Objective

2

To observe the efficacy of "

Tiaojing Cuyun

Acupuncture" combined with hormone replacement therapy in the treatment of premature ovarian failure (POF)

and to investigate differences in vaginal microbiota among patients with different therapeutic responses

thereby preliminarily exploring the mechanism underlying efficacy differences.

Methods

2

Ninety-eight patients with POF were randomly divided into an observation group (49 cases

1 case was eliminated)and a control group (49 cases

1 case dropped out). The control group was treated with hormone replacement therapy with Femoston

one tablet each time

once daily. On the basis of the control group

the observation group was additionally treated with "

Tiaojing Cuyun

Acupuncture". Acupoint group 1 included Baihui (GV20)

Zhongwan (CV12)

Guanyuan (CV4)

and bilateral Tianshu (ST25)

Zigong (EX-CA1)

Dahe (KI12)

Zusanli (ST36)

Sanyinjiao (SP6)

and Taichong (LR3). Acupoint group 2 included Baihui (GV20)

bilateral Shenshu (BL23)

Ciliao (BL32)

and Taixi (KI3). The two acupoint groups were used alternately

beginning with acupoint group 1. Treatment was administered once every other day

three times per week.Both groups were treated for three menstrual cycles. Serum follicle-stimulating hormone (FSH)

luteinizing hormone (LH)

estradiol (E2)

and anti-M ü llerian hormone (AMH) levels on days 3-5 of the menstrual cycle were measured before and after treatment in the two groups. Self-rating anxiety scale (SAS) scores were assessed before and after treatment

and clinical efficacy was evaluated in the two groups. Five effective patients (G0 subgroup) and five ineffective patients (G1 subgroup)were randomly selected from each group

and their vaginal microbio

ta structure was analyzed using 16S rRNA sequencing.

Results

2

After treatment

FSH levels in both groups were lower than those before treatment (

P

<

0.05); SAS scores in both groups were lower than those before treatment (

P

<

0.05)

and the observation group had lower SAS score than the control group (

P

<

0.05). The total effective rate was 77.1% (37/48) in the observation group

which was higher than 56.3% (27/48) in the control group (

P

<

0.05). Vaginal microbiota analysis showed that at the phylum level

the relative abundance of

Firmicutes

in the G0 subgroup of the control group was higher than that in the G1 subgroup

while the relative abundances of

Bacteroidetes

Actinobacteria

and

Proteobacteria

were lowed in the G0 subgroup. In contrast

the observation group exhibited an opposite trend: the G0 subgroup had lower

Firmicutes

abundance but higher abundances of

Actinobacteria

Bacteroidetes

and

Proteobacteria

compared with the G1 subgroup. At the family and genus levels

Bifidobacterium

was enriched in the G0 subgroups of both groups

whereas

Lactobacillus

predominated in the G1 subgroups. The G0 subgroup of the control group showed higher abundance of

Gardnerella

while both

Lactobacillus

and

Gardnerella

were concurrently elevated in the G1 subgroup of the observation group. Additionally

in the observation group indicated that

Clostridiales

and

Rikenellaceae

were significantly more abundant in the G0 subgroup than in the G1 subgroup (

P

<

0.05).

Conclusion

2

The "

Tiaojing Cuyun

Acupuncture" combined with hormone replacement therapy is superior to hormone replacement therapy alone in improving

anxiety. There are differences in vaginal microbiota structure among patients with different theraputic efficacy

suggesting that the vaginal microecological environment may be involved in the mechanism of treatment response in POF.