加味巴仙汤对肾阳虚型PCOS患者RAS的影响及促排卵的临床研究

Studying the Efficiency of Revised Baxian Decoction on Renin-Angiotensin System(RAS) and Inducing Ovulation of Polycystic Ovary Syndrome(PCOS) Patients with Kidney-Yang Deficiency

[目的]研究加味巴仙汤对肾阳虚型多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者肾素-血管紧张素系统(renin-angiotensin system,RAS)、胰岛素抵抗(insulin resistance,IR)、性激素水平的影响及促排卵的疗效并探讨其可能的作用机制。[方法]选取肾阳虚型PCOS患者62例,按就诊尾号单双数分为中药组(28例)和西药组(34例)。西药组口服炔雌醇环丙孕酮片(达英-35),1片/d,21片为1个周期;中药组予以加味巴仙汤水煎服,1剂/d,遇经期停服。评估两组患者治疗前后的性激素、空腹血糖(fasting blood sugar,FBS)、IR、肾素活性(plasma renin activity,PRA)、血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)、体重指数(body mass index,BMI)以及卵巢体积、窦卵泡数目、周期排卵率及妊娠率等临床指标。[结果](1)PCOS患者AngⅡ水平与PRA、促黄体生成素(luteinizinghormone,LH)、血清总睾酮(testosternoe,T)水平及LH/FSH比值呈正相关(P<0.01),与促卵泡生长素(follicle stimulating hormone,FSH)、雌二醇(estradiol,E2)、空腹胰岛素(fasting insulin,FINS)、FBS、IR及BMI无相关性(P>0.05)。(2)与治疗前比较,治疗后两组患者AngⅡ、LH/FSH、T、卵泡数目明显减少,卵巢体积明显缩小(P<0.05,P<0.01);中药组患者PRA、FBS、LH、BMI水平下降明显(P<0.01),IR程度减轻(P<0.01),西药组患者上述指标无明显变化(P>0.05),且BMI水平明显上升(P<0.01)。(3)治疗后两组间比较,中药组FBS、FINS、IR、BMI显著下降(P<0.05,P<0.01),而妊娠率及周期排卵率无统计学差异(P>0.05)。[结论](1)PCOS患者的RAS与性激素水平及IR存在密切联系;(2)加味巴仙汤可有效改善肾阳虚型PCOS患者的性激素水平,抑制RAS激活,提高妊娠率,其效果与炔雌醇环丙孕酮片无明显差异,同时可改善IR,避免水钠潴留,起到轻身减肥之效。

[Objective] To elucidate the effect of revised Baxian Decoction on polycystic ovary syndrome（PCOS） with kidney-Yang vacuity. We study the patients＇ sex hormone, renin-angiotensin system（RAS）,insulin resistance and the effect of revised Baxian Decoction on PCOS patients ＇induced ovulation, in order to explore its action mechanism. [Methods] Sixty-two cases with PCOS were divided into 2 groups by random. Twenty eight cases received treatment with decoction, one dose a day, morning and eventing hours service during intermenstruum, the others treated with Diane-35, one tablet once a day orally for every 21 days. Both herbal and Diane-35 groups were evaluated their basal hormonal profile, fasting blood sugar（FBS）, insulin resistance（IR）, plasma renin activity（PRA）, angiotensin Ⅱ（AngⅡ