多囊卵巢综合征患者西医亚型与中医证型的相关研究
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摘要
目的探讨多囊卵巢综合征(PCOS)患者西医亚型与中医证型之间的关系,为中西医结合治疗PCOS提供依据。方法由临床科研信息一体化平台共纳入PCOS患者506例,根据西医诊断标准分为Ⅰ型(稀发/无排卵+高雄激素临床和/或生化特征+卵巢多囊样改变)、Ⅱ型(稀发/无排卵+卵巢多囊样改变)、Ⅲ型(稀发/无排卵+高雄激素临床和/或生化特征)3个亚型,根据中医证候特点分为脾虚痰湿证、肾虚肝郁证、痰瘀互结证、肾虚血瘀证4个中医证型,比较分析不同亚型及证型患者性激素水平的差异。结果 506例PCOS患者中,西医亚型Ⅰ型258例、Ⅱ型123例、Ⅲ型125例,中医证型脾虚痰湿证203例、肾虚肝郁证146例、痰瘀互结证55例、肾虚血瘀证102例;各西医亚型中中医证型所占比,Ⅰ型中肾虚肝郁证>脾虚痰湿证>肾虚血瘀证>痰瘀互结证(P均<0.05),Ⅱ型中脾虚痰湿证>痰瘀互结证>肾虚肝郁证/肾虚血瘀证(P均<0.05),Ⅲ型中肾虚血瘀证>脾虚痰湿证>痰瘀互结证/肾虚肝郁证(P均<0.05)。促黄体生成素(LH)/促卵泡生成素(FSH)>2的发生率,Ⅰ型和肾虚肝郁证接近,Ⅱ型与痰瘀互结证接近;睾酮(T)>60 ng/dL的发生率,Ⅰ型和肾虚血瘀证相近;高雄烯二酮(AND)发生率,Ⅲ型和肾虚血瘀证相近;低性激素结合球蛋白(SHBG)发生率,Ⅱ型与痰瘀互结证接近。Ⅰ型和Ⅲ型LH、T、硫酸脱氢表雄酮(DHEAS)、AND水平和LH/FSH比值均明显高于Ⅱ型(P均<0.05);Ⅰ型T水平明显高于Ⅲ型(P<0.05),Ⅰ型和Ⅱ型雌二醇(E_2)水平明显低于Ⅲ型(P均<0.05)。肾虚肝郁证LH水平和LH/FSH比值升高,T水平最高,SHBG水平降低;肾虚血瘀证LH水平和LH/FSH比值升高,SHBG水平较高;脾虚痰湿证LH水平和LH/FSH比值最低,SHBG水平较高;痰瘀互结证LH、SHBG水平和LH/FSH比值低。结论肾虚肝郁证可能为Ⅰ型的主要中医证型,痰瘀互结证和脾虚痰湿证可能为Ⅱ型的主要中医证型,肾虚血瘀证可能为Ⅲ型的主要中医证型。
Objective It is to explore the relationship between clinical subtypes and TCM syndromes in patients with polycystic ovary syndrome(PCOS), so as to provide evidence for integrated traditional Chinese and western medicine in the treatment of PCOS. Methods A total of 506 patients with PCOS from the clinical research information integration platform were divided into three type according to the clinical subtypes, type Ⅰ(rare ovulation/anovulia+hyperandrogenemia clinical and/or biochemical characteristics+polycystic ovary), type Ⅱ(rare ovulation/anovulia+polycystic ovary), type Ⅲ(rare ovulation/anovulia+hyperandrogenemia clinical and/or biochemical characteristics); According to TCM syndrome type they were divided into four groups: syndrome of spleen deficiency and phlegm-damp, syndrome of kidney deficiency and liver constraint, syndrome of binding of phlegm and stasis and syndrome of kidney deficiency and blood stasis, then the difference of sex hormone levels in each group were analyzed and compared. Results Among 506 PCOS patients, distribution of subtypes in western medicine were 258 cases of type Ⅰ, 123 cases of type Ⅱ and 125 cases of type Ⅲ, distribution of TCM syndrome types were 203 cases of syndrome of spleen deficiency and phlegm-damp, 146 cases of syndrome of kidney deficiency and liver constraint, 55 cases of syndrome of binding of phlegm and stasis and 102 cases of syndrome of kidney deficiency and blood stasis. The proportion of TCM syndromes in various western medicine subtypes: type Ⅰ, kidney deficiency and liver constraint>spleen deficiency and phlegm-damp>kidney deficiency and blood stasis>binding of phlegm and stasis(P<0.05); type Ⅱ, spleen deficiency and phlegm-damp>binding of phlegm and stasis>kidney deficiency and liver constraint/kidney deficiency and blood stasis(P<0.05); type Ⅲ, kidney deficiency and blood stasis>spleen deficiency and phlegm-damp>binding of phlegm and stasis/kidney deficiency and liver constraint(P<0.05). The incidence of LH/FSH>2 was close to the type Ⅰ and kidney deficiency and liver constraint, and type Ⅱ was close to binding of phlegm and stasis. The incidence of T>60 ng/dL was close to the type Ⅰ and kidney deficiency and blood stasis; The incidence of high AND was similar in type Ⅲ and kidney deficiency and blood stasis; The low SHBG in type Ⅱ was close to binding of phlegm and stasis. LH, LH/FSH ratio, T, DHEAS and AND was higher in type Ⅰ than in type Ⅱ(P<0.05). T in type Ⅰ was the higher than in type Ⅲ(P<0.05), E_2 in type Ⅰ and type Ⅱ was the lower than in type Ⅲ(P<0.05). In kidney deficiency and liver constraint, LH and LH/FSH ratio rise, T was the highest and SHBG was decreased; In kidney deficiency and blood stasis, LH and LH/FSH ratio rise and the level of SHBG was higher; In spleen deficiency and phlegm-damp, LH and LH/FSH ratio were the lowest, and SHBG was higher; In binding of phlegm and stasis, LH, LH/FSH ratio and SHBG all decreased. Conclusion kidney deficiency and liver constraint may be the main TCM syndrome type of type Ⅰ, spleen deficiency and phlegm-damp and binding of phlegm and stasis may be the main TCM syndrome type of the type Ⅱ, and kidney deficiency and blood stasis may be the main TCM syndrome type of the type Ⅲ.
