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

Study on the Differences on the Glucose and Lipid Metabolism and Sex Hormone Levels Between Different Traditional Chinese Medicine Syndromes of Polycystic Ovary Syndrome Patients

目的:分析研究多囊卵巢综合征患者不同中医证型的糖脂代谢水平及性激素水平的差异。方法:便利抽取2014年12月~2016年12月来我院进行治疗的多囊卵巢综合征患者110人,采集患者详细临床资料,结合诊断标准确定患者中医证型分型情况;检测患者的糖脂代谢水平及性激素水平指标,比较不同中医证型患者在上述指标方面表现出的差异性。结果:四种中医证型占比比例由高到底依次为:脾虚痰湿型(32.73%)、肾虚肝郁型(27.27%)、痰瘀互结证(26.36%)和肾虚血瘀型(13.64%);脾虚痰湿型和痰瘀互结型的葡萄糖、胰岛素和稳态模型的胰岛素抵抗指数远远高于另外两种中医证型,且差异具有统计学意义(P<0.05);脾虚痰湿型和痰瘀互结型甘油三酯、低密度脂蛋白胆固醇、载脂蛋白B、载脂蛋白B/A1明显高于另外两种,而其低密度脂蛋白胆固醇和载脂蛋白A1明显低于另外两种,差异均具有统计学意义(P<0.05);肾虚肝郁型和肾虚血瘀型的黄体生成素和性激素结合球蛋白明显高于另外两组,而其游离雄激素指数明显低于另外两组,差异均具有统计学意义(P<0.05);肾虚肝郁型和肾虚血瘀型的黄体生成素/促卵泡激素,分别为2.13±1.26和2.18±1.15,且高于另外两组,但是差异不具有统计学意义(P>0.05)。结论:多囊卵巢综合征患者的主要证型为脾虚痰湿型;脾虚痰湿型和痰瘀互结型患者糖脂代谢异常程度比另外两种证型更严重;肾虚肝郁型和肾虚血瘀型的主特征为黄体生成素和性激素结合球蛋白上升,而脾虚痰湿型和痰瘀互结型的主特征为游离雄激素指数下降。

Objective： To study the differences on the glucose and lipid metabolism and sex hormone levels between different TCM syndromes of polycystic ovary syndrome patients. Methods： The clinical data of ll0patients with polycystic ovary syndrome who were treated in our hospital from December 2014to December 2016were selected. In the course of the experiment, the clinical information were collected to determine the level of TCM syndromes combined with the diagnostic criteria. The glycolipid metabolism and sex hormone levels were tested to study the differences on the two above levels between different TCM syndromes. Results： Four proportion of TCM syndromes from high to low in the order： spleen- deficiency phlegmdampness type （32. 73% ）, kidney-deficiency liver-depression type （27.27%）, phlegm and blood-stasis type （26. 36% ）, kidney-deficien- cy blood-stasis type （13.64%）. The glucose, insulin and steady-state models of insulin resistance index of spleen-deficiency phlegm-dampness type and phlegm and blood-stasis type was much higher than that of the other two TCM syndromes, and the difference was statistically significant （P〈0. 05）. The triglyceride, low-density lipoprotein cholesterol, apolipoprotein B, the rate of apolipoprotein B and apolipoprotein Alof spleen-deficiency phlegm-dampness type and phlegm and blood-stasis type were significantly higher than the other two, but its low-density lipoprotein cholesterol and apolipoprotein Alwas significantly lower than the other two, and the difference was statistically significant （P〈0. 05）. The Luteinizing hormone and sex hormone-binding globulin of kidney-deficiency blood-stasis type was significantly higher than the other two kinds, but its free androgen index was significantly lower than the other two, and the difference was statistically significant （P〈0. 05）. The rate of Luteinizing hormone and follicle stimulating hormone of kidney-deficiency liver-depression type and kidney-deficieno blood-stasis type were 2. 13 ± 1.26and 2. 18± 1.15respectively which were higher than the other two groups, but the difference was not statistically significant （P〉0. 05）. Conclusion ： The main syndromes of patients with polycystic ovary syndrome was spleen-deficiency phlegm-damp-ness type. The glucose and lipid metabolism abnormalities of spleen-deficiency phlegm-dampness type and phlegm and blood- stasis type were more serious than the other two. The main features of kidney-deficiency liver-depression type and kidney-defi- ciency blood-stasis type were the increasing Luteinizing hormone and the increasing sex hormone binding globulin, and the main features of spleen and spleen-deficiency phlegm-dampness type and phlegm and blood-stasis type were the decreasing free androgen index.