【作者】 貌杨萍；

【导师】 伦新；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 硕士

【摘要】 免疫性不孕约占女性不孕症患者的10%～30%,可分为同种免疫性不孕和自身免疫性不孕,同种免疫性不孕由抗精子抗体(AsAb)所致,自身免疫性不孕主要由不孕妇女血清中的抗子宫内膜抗体和透明带抗体引起。目前西医主要通过类固醇药物、避孕套疗法、人工授精法及体外授精与胚胎移植法帮助受孕,但疗效不够满意,并存在副作用大、费用高等缺点。近年来,中医药在免疫性不孕的治疗方面常获满意疗效,并且中医药副作用低,费用少,因此得到广大患者的认可。许多研究表明,中药对于免疫性不孕具有较佳临床疗效,而针灸对于人体免疫调节也有良好的作用。但将针灸与中药相结合治疗女性免疫性不孕的报道较少,同时针药结合疗法的获效机理也不十分清楚,这都成为进一步发挥中医药在免疫性不孕的治疗优势的障碍。目的：本研究拟从神经调节的角度出发,通过临床观察和动物试验两方面的综合研究,分别采用针灸配合中药治疗(治疗组)和中药治疗(对照组)的方法进行治疗,根据受试对象治疗前后血清AsAb、β-内啡肽(β-EP)等免疫学及神经递质相关指标的变化,以及患者最后妊娠的情况,旨在观察针药治疗免疫性不孕的临床疗效及部分作用机理。方法：1.临床研究。按随机对照的原则,将符合本研究纳入标准的患者分为针刺组30例和中药对照组30例。两组患者均服用归肾丸(熟地黄、菟丝子各30g,女贞子、山药各15g,枸杞子、首乌、桑寄生各20g,山茱萸、淫羊藿各10g组成。加减：偏血瘀者,加三七15g,丹参30g；若偏气虚者,加党参15g,黄芪30g；若兼有生殖道炎症者,加用蒲公英30g),每日1剂,水煎,分2次服,3个月为1疗程,治疗1～2个疗程。治疗组在中药治疗的基础上给予针刺,主穴选肾俞、三阴交、太溪。配穴：血瘀者配内关、膈俞；气虚配足三里、关元；生殖道炎症配丰隆。一周治疗2次,疗程同上。2.动物实验。将55只雌性大鼠中随机分成5组,分别为健康空白组8只,阳性空白组8只,中药组13只,针刺组13只,针药组13只。于除健康空白组以外的SD大鼠双侧腹股沟及颈背部多点皮下注射1ml抗原作为首次免疫。未产生AsAb者于首次免疫第2周用同样方法加强免疫一次。健康空白组大鼠在造模大鼠免疫同时于双侧腹股沟及颈背部多点注射生理盐水,每只每次1ml。造模成功后开始给药,连续给药4周。中药组及针药组的SD大鼠采用归肾液灌胃,剂量为每日4ml；健康空白组灌以相同容量的生理盐水。针刺组及针药组开始针刺,将大鼠固定在鼠夹,针刺肾俞、三阴交、太溪,每次留针20 min,每天1次,连续4周。结果：临床研究中,针药组的临床疗效总有效率、ASAb的转阴率及妊娠率分别为93.33%、56.67%、36.67%,中药组组的临床疗效总有效率、ASAb的转阴率及妊娠率分别为86.67%、30%、13.33%,以及两组治疗前后血清ASAb下降水平的差异,均有统计学意义。动物实验中,针药组、中药组与阳性空白组治疗后血清β-EP水平比较,针药组与中药组治疗后血清β-EP水平比较,均有统计学意义。结论：1.本研究中采用ELISA法测定血清AsAb水平,借助实验室检查指标诊断免疫性不孕症,用西医的诊断技术,克服中医免疫性不孕症诊断的不足。2.治疗后结合现代医学诊疗手段判断疗效,检测血清ASAb下降水平,同时观察患者妊娠情况,发现针药组治疗免疫性不孕症疗效确切,能促进患者受孕。3.针药通过调节β-EP的分泌,从而通过NIM网络调节生殖免疫功能,抑制ASAb的产生,改善患者体内生殖免疫环境。4.针药结合治疗比单纯中医或西医治疗效果佳,值得推广应用。更多还原

