补肾化痰序贯疗法对PCOS伴IR患者内分泌、代谢及血清Apelin表达的影响

Effects of kidney-tonifying and phlegm-eliminating sequential therapy on endocrine,metabolism,and serum apelin level in polycystic ovary syndrome patients with insulin resistance

目的:观察补肾化痰序贯疗法对肾虚痰湿型多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)患者内分泌、代谢及血清Apelin表达的影响,研究其治疗PCOS伴IR的疗效机制。方法:选取PCOS伴IR患者60例,随机分为两组各30例,治疗组采用中药联合复方醋酸环丙孕酮治疗,对照组单纯采用复方醋酸环丙孕酮治疗,治疗3个周期后观察两组患者肾虚痰湿证候的改善情况,血清促卵泡生成素(FSH)、黄体生成素(LH)、睾酮(T)、雌二醇(E2)的变化,总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)指标的变化,空腹胰岛素(INS)、空腹血糖(FBG)、胰岛素敏感指数(ISI)、体质量指数(BMI)、腰围/臀围(WHR)、Apelin的变化,并对Apelin水平与BMI、WHR、FBG、INS、ISI、HDL的水平进行相关性分析。后对两组患者促排卵治疗3个周期,统计排卵率及妊娠率。结果:(1)治疗组肾虚痰湿证候改善显著优于对照组。(2)两组血清Apelin水平、LH、T、INS均降低,ISI升高,FBG、BMI、WHR改善不明显。(3)治疗组血清Apelin水平、LH、T、INS、ISI水平与对照组比较差异有统计学意义,FBG、BMI、WHR两组比较差异无统计学意义。(4)Apelin水平与BMI、WHR、FBG、INS、ISI呈正相关,与HDL呈负相关。(5)两组排卵率差异不明显,但两组妊娠率差异有统计学意义。结论:(1)补肾化痰序贯疗法能有效改善肾虚痰湿PCOS伴IR患者的全身症状。(2)PCOS患者血清Apelin水平升高,可能参与胰岛素代谢及血管舒缩,而补肾化痰序贯疗法通过降低血清Apelin水平、LH、T、INS的表达,升高ISI,有效改善了肾虚痰湿型PCOS患者的胰岛素抵抗状态,提高了排卵率,从而提高临床妊娠率。

Objective ： To observe the effects of kidney - tonifying and phlegm - eliminating sequential therapy on the endocrine, metabolism, and serum apelin level in kidney - deficiency and phlegm - dampness type polycystic ovary syndrome（PCOS） patients with insulin resistance（IR）. Methods： Sixty PCOS patients with IR were randomly divided into treatment group （ n = 30） and control group （ n = 30）. The treatment group received traditional Chi- nese medicines combined with compound cyproterone acetate, while the control group received compound cyprot- erone acetate alone. After 3 weeks of treatment, the improvements in kidney - deficiency and phlegm - dampness syndrome and the changes in serum follicle - stimulating hormone （ FSH ）, luteinizing hormone （ LH ）, testosterone （ T）, estradiol, total cholesterol, triglyceride, high - density lipoprotein （ HDL）, low - density lipoprotein, fasting in-sulin （ FINS）, and fasting blood glucose （ FBG）, insulin sensitivity index （ ISI ）, body mass index （ BMI ）, waist - to - hip ratio（WHR） , and serum apelin level were assessed, and the correlations of apelin level with BMI, WHR, FBG, FINS, ISI, and HDL were analyzed. Then, the two groups were treated for 3 courses to promote ovulation. The ovula- tion rate and pregnancy rate were calculated. Results ： （ 1 ） The treatment group had a significantly more improvement in kidney -deficiency and phlegm -dampness syndrome than the control group. （2）Both groups showed decreases in apelin, LH,T, and FINS levels and an increase in 1SI;no significant improvements in FBG, BMI, and WHR were found. （3）Serum apelin, LH, T, and FINS levels and ISI showed significant differences between the treatment group and control group, while no significant differences were observed in FBG, BM1, and WHR. （4）Apelin level was positively correlated with BMI, WHR, FBG, FINS, and ISI, but negatively correlated with HDL. （5） Ovulation rate showed no significant difference between the two groups, but there was a significant difference in pregnancy rate between the two groups. Conclusion ： （ 1 ） Kidney - tonifying and phlegm - eliminating sequential therapy can effectively relieve the systemic symptoms in kidney -deficiency and phlegm -dampness type PCOS patients with IR. （2）Serum apelin level increases in PCOS patients ,which may be involved in insulin metabolism and vasomotion. Kidney - tonifying and phlegm - eliminating sequential therapy can reduce serum apelin, LH, T, and FINS levels and increase ISI to effectively reduce the insulin resistance in patients with kidney - deficiency and phlegm - dampness type P- COS ,thus increasing their ovulation rate and pregnancy rate.