Meta Analysis And Clinical Study Of Cupuncture And Moxibustion In The Treatment Of Thin Endometrium

Thin endometrial thickness means that the thickness of endometrium is lower than the threshold thickness of pregnancy.The incidence of thin endometrium in ART was about 2.4%.Thin endometrium is related to endometritis,the use of clomiphene or contraceptives,or iatrogenic procedures.There are still some patients with thin endometrium with unknown causes.Too thin endometrium will affect embryo implantation and reduce the success rate of assisted reproductive technology.The 2019 Canadian fertility and andrology Association guidelines believe that doctors should recommend canceling the transplant cycle for patients with thin endometrium.Interventions for thin endometrium mainly include high-dose estrogen,low-dose aspirin,sildenafil,pentoxifylline,intrauterine perfusion of granulocyte colony stimulating factor,etc.At present,there is no effective treatment to thicken the thin endometrium and improve the clinical outcome of subsequent embryo transfer.Therefore,thin endometrium is still a hot and difficult issue in reproductive medicine research.Previous studies have found that acupuncture combined with drugs in the treatment of thin endometrium can increase the thickness of endometrium.This study intends to systematically evaluate the previous randomized controlled trials of acupuncture and medicine in the treatment of thin endometrium,in order to provide evidence support for the effectiveness of acupuncture and medicine in the treatment of thin endometrium.In the previous randomized controlled trial studies,most of the intervention measures involved were acupuncture and moxibustion combined drugs,and the single acupuncture therapy was not used as the intervention measure.The effectiveness of acupuncture in the treatment of thin endometrium has not been determined.Therefore,this study continued to carry out a prospective case series study of acupuncture in the treatment of thin endometrium to observe the clinical efficacy of acupuncture on thin endometrium.Objective:(1)this study used meta-analysis to evaluate the effectiveness of acupuncture and moxibustion in the treatment of thin endometrium,in order to provide evidence-based medical support for the effectiveness of acupuncture and moxibustion in the clinical treatment of thin endometrium.(2)To evaluate the efficacy of simple acupuncture in the treatment of thin endometrium through case series study.Methods:(1)Seven databases including CNKI and Cochrane library are searched by computer,and the retrieval time limit is from the establishment of the database to December 1,2021.RCTs meeting the inclusion criteria were screened,and rob(risk of bias)was used to evaluate the methodological quality of the original study.Revman5.3 was used for meta-analysis.(2)In a prospective case series study,40 patients with thin endometrium were treated with acupuncture for 3 months,a total of 36 times.The primary efficacy index was endometrial thickness,and the secondary efficacy indexes included PI,RI,S/D,VI,fi,VFI and CPR.The effect of acupuncture on thin endometrium was evaluated by comparing the changes of each index at the end of 3 months.Results:(1)the results of meta-analysis showed that:① endometrial thickness:compared with western medicine,acupuncture combined treatment can significantly increase the endometrial thickness of patients with thin endometrium(MD=1.26,95%CI[0.59,1.94],z=3.65),P=0.0003).We did a subgroup analysis and found that acupuncture+western medicine and acupuncture+Chinese herbs+western medicine were better than hormone therapy alone in increasing endometrial thickness(MD=1.15,95%CI[0.36,1.93],z=2.85,P=0.004;MD=1.23,95%CI=[0.14,2.33],z=2.21,P=0.03),acupuncture+Chinese medicine is not superior to estrogen alone(MD=1.49,95%CI[-0.45,3.43],z=1.51,P=0.13).②type A endometrial ratio:compared with western medicine,acupuncture combined treatment can significantly improve the proportion of type a endometrium(RR=1.59,95%CI[1.37,1.84],z=6.15,P<0.00001).We did a subgroup analysis,the results of subgroup analysis showed that acupuncture+western medicine and acupuncture+Chinese herbs+western medicine were better.(RR=1.70,95%CI[1.15,2.51],z=2.68,P=0.007,RR=1.74,95%CI[1.44,2.11],z=5.66,P<0.00001).acupuncture+Chinese herbs is not superior to estrogen alone(RR=1.17,95%CI[0.72,1.91],z=0.63,P=0.53).③ RI index:compared with western medicine,acupuncture combined treatment can significantly reduce RI index(MD=-0.13,95%CI[-0.20,-006],z=3.75,P=0.0002).Subgroup analysis showed that acupuncture+western medicine,acupuncture+Chinese herbs,acupuncture+Chinese herbs+western medicine were better than western medicine treatment(MD=-0.18,95%CI[-0.36,-0.01],z=2.03,P=0.04;MD=-0.12,95%CI[-0.18,-0.06],z=4.13,P<0.0001;MD=-0.12,95%CI[-0.18,-0.05],z=3.57,P=0.0004).④PI index:compared with western medicine,acupuncture combined treatment can significantly reduce PI index(MD=-0.23,95%CI[-0.31,-0.16],z=5.92,P<0.00001).Through subgroup analysis,the results showed that acupuncture+western medicine,acupuncture-+Chinese herbs,acupuncture+Chinese herbs+western medicine were better than simple western medicine treatment(MD=-0.22,95%CI[-0.23,-0.21],z=51.52,P<0.00001;MD=-0.28,95%Ci[-0.56,-0.01],Z=2.01,P=0.04;MD=-0.21,95%CI[-0.28,-0.14],Z=5.97,P<0.00001).⑤CPR:acupuncture combined with drug therapy increased clinical pregnancy rates compared with hormone therapy alone(RR=1.81,95%CI[1.55,2.12],z=7.47,P<0.00001).The subgroup analysis showed that in terms of CPR,the curative effects of acupuncture+Chinese herbs,acupuncture+western medicine group and acupuncture+Chinese herbs+western medicine group were better than those of western medicine(RR=1.69,95%CI[1.13,2.52],z=2.57,P=0.01;RR=1.72,95%CI[1.24,2.39],z=3.24,P=0.001;RR=1.94,95%CI[1.57,2.41],z=6.09,P<0.00001).(2)Prospective case series study on acupuncture treatment of thin endometrium:① endometrial thickness:the results of this study showed that compared with the baseline period,the endometrial thickness of 40 patients with thin endometrium increased significantly after 3 months of acupuncture treatment(P<0.001).②Uterine artery blood flow:compared with the baseline period,the PI,RI and s/d values of 40 patients with thin endometrium decreased significantly before and after 3 months of treatment(P<0.001,P=0.002,P=0.011).③Endometrial blood flow:compared with the baseline period,FI increased significantly in 40 patients with thin endometrium after 3 months of acupuncture treatment(P=0.011).VI.VFI had an upward trend,but the difference before and after treatment was not statistically significant(P>0.05).④clinical pregnancy rate:the clinical pregnancy rate in this study was 15%(6/40).Conclusion:(1)the meta results show that acupuncture combined with acupuncture in the treatment of thin endometrium is superior to western medicine hormone therapy in increasing endometrial thickness,increasing the proportion of type a endometrium and reducing RI and PI.(2)Acupuncture can increase the thickness of endometrium and improve the blood perfusion of endometrium in patients with thin endometrium.