Evaluation timeVAS,CMSS,EHP-5,and PBAC 4 indicators were collected at baseline and during the 1st,2nd,and 3rd cycles of treatment.Uterine volume index,at the baseline period,the treatment of the 3rd cycle,a total of two time points for data collection.3 Statistical methodsApply SPSS20.0.Measured data were described as mean ± standard deviation(x±s).Repeated measurements were analyzed using univariate analysis of variance,and two consecutive variables were analyzed using Pearson or Spearman correlation coefficients.The counting data adopts frequency and composition ratio description.P<0.05 indicates that the difference was statistically significant.Results:Study Ⅰ Literature study1 Include literature overview327articles(320 in Chinese and 7 in English)were eventually searched.After reading titles,abstracts,and full texts.14RCTs were probable after screening and exclusion,of which 2 were the same study and a total of 13RCTs were included.All domestic reports were reported.The diagnostic criteria and efficacy criteria were different.The sample size was small and none of the sample sizes were described.Control designs included:acupuncture combined with western medicine,acupuncture and medicine,and simple medicine(Chinese medicine/Chinese patent medicine,or western medicine).2 Result analysisQuantitative analysis:The overall curative effect of acupuncture or acupuncture combined with western medicine was better than that of western medicine.The overall effect of acupuncture combined with traditional Chinese medicine/Chinese traditional medicine was equivalent;the effect of acupuncture treatment was to improve dysmenorrhea symptoms and TCM syndromes,and had little effect on uterine volume.Qualitative analysis:Acupuncture almost no adverse reactions,and hormones might be hot flashes,vaginal bleeding and other adverse reactions.At present,almost all were dysmenorrhea,there was no research on pregnancy outcomes.Acupoint analysis:The Spleen Meridian and Renmai acupoints were selected,and the main point used was SP6(9/13),which used acupuncture with multiple needles;other commonly used main points included CV4(8/13),EX-CA1(6/13),and ground.SP8(5/13),CV-3(5/13).The treatment start time started from about the first week to the first 1-5 days of menstrual cramps(6/13),only during the non-menstrual period and stopped at the menstrual period(5/13).3 Quality EvaluationThe overall efficacy and main outcome measures(pain severity,dys-menorrhea symptom scores)were of low or very low body mass,which might limit the accuracy and extrapolation of the conclusions.Study Ⅱ Clinical Study1 Result analysisA survey of patients’ treatment tendencies has found that most of them expressed their preference for western medicine,while those who chose Chinese medicine had conflict with western medicine.Western medicine control subjects had difficulty recruit-i ng;aboutone third of patients had no symptoms of dysmenorrhea.A total of 36 patients were included in clinical trials for clinical studies,5 were s hedding,and 1 was excluded.Finally,a total of 30 effective cases were included in the statistical data,with an average age of(36.53±5.24)years,duration(4.1±2.86)years,and mean menstrual period(At 6.22±1.34 days,the pain VASscore was average(81.67±12.06),and the menstrual pain duration was(6.17±1.88)days.1.1 Key observationsPain VAS score:The VAS of the 1st,2nd and 3rd cycles of treatment were significantly lower than before treatment(P<0.01),and the 2nd and 3rd cycles were lower than the 1st and 2nd cycles,respectively(P<0.05).1.2 Secondary observationsCMSS:The 1st,2nd and 3rd cycle of CMSS were significantly lower than before treatment(P<0.01),and the 2nd and 3rd cycles were significantly lower than the 1st and 2nd cycles,respectively(P<0.01).PBAC:①Overall:PBAC in the 1st,2nd,and 3rd cycle of treatment was lower than before treatment,and the 2nd and 3rd cycles were lower than the 1st and 2nd cycles respectively,but the difference was not statistically significant(P>0.05).②Stratification:statistics were made for menorrhagia(PBAC>100,18cases)and normal or lesser(PBAC≤100,12cases).In menorrhagia,PBAC in the 1st,2nd,and 3rd cycles of treatment was significantly lower than before treatment(P<0.01),but the 2nd and 3rd cycle s were lower than the 1st and 2nd cycles respectively,with no statistically significant difference(P>0.05),with less menorrhagia or normal.PBAC during the 1st,2nd,and 3rd cycles of treatment was higher than before treatment,and the 2nd and 3rd cycles were higher than the 1st and 2nd cycles,respectively,but the difference was not statistically significant(P>0.05).EHP-5:The EHP-5 levels in the 1st,2nd,and 3rd cycles of treatment were lower than those before treatment(P<0.05),and the 3rd cycle was lower than the 2nd cycle(P<0.05),but there was no statistical difference in the 2nd cycle compared with the 1st cycle(P>0.05).The volume of uterus:the mean value was(145.54±104.02)cm3 before treatment and(136.55±84.90)cm3 after treatment.The volume of uterus decreased before and after treatment,but the difference was not statistically significant(P>0.05).2 Analysis of the correlation between clinical manifestations,quality of life,and uterine volumeThere was a significant positive correlation between CMSS and EHP-5 at 0.01 le vel,and there was no significant correlation between VAS and CMSS and EHP-5.There was no significant correlation between uterine volume and VAS,CMSS,EHP-5 and PBAC.Conclusions:1 The acupuncture regimen has a significant effect on the secondary dysmenorrhea of adenomyosis,relieves the symptoms of menstrual discomfort,regulates the menstrual flow,and improves the quality of life.With the extension of treatment time,the curative effect is gradually enhanced.2 Acupuncture has no significant effect on the reduction of uterine volume,but there is no significant correlation between uterine volume and the severity of clinical manifestations and quality of life.3 There is a significant positive correlation between the severity of dysmenorrhea symptoms and quality of life in patients with adenomyosis.The results of this clinical study are basically consistent with the results of the literature.Both show that acupuncture treatment of adenomyosis has the advantages of analgesia,alleviation of symptoms,and improvement of quality of life. |
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