Objective It is to explore the relationship between clinical subtypes and TCM syndromes in patients with polycystic ovary syndrome(PCOS), so as to provide evidence for integrated traditional Chinese and western medicine in the treatment of PCOS. Methods A total of 506 patients with PCOS from the clinical research information integration platform were divided into three type according to the clinical subtypes, type Ⅰ(rare ovulation/anovulia+hyperandrogenemia clinical and/or biochemical characteristics+polycystic ovary), type Ⅱ(rare ovulation/anovulia+polycystic ovary), type Ⅲ(rare ovulation/anovulia+hyperandrogenemia clinical and/or biochemical characteristics); According to TCM syndrome type they were divided into four groups: syndrome of spleen deficiency and phlegm-damp, syndrome of kidney deficiency and liver constraint, syndrome of binding of phlegm and stasis and syndrome of kidney deficiency and blood stasis, then the difference of sex hormone levels in each group were analyzed and compared. Results Among 506 PCOS patients, distribution of subtypes in western medicine were 258 cases of type Ⅰ, 123 cases of type Ⅱ and 125 cases of type Ⅲ, distribution of TCM syndrome types were 203 cases of syndrome of spleen deficiency and phlegm-damp, 146 cases of syndrome of kidney deficiency and liver constraint, 55 cases of syndrome of binding of phlegm and stasis and 102 cases of syndrome of kidney deficiency and blood stasis. The proportion of TCM syndromes in various western medicine subtypes: type Ⅰ, kidney deficiency and liver constraint>spleen deficiency and phlegm-damp>kidney deficiency and blood stasis>binding of phlegm and stasis(P<0.05); type Ⅱ, spleen deficiency and phlegm-damp>binding of phlegm and stasis>kidney deficiency and liver constraint/kidney deficiency and blood stasis(P<0.05); type Ⅲ, kidney deficiency and blood stasis>spleen deficiency and phlegm-damp>binding of phlegm and stasis/kidney deficiency and liver constraint(P<0.05). The incidence of LH/FSH>2 was close to the type Ⅰ and kidney deficiency and liver constraint, and type Ⅱ was close to binding of phlegm and stasis. The incidence of T>60 ng/dL was close to the type Ⅰ and kidney deficiency and blood stasis; The incidence of high AND was similar in type Ⅲ and kidney deficiency and blood stasis; The low SHBG in type Ⅱ was close to binding of phlegm and stasis. LH, LH/FSH ratio, T, DHEAS and AND was higher in type Ⅰ than in type Ⅱ(P<0.05). T in type Ⅰ was the higher than in type Ⅲ(P<0.05), E_2 in type Ⅰ and type Ⅱ was the lower than in type Ⅲ(P<0.05). In kidney deficiency and liver constraint, LH and LH/FSH ratio rise, T was the highest and SHBG was decreased; In kidney deficiency and blood stasis, LH and LH/FSH ratio rise and the level of SHBG was higher; In spleen deficiency and phlegm-damp, LH and LH/FSH ratio were the lowest, and SHBG was higher; In binding of phlegm and stasis, LH, LH/FSH ratio and SHBG all decreased. Conclusion kidney deficiency and liver constraint may be the main TCM syndrome type of type Ⅰ, spleen deficiency and phlegm-damp and binding of phlegm and stasis may be the main TCM syndrome type of the type Ⅱ, and kidney deficiency and blood stasis may be the main TCM syndrome type of the type Ⅲ.
