女性健康与中西医结合医学

Women’s health and Chinese integrative medicine 女性健康与中西医结合医学 1 first-author †E-mail:qufan43@outlook.com †E-mail:qufan43@outlook.com qufan43@outlook.com 1 2 3 Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China School of Health and Social Care, London South Bank University, London, SE1 0AA, UK School of Health and Social Care, London South Bank University, London, SE1 0AA, UK Institute for Women’s Health, University College London Medical School, London, NW3 2PF, UK Institute for Women’s Health, University College London Medical School, London, NW3 2PF, UK Researchers in the fields of obstetrics, gynecology, and Chinese integrative medicine (CIM) were invited to share their perspectives on the most recent studies. 中西医结合医学在治疗妇科和产科疾病方面都具有显著优势。早在公元1237年，第一本致力于中医妇产科学的专著《妇人大全良方》问世。然而仍需要更多的大型、随机、多中心临床试验来完善和加强中西医结合医学在治疗妇女疾病方面的循证基础。 obstetrics gynecology 女性健康 中西医结合医学 妇产科学 Researchers in the fields of obstetrics, gynecology, and Chinese integrative medicine (CIM) were invited to share their perspectives on the most recent studies. In vitro fertilization (IVF) is a choice for more than 1 000 000 infertile couples each year, and is linked to over 3 000 000 babies born worldwide (Horsey, 2006 2006 ). In Europe, over 300 000 treatment cycles of IVF or intracytoplasmic sperm injections (ICSI) are performed each year (Andersen et al., 2007 2007 ), and in the United States, the children conceived through IVF or ICSI comprise 2%‒3% of total births (Nygren and Andersen, 2001 2001 ). Various traditional medical practices originating in China have been widely used worldwide by women to improve health outcomes. CIM has been used to prevent miscarriage during the early phase of pregnancy, regulate the menstrual cycle, and alleviate menopausal symptoms. In recent years, many infertile couples have chosen CIM as an adjunct when they undergo IVF (Qu et al., 2012 2012 ; Cao et al., 2013 2013 ). However, as the conclusions from the clinical trials have been inconsistent, clinical practitioners and infertile couples find it difficult to make a final decision on whether to choose CIM to improve IVF outcomes (Myers, 2006 2006 ). As well as with IVF, CIM is believed to improve outcomes when used in relation to unexplained infertility, early ovarian failure, polycystic ovary syndrome (PCOS), and amenorrhoea (Qu et al., 2012 2012 ; Wu et al., 2016 2016 ). Additionally it is used if the menstrual cycle is prolonged due to an ovarian problem or where the patient wants to conceive quickly, such as with advancing age (35 years plus) or for other personal reasons. Based on the Special Research Fund for the Public Welfare Industry of Health of China (No. 201302013), a series of clinical trials has been conducted to promote better evidence-based clinical practices for the use of transcutaneous electrical acupoint stimulation (TEAS), a new and non-invasive acupuncture treatment, in reproductive medicine. Ye et al. ( 2017 2017 ) reached a revised group consensus on the use of TEAS in reproductive medicine, which may provide useful recommendations and guidelines for clinical practitioners. Human cervical cancer is the third most common cancer in women worldwide (Jemal et al., 2011 2011 ). Oncogenic human papillomavirus (HPV) infection is a prerequisite for the development of cervical cancer and its precursor lesions (Clifford et al., 2003 2003 ). More than 150 serotypes of HPV have been identified to date, of which about 40 types can infect the cervix. These HPV types are divided into high-risk and low-risk groups (Schiffman et al., 2011 2011 ). Persistent high-risk HPV (HR-HPV) infection is a major cause of cervical cancer. The introduction of cytological screening has remarkably reduced the incidence and mortality of cervical cancer and the cytology test has been a most widely accepted triage for patients with a positive primary HPV test (Zappacosta et al., 2013 2013 ). However, many developing countries, including China, lack well-trained cytologists, and therefore the cytology test cannot be carried out effectively. Therefore, other triage options should be considered in these countries. HPV testing has been recommended as a primary screening for cervical cancer in many countries (Zappacosta et al., 2013 2013 ). More than 90% of women will experience HPV infection in their lifetime. A productive HR-HPV infection may develop into low-grade cervical lesions (low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 (LSIL/CIN1)). HPV testing alone may increase the psychological burden and may cause over-referral to colposcopy. It has been reported that HPV E6/E7 mRNA expression