多囊卵巢综合征中医证型分布规律及性激素水平、糖代谢特点

Distribution Laws of PCOS Syndrome Types and Features of Sex Hormone Levels and Glucose Metabolism

目的分析多囊卵巢综合征(polycystic ovary syndrome,PCOS)中医证型分布规律及性激素水平、糖代谢特点,为临床辨证分析及诊治提供一定的依据。方法收集237例PCOS患者,采集基本信息及临床资料进行辨证分型,将其分为肾阴虚型、肾阳虚型、肝郁型、痰湿型和血瘀型共5型。运用SPSS 21.0软件包对数据进行处理分析,观察不同证型PCOS患者的基本特点及激素水平、糖代谢特点。结果(1)证型分布规律:肾阴虚型46例(19.41%),肾阳虚型61例(25.74%),肝郁型48例(20.25%),痰湿型46例(19.41%),血瘀型36例(15.19%)。(2)性激素水平:与肾阴虚比较,肾阳虚促黄体生成素(luteinizing hormone,LH)水平升高,肝郁型和痰湿型LH水平降低(P<0.01,P<0.05),痰湿型血清促卵泡生成素(follicle stimulating hormone,FSH)水平降低(P<0.05),肾阳虚LH/FSH比值升高(P<0.01),肝郁型和血瘀型血清雄激素(testosterone,T)水平降低(P<0.05,P<0.01),肝郁型和痰湿型泌乳素(prolactin,PRL)升高(P<0.01,P<0.05)。与肾阳虚型比较,肝郁型、痰湿型和血瘀型LH、LH/FSH比值均降低(P<0.01),痰湿型血清FSH降低(P<0.05),肝郁型和血瘀型血清T亦降低(P<0.05,P<0.01),肝郁型和痰湿型PRL升高(P<0.01,P<0.05)。与肝郁型比较,痰湿型和血瘀型PRL降低(P<0.01)。与其他4证型比较,血瘀型硫酸脱氢表雄酮(dehydroepiandrosterone sulfate,DHEAS)均降低(P<0.05,P<0.01);各组间雌二醇(estradiol,E2)比较,差异均无统计学意义(P>0.05)。(3)糖代谢特点:与痰湿型比较,肾阴虚型、肾阳虚型、肝郁型和血瘀型空腹胰岛素(fasting insulin,FINS)、2 h胰岛素(2 h insulin,INS 2 h)、3 h胰岛素(3 h insulin,INS 3h)、胰岛参数(insulin/glucose,I/G)和葡萄糖稳态模型指数(homeostatic model for insulin resistance,HOMAIR)均降低(P<0.01),肾阳虚型、肝郁型和血瘀型胰岛β细胞功能指数(isletβ-cell function index,HOMA-β)均降低(P<0.01),肾阴虚、肾阳虚和血瘀型2 h葡萄糖(2 h glucose,GLU 2 h)水平降低(P<0.05,P<0.01),肾阴虚型3 h葡萄糖(3 h glucose,GLU 3 h)水平降低(P<0.05)。与肝郁型比较,肾阴虚型INS 2 h及GLU 2 h亦降低(P<0.05,P<0.01)。结论 PCOS证型分布上存在一定的规律,且不同证型与性激素水平、糖代谢特点存在一定的联系。

Objective To analyze distribution laws of polycystic ovary syndrome PCOS） syndrome types and features of sex hormone levels and glucose metabolism, providing evidence for clinical syndrome typing, diagnosis and treatment. Methods Totally 237 PCOS patient were recruited. Their basic information and clinical data were collected and syndrome typed as Shen yin deficiency type, Shen yang deficiency type, Gan depression type, phlegm dampnesstype, blood stasis type. Data were analyzed by using SPSS21. 0 Software package. Basic features, hormone levels, and glucose metabolism were observed in patients with different syndrome types. Results（1） The laws of syndrome distribution： Shen yin deficiency type in 46 cases（19. 41%）, Shen yang deficiency type in 61 cases（25. 74%）, Gan depression type in 48 cases（20. 25%）, phlegm dampness type in 46 cases（19. 41%）, blood stasis type in 36 cases（15. 19%）.（2） The levels of sex hormones： Compared with patients with Shen yin deficiency type, luteinizing hormone（LH） was higher in patients with Shen yang deficiency type（P 〈0. 01, P 〈0. 05）; LH was lower in patients with Gan depression type and phlegm dampness type（P 〈0. 01, P 〈0. 05）; follicle stimulating hormone（FSH） was lower in patients with phlegm dampness type（P 〈0. 05）; LH/FSH ratio was higher in patients with Shen yang deficiency type（P 〈0. 01）; testosterone（T） level was lower in patients with Gan depression type and blood stasis type（P 〈0. 05, P 〈0. 01）; prolactin（PRL） level was higher in patients with blood stasis type and phlegm dampness type（P 〈0. 05, P 〈0. 01）. Compared with patients with Shen yang deficiency type, LH level and LH/FSH ratio were lower in patients with Gan depression type, phlegm dampness type, and blood stasis type（P 〈0. 01）; FSH was lower in patients with phlegm dampness type（P 〈0. 05）; T was also lower in patients with Gan depression type and blood stasis type（P 〈0. 05, P 〈0. 01）; PRL was higher in patients with Gan depression type and phlegm dampness type（P 〈0. 01, P 〈0. 05）. Compared with patients with Gan depression type, PRL was lower in patients with phlegm dampness type and blood stasis type（P 〈0. 01）.Ddehydroepiandrosterone sulfate（DHEAS） level was the lowest in patients with blood stasis type（P 〈0. 05, P 〈0. 01）.There was no statistical difference in estradiol（E2） among all groups（P 〈0. 05）.（3） The characteristics of glucose metabolism： Compared with patients with phlegm dampness type, fasting insulin（FINS）, 2 h insulin（INS 2 h）, 3 h insulin（INS 3 h）, insulin/glucose（I/G）, homeostatic model for insulin resistance（HOMA-IR） were lower in patients with Shen yin deficiency type, Shen yang deficiency type, Gan depression type, blood stasis type（P 〈0. 01）; islet β-cell function index（HOMA-β） was lower in patients with Shen yang deficiency type, Gan depression type, blood stasis type（all P 〈0. 01）; 2 h glucose（GLU 2 h） was lower in patients with Shen yin deficiency type, Shen yang deficiency type, blood stasis type（P 〈0. 05, P 〈0. 01）; 3 h glucose（GLU 3 h） was lower in patients with Shen yin deficiency type（P 〈0. 05）.Compared with patients with Gan depression type, INS 2 h and GLU 2 h were also lower patients with Shen yin deficiency type（P 〈0. 05, P 〈0. 01）. Conclusions There exists certain distribution laws of syndrome types in PCOS patients. Besides, different syndrome types had certain relevance with sex hormone and glucose metabolism fea-tures.