多囊卵巢综合征的中医证候分布及其规律探讨

Distribution of Chinese Medicine Syndrome Patterns and Its Laws in Patients with Polycystic Ovarian Syndrome

目的探讨多囊卵巢综合征(PCOS)中医证型及相关临床症状的分布规律,以及PCOS相关参数的改变与中医证候分类可能存在的联系,指导选用与证型紧密相关的指标评价疗效。方法 运用临床流行病学方法、数理统计方法,对228例PCOS患者中医证候进行研究,总结并归纳PCOS的中医证候分布特点。结果 PCOS临床上以肾虚血瘀证最为多见,其次为脾虚痰湿证、脾肾阳虚证及肾阴虚证。卵泡刺激素(FSH)与脾肾阳虚证呈正相关;空腹血糖(FBS)、腰臀比值(WHR)、体重指数(BMI)、空腹胰岛素(FIN)多毛分值与脾虚痰湿证呈正相关;催乳素(PRL)、雌二醇(E2)与气滞血瘀证呈正相关;孕酮(PRG)、FSH、FIN、BMI及痤疮评分与肝郁血热证呈正相关;黄体生成素(LH)与肾虚血瘀证呈正相关。LH/FSH>3在脾虚痰湿证、脾肾阳虚证可能较为常见。各型患者均可见家系遗传表现,肾虚血瘀证多见女性家系遗传,肾阴虚证多见男性家系遗传。结论 PCOS中医临床证候以肾虚血瘀证、脾虚痰湿证、脾肾阳虚证、肾阴虚证最为常见;性激素6项、FBS、FIN、WHR、BMI等指标分别与各证型有不同程度的相关性,可作为临床辨证的参考。

Objective To study the distribution laws of the Chinese medicine syndrome patterns and its correlated symptoms in patients with polycystic ovarian syndrome（PCOS）,and the possible correlation between Chinese medicine syndrome patterns and PCOS associated parameters,thus to provide a guidance for selecting proper indices in curative effectiveness assessment.Methods Using clinical epidemiological methods and mathematical statistics,the Chinese medicine syndrome patterns were studied in 228 PCOS patients.The distribution features of Chinese medicine syndrome patterns were summarized.Results Shen-deficiency blood-stasis syndrome was the most frequently seen in PCOS patients,followed by Pi-deficiency phlegm-dampness syndrome,Pi-Shen yang-deficiency syndrome,and Shen-yin deficiency syndrome.Positive correlation existed between serum levels of follicle stimulating hormone（FSH） and Pi-Shen yang-deficiency syndrome.Positive correlation existed between fasting blood sugar（FBS）,waist to hip ratio（WHR）,body mass index（BMI）,fasting insulin（FIN）,and Hirsutism score and Pi-deficiency phlegm-dampness syndrome.Positive correlation existed between serum levels of prolactin（PRL）,estradiol（E2） and qi stagnancy and blood stasis syndrome.Positive correlation existed between serum progesterone（PRG） level,FSH,FIN,BMI,acne score and Gan stagnancy and blood heat syndrome.Positive correlation existed between luteinizing hormone（LH） and Shen-deficiency blood-stasis syndrome.Besides,LH/FSH3 was possibly more frequently seen in Pi-deficiency phlegm-dampness syndrome and Pi-Shen yang-deficiency syndrome.Family heritability could be seen in each syndrome patterns.Among them,female heritability was more often seen in Shen-deficiency blood-stasis syndrome,while male heritability was more often seen in Shen-yin deficiency syndrome.Conclusions Shen-deficiency blood-stasis syndrome,Pi-deficiency phlegm-dampness syndrome,Pi-Shen yang-deficiency syndrome,and Shen-yin deficiency syndrome were most frequently seen in PCOS patients.The sex hormones（including 6 items）,FBS,FIN,WHR and BMI,etc.were correlated with each Chinese medicine syndrome pattern to various extents,which could be taken as reference in Chinese medicine syndrome differentiation.