引文
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[4] 黄茹蓓,田丽颖.中医疗法对多囊卵巢综合征激素水平影响的研究进展[J].亚太传统医药,2018,14(1):71-73
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[7] 张少娣,张合龙,李萌,等.不同亚型多囊卵巢综合征患者的临床及生化特征比较[J].生殖医学杂志,2014,23(2):100-104
[8] 岳瑶函,赵嘉晶,汪颖珏.多囊卵巢综合征不同中医证型与糖脂代谢水平及性激素水平差异性分析[J].四川中医,2018,36(1):78-81
[9] 华永芳.多囊卵巢综合征亚型中医证型间激素水平的差异性研究[D].乌鲁木齐:新疆医科大学,2016
[10] Mahalingaiah S,Diamanti-kandarakis E.Targets to treat metabolic syndrome in polycystic ovary syndrome[J].Expert Opin Ther Targets,2015,19(11):1561-1574
[11] Pellegrinelli V,Carobbio S,Vidal-Puig A.Adipose tissue plasticity:how fat depots respond differently to pathophysiological cues[J].Diabetologia,2016,59(6):1075-1088
[12] 张春兰,侯丽辉,李妍,等.侯丽辉教授治疗多囊卵巢综合征经验总结[J].四川中医,2015,33(8):12-15
[13] 程智玲,谭明红.祛湿化痰法治疗多囊卵巢综合征患者的临床研究[J].中医临床研究,2017,9(30):112-116
[14] 彭艳,丛晶,胡妮娜,等.针刺化痰法对多囊卵巢综合征的临床疗效评价[J].针灸临床杂志,2017,33(2):5-8
[2] 郑艳.肥胖型多囊卵巢综合征患者临床特征分析[J].中国现代药物应用,2015,9(3):57-58
[3] 刘颖华,侯丽辉,郝松莉,等.名老中医治疗多囊卵巢综合征的用药规律研究[J].中国中医基础医学杂志,2016,22(4):537-538;547
[4] 黄茹蓓,田丽颖.中医疗法对多囊卵巢综合征激素水平影响的研究进展[J].亚太传统医药,2018,14(1):71-73
[5] 刘伟伟.多囊卵巢综合征的中医诊疗进展[J].光明中医,2018,33(4):592-594
[6] 徐驰,王随郧.多囊卵巢综合征不同亚型的患者临床和实验室的指标特征分析[J/CD].实用妇科内分泌杂志:电子版,2017,4(1):66-68
[7] 张少娣,张合龙,李萌,等.不同亚型多囊卵巢综合征患者的临床及生化特征比较[J].生殖医学杂志,2014,23(2):100-104
[8] 岳瑶函,赵嘉晶,汪颖珏.多囊卵巢综合征不同中医证型与糖脂代谢水平及性激素水平差异性分析[J].四川中医,2018,36(1):78-81
[9] 华永芳.多囊卵巢综合征亚型中医证型间激素水平的差异性研究[D].乌鲁木齐:新疆医科大学,2016
[10] Mahalingaiah S,Diamanti-kandarakis E.Targets to treat metabolic syndrome in polycystic ovary syndrome[J].Expert Opin Ther Targets,2015,19(11):1561-1574
[11] Pellegrinelli V,Carobbio S,Vidal-Puig A.Adipose tissue plasticity:how fat depots respond differently to pathophysiological cues[J].Diabetologia,2016,59(6):1075-1088
[12] 张春兰,侯丽辉,李妍,等.侯丽辉教授治疗多囊卵巢综合征经验总结[J].四川中医,2015,33(8):12-15
[13] 程智玲,谭明红.祛湿化痰法治疗多囊卵巢综合征患者的临床研究[J].中医临床研究,2017,9(30):112-116
[14] 彭艳,丛晶,胡妮娜,等.针刺化痰法对多囊卵巢综合征的临床疗效评价[J].针灸临床杂志,2017,33(2):5-8