level is highly correlated with the severity of cervical lesions (Ho et al., 2010 2010 ). HPV E6/E7 mRNA may be useful as a marker for potentially progressive HR-HPV infections and may constitute a useful tool for screening and/or patient management. In this issue, two studies by Yao et al. ( 2017 2017 ) and Ye et al. ( 2017 2017 ), respectively, focus on some new research. As we know, it has been widely recognized that maternal pre-pregnancy body mass index (pre-BMI) and gestational weight gain are closely associated with pregnancy outcomes including neonatal birth weight (NBW) (Stamnes Koepp et al., 2012 2012 ; Li et al., 2014 2014 ). In 2009, the Institute of Medicine (IOM) of America introduced a guideline concerning appropriate maternal weight gain during different trimesters for singleton pregnancy, which may result in a better pregnancy outcome (Oken et al., 2009 2009 ). However, there has been no consensus about the suitability of this guideline for Chinese women and the reported appropriate gestational weight gain differs (Liu et al., 2012 2012 ). In this issue, Du et al. ( 2017 2017 ) retrospectively analyzed the influence of maternal pre-BMI and weight gain in each trimester on NBW, hoping to properly guide maternal weight gain based on pre-BMI for Chinese pregnant women. Overview 1 CIM has significant advantages in treating gynecological and obstetrics disorders. As early as in 1237 A.D., the first book devoted solely to gynecology and obstetrics of Chinese medicine, The Complete Book of Effective Prescriptions for Diseases of Women , was published. However, more large-size, randomized and multicenter trials should be conducted to improve the evidence base for the use of CIM for treating women’s disorder. References AN Andersen , V Goossens , L Gianaroli , 等 . Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE . Hum Reprod , 2007 . 22 ( 6 ): 1513 - 1525 . (Available from: http://dx.doi.org/10.1093/humrep/dem053 http://dx.doi.org/10.1093/humrep/dem053 ) . Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE H Cao , M Han , EH Ng , 等 . Can Chinese herbal medicine improve outcomes of in vitro fertilization? A systematic review and meta-analysis of randomized controlled trials . PLoS ONE , 2013 . 8 ( 12 ): e81650 (Available from: http://dx.doi.org/10.1371/journal.pone.0081650 http://dx.doi.org/10.1371/journal.pone.0081650 ) . Can Chinese herbal medicine improve outcomes of in vitro fertilization? A systematic review and meta-analysis of randomized controlled trials GM Clifford , JS Smith , T Aguado , 等 . Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: a meta-analysis . Br J Cancer , 2003 . 89 ( 1 ): 101 - 105 . (Available from: http://dx.doi.org/10.1038/sj.bjc.6601024 http://dx.doi.org/10.1038/sj.bjc.6601024 ) . Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: a meta-analysis MK Du , LY Ge , ML Zhou , 等 . Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight . J Zhejiang Univ-Sci B (Biomed & Biotechnol) , 2017 . 18 ( 3 ): 263 - 271 . (Available from: http://dx.doi.org/10.1631/jzus.B1600204 http://dx.doi.org/10.1631/jzus.B1600204 ) . Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight CM Ho , BH Lee , SF Chang , 等 . Type-specific human papillomavirus oncogene messenger RNA levels correlate with the severity of cervical neoplasia . Int J Cancer , 2010 . 127 ( 3 ): 622 - 632 . (Available from: http://dx.doi.org/10.1002/ijc.25078 http://dx.doi.org/10.1002/ijc.25078 ) 15022656 . Type-specific human papillomavirus oncogene messenger RNA levels correlate with the severity of cervical neoplasia K Horsey . 3 000 000 IVF babies born worldwide since 1979. Presented at the Annual Conference of the European Society of Human Reproduction and Embryology (ESHRE) , 2006 . : Prague, Czech Republic 15788499 . 3 000 000 IVF babies born worldwide since 1979. Presented at the Annual Conference of the European Society of Human Reproduction and Embryology (ESHRE) Jemal, A., Bray, F., Center, M.M., Global cancer statistics . CA Cancer J Clin , 2011 . 61 ( 2 ): 69 - 90 . (Available from: http://dx.doi.org/10.3322/caac.20107 http://dx.doi.org/10.3322/caac.20107 ) 11565527 . Global cancer statistics Y Li , X Chen , S Chen , 等 . A cohort study on the impacts of pre-pregnancy maternal body mass index, gestational weight gain on neonate birth status and perinatal outcomes in Fujian province . Zhonghua Liu Xing Bing Xue Za Zhi , 2014 . 35 ( 6 ): 635 - 640 . (in Chinese) 22966246 . A cohort study on the impacts of pre-pregnancy maternal body mass index, gestational weight gain on neonate birth status and perinatal outcomes in Fujian province Y Liu , W Dai , X Dai , 等 . Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292 568 cases in China . Arch Gynecol Obstet , 2012 . 286 ( 4 ): 905 - 911 . (Available from: http://dx.doi.org/10.1007/s00404-012-2403-6 http://dx.doi.org/10.1007/s00404-012-2403-6 ) 7651477 . Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292 568 cases in China ER Myers . Acupuncture as adjunctive therapy in assisted reproduction: remaining uncertainties . Fertil Steril , 2006 . 85 ( 5 ): 1362 - 1363 . (Available from: http://dx.doi.org/10.1016/j.fertnstert.2005.10.062 http://dx.doi.org/10.1016/j.fertnstert.2005.10.062 ) . Acupuncture as adjunctive therapy in assisted reproduction: remaining uncertainties KG Nygren , AN Andersen . Assisted reproductive technology in Europe, 1997. Results generated from European registers by ESHRE. The European IVF-monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE) . Hum Reprod , 2001 . 16 ( 2 ): 384 - 391 https://doiorg/101093/humrep/162384 . 20943753 . Assisted reproductive technology in Europe, 1997. Results generated from European registers by ESHRE. The European IVF-monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE) E Oken , KP Kleinman , MB Belfort , 等 . Associations of gestational weight gain with short-and longer-term maternal and child health outcomes . Am J Epidemiol , 2009 . 170 ( 2 ): 173 - 180 . (Available from: http://dx.doi.org/10.1093/aje/kwp101 http://dx.doi.org/10.1093/aje/kwp101 ) . Associations of gestational weight gain with short-and longer-term maternal and child health outcomes F Qu , J Zhou , RX Ren . Effects of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis . J Altern Complement Med , 2012 . 18 ( 5 ): 429 - 439 . (Available from: http://dx.doi.org/10.1089/acm.2011.0158 http://dx.doi.org/10.1089/acm.2011.0158 ) 24073009 . Effects of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis M Schiffman , N Wentzensen , S Wacholder , 等 . Human papillomavirus testing in the prevention of cervical cancer . J Natl Cancer Inst , 2011 . 103 ( 5 ): 368 - 383 . (Available from: http://dx.doi.org/10.1093/jnci/djq562 http://dx.doi.org/10.1093/jnci/djq562 ) 23482444 . Human papillomavirus testing in the prevention of cervical cancer UM Stamnes Koepp , L Frost Andersen , K Dahl-Joergensen , 等 . Maternal pre-pregnant body mass index, maternal weight change and offspring birthweight . Acta Obstet Gynecol Scand , 2012 . 91 ( 2 ): 243 - 249 . (Available from: http://dx.doi.org/10.1111/j.1600-0412.2011.01321.x http://dx.doi.org/10.1111/j.1600-0412.2011.01321.x ) . Maternal pre-pregnant body mass index, maternal weight change and offspring birthweight Y Wu , N Robinson , PJ Hardiman , 等 . Acupuncture for treating polycystic ovary syndrome: guidance for future randomized controlled trials . J Zhejiang Univ-Sci B (Biomed & Biotechnol) , 2016 . 17 ( 3 ): 169 - 180 . (Available from: http://dx.doi.org/10.1631/jzus.B1500301 http://dx.doi.org/10.1631/jzus.B1500301 ) . Acupuncture for treating polycystic ovary syndrome: guidance for future randomized controlled trials YL Yao , QF Tian , B Cheng , 等 . Human papillomavirus (HPV) E6/E7 mRNA detection in cervical exfoliated cells: a potential triage for HPV positive women . J Zhejiang Univ-Sci B (Biomed & Biotechnol) , 2017 . 18 ( 3 ): 256 - 262 . (Available from: http://dx.doi.org/10.1631/jzus.B1600288 http://dx.doi.org/10.1631/jzus.B1600288 ) 24661732 . Human papillomavirus (HPV) E6/E7 mRNA detection in cervical exfoliated cells: a potential triage for HPV positive women J Ye , B Cheng , YF Cheng , 等 . Prognostic value of human papillomavirus 16/18 genotyping in low-grade cervical lesions preceded by mildly abnormal cytology . J Zhejiang Univ-Sci B (Biomed & Biotechnol) , 2017 . 18 ( 3 ): 249 - 255 . (Available from: http://dx.doi.org/10.1631/jzus.B1600473 http://dx.doi.org/10.1631/jzus.B1600473 ) . Prognostic value of human papillomavirus 16/18 genotyping in low-grade cervical lesions preceded by mildly abnormal cytology R Zappacosta , D Caraceni , L Ciccocioppo , 等 . Implementing specificity of HPV-DNA primary screening in a successful organised cervical cancer prevention programme . Gynecol Oncol , 2013 . 128 ( 3 ): 427 - 432 . (Available from: http://dx.doi.org/10.1016/j.ygyno.2012.11.030 http://dx.doi.org/10.1016/j.ygyno.2012.11.030 ) . Implementing specificity of HPV-DNA primary screening in a successful organised cervical cancer prevention programme 10.1631/jzus.B17ed001 2017-02-09 2017-02-09 2017-02-13 2022-01-05 Copyright © Zhejiang University and Springer-Verlag Berlin Heidelberg 2017 2017 Journal of Zhejiang University-SCIENCE B (Biomedicine and Biotechnology) 03 18