Electroacupuncture Improves Anxiety And Depression In Unmarried Patients With Polycystic Ovarian Syndrome By Modulating Neurotransmitters:A Clinical Trial

Objective: To evaluate the efficacy of electroacupuncture for the treatment of anxiety and depression by secondary analysis of a randomized controlled trial of electroacupuncture therapy for unmarried patients with polycystic ovarian syndrome(PCOS)and explore the mechanism.Methods: Participants in the clinical trial were assigned to the electroacupuncture group and the control group,with 27 patients in each group.Both groups were intervened for 16 weeks.Serum levels of neurotransmitters including norepinephrine(NE),adrenaline(AD),serotonin(5-HT)and γ-aminobutyric acid(GABA)were measured by Elisa kits at the beginning and ending of clinical trial and the outcomes of change of neurotransmitters level were observed.Moreover,scores of SAS and SDS in electroacupuncture group and control group were collected at the beginning and ending of clinical trial and the effect of electroacupuncture on anxiety and depression was obtained.At the same time,questionnaires including SF-36 、PCOSQOL and CHQOL about health related quality of life in both group were collected at the beginning and ending of clinical trial and the outcome of electroacupuncture improving quality of life in PCOS women were evaluated.Results: Comparing to pre-treatment,an increase in serum NE and reduction in 5-HT were observed in the electroacupuncture group(P<0.05)and serum level of GABA decreased in both groups(P<0.01).Comparing electroacupuncture group with sham electroacupuncture group,there were no significant differences between two groups in the levels of any neurotransmitters(including 5-HT、NE、GABA and AD)at the pre-treatment and post-treatment(p>0.05).Comparing to pre-treatment,SAS and SDS scores were decreased in the electroacupuncture group(P<0.05).Comparing to sham electroacupuncture group,scores of SAS and SDS were lower after therapy(P<0.01).Comparing to pre-treatment,the SF-36 domain scores for mental health and health transition in the electroacupuncture group were increased(P<0.05)and the SF-36 domain scores for vitality and general health were decreased in the sham electroacupuncture after therapy(P<0.05).Comparing electroacupuncture group with sham electroacupuncture group,SF-36 domain scores for vitality、general health and social functioning in electroacupuncture group were higher than sham electroacupuncture group and SF-36 domain scores for role-physical(P<0.01)and role-emotional in the sham electroacupuncture group were higher than electroacupuncture group(P<0.05).Comparing to pre-treatment,the PCOSQOL domain scores for emotion、infertility problems and body hair in electroacupuncture group were increased(P<0.05)and PCOSQOL domain scores for emotion in the sham electroacupuncture group were increased(P<0.05).Comparing electroacupuncture group with sham electroacupuncture group,all domain scores of PCOSQOL were not found different between two groups after therapy and before therapy.Comparing to sham electroacupuncture group,total CHQOL scores in electroacupuncture group were higher after therapy(P<0.05).Conclusion: Electroacupuncture could decrease scores of SAS and SDS,which showed electroacupuncture could improve symptoms of anxiety and depression.The mechanism of electroacupuncture improving symptom of anxiety and depression may be associated with neurotransmitters(including NE and 5-HT).Moreover,quality of life questionnaires(including SF-36,PCOSQOL and CHQOL)indicated that electroacupuncture could improve quality of life in unmarried PCOS women.Trial registration number: NCT01812161;ChiCTR-TRC-12002529.Objective: To evaluate whether circulating kisspeptin in blood is associated with PCOS and provide evidences by meta-analysis.To explore whether kisspeptin was related with T、LH、BMI and HOMA-IR.Methods: All literature was searched until 2019.The databases included Pubmed,Embase,Cochrane library,web of science,CNKI,Wanfang Data and CBM.Random-effects model was applied to estimate the standardized mean differences(SMDs)with 95% confidence intervals(CIs).Results: Thirteen case-control studies were included in the study(including 722 PCOS patients and 638 controls).Level of kisspeptin in PCOS patients was higher than control group(SMD=0.52,95%CI=0.18-0.86,P=0.003).According to Galbraith plot and meta-regression,heterogeneity(I2=87.6% and P<0.001)was from two studies(divided into four studies to meta-analysis)and heterogeneity was caused from the country and data type.According to country and data type,subgroup analysis was evaluated and heterogeneity was decreased.Funnel plot and Egger test showed publication bias was not significant(P>0.05).Sensitivity analysis indicated outcomes of meta-analysis were stable and credible.According to the disparity of T,LH,BMI and HOMA-IR between two groups,subgroup analysis was estimated.Whatever level of testosterone,luteinizing hormone and BMI in PCOS patient was higher or not higher than control group,circulating kisspeptin in PCOS patients was always higher than control group.Circulating kisspeptin in PCOS patients was found higher than control group while HOMA-IR is not higher than control group.Conclusions: Circulating kisspeptin is positively associated with PCOS and level of kisspeptin in PCOS women was higher than controls.There were not significant differences between kisspeptin 、 T 、 LH and BMI.Circulating Kisspeptin was negatively associated with HOMA-IR.Circulating kisspeptin may be a biomarker of PCOS women.