【Abstract】 Immune infertility accounts for about 10% to 30% in female infertility, can be divided into Alloimmune infertility and Autoimmune infertility. Alloimmune infertility is caused by the AsAb, while Autoimmune infertility is mainly caused by anti-endometrial antibody and zona pellucida antibodies in serum of Infertility. Currently, western medicine mainly help conception through steroids, condom therapy, artificial insemination and in vitro fertilization method and embryo transplant, but the effect is not satisfied and it has the shortcomings of side effects and high cost. In recent years, traditional Chinese medicine in the treatment of immune infertility often makes satisfactory effect, and the majority of patients receive the recognition because of the low side effects and less cost. Many studies show that traditional Chinese medicine for immunological infertility have a better clinical effect, also the effect of acupuncture on the human body immune function is good.But the report which combines acupuncture and traditional Chinese medicine to treat the feminine immune infertility is very few, and the effect mechanism of combined therapy is not very clear. And for that Chinese medicine in immune infertility treatment superiority will be impeded.Objective:This research starts from the perspective of neuromodulation. With clinical observation and animal experiments, we adopt acupuncture with herbal treatment or herbel treatment for patients. After treatment, we observe the clinical curative effect and part of the mechanism on immune infertility by acupuncture.Method: 1. Clinical research. This study divide the patients who accord with the acceptable standards, in accordance with the principle of randomized controlled, into’Acupuncture with Herbal treatment’treatment group with 30 and’Traditional Chinese medicine’control group with30. Both two groups take traditional Chinese medicine’Guishen liquid’(Ripe rehmannia glutinosa 30g, dodder 30g,Ligustrum lucidum 15g,Chinese yam 15g, Medlar 20g,Shou Wu 20g, loranthus parasiticus 20g, dogberry 10g, herba epimedii 10g;add-subtract: partial blood stasis, add panax notoginseng 15g, Salvia miltiorrhiza 30g;if partial deficiency, add Codonopsis 15g, Astragalus membranaceus 30g;genital tract inflammation, add dandelion 30g), once a day, decoction, drink it in the morning and night, three months per course, a total of 1-2 courses. The treatment group also take acupuncture, the main points are Shenshu, Sanyinjiao, Taixi, add-subtract:blood stasis, add Geshu;if partial deficiency, add Zusanli, Guanyuan;genital tract inflammation, add Fenglong. Once every other day,30 minutes keeping every time, three months per course, a total of 1～2 courses.2. Animal experiments.55 female rats are randomly divided into 5 groups, healthy control group8, positive control group 8, traditional Chinese medicine group 13, acupuncture group 13, acupuncture with herbal group13. Injecting lml antigen in some points in bilateral inguinal and neck back of each SD rat as the first immunization except the healthy control group. AsAb who has not been created in the first immunization should be intensified in the same way in next week. At the same time, injecting lml NS in some points in bilateral inguinal and neck back of the healthy control group, 1ml per each rat.After the modeling, we will start to give rats medicine for 4 weeks. Traditional Chinese medicine group, Acupuncture with herbal group are fed 4ml Guishen liquid daily, the healthy control group are fed 4ml NS daily. Acupuncture group, Acupuncture with Chinese medicine group start acupuncture. The rats are fixed on the rat trap, acupuncture Shenshu, Sanyinjiao, Taixi,30 minutes keeping every time,1 time per day for 4 weeks.Results:Clinical research:In the treatment group,the total clinical effects is 93.33%, the negative rate of ASAb is 56.67%, and the pregnancy rate is 36.67%. In the control group, the total clinical effects is 86.67%, the negative rate of ASAb is 30%,and the pregnancy rate is 13.33%. and the levels of serum anti-sperm antibodies (ASAb) in the two groups after treatment has decreased. All are significant. Animal experiments:After treatment, the compares of serumβ-EP between Acupuncture with herbal group, Chinese medicine group and positive control group are significant, the compare of serumβ-EP between Acupuncture and Chinese medicine group and Chinese medicine group is also significant.Conclusion:1. This study adopts ELISA method for detection of serum ASAb. Using laboratory diagnosis immunity infertility index, with western medicine diagnosis technology,We overcome the shortage of Chinese medicine diagnosis of immune infertility.2. After treatment, combining modern medical diagnosis, we detect the level of serum ASAb and observe whether patients are pregnant. We find that the treatment of immune infertility in treatment group is effective, it can promote pregnancy.3. Acupuncture and Chinese medicine can adjustβ-EP, thereby adjust reproductive immune function by NIM, inhibit the generation of ASAb to improve patient reproductive immune environment.4. Combined treatment of Acupuncture and Chinese medicine is better than simply Chinese medicine and Western medicine treatment. It is worth to generalize and apply as treatment method.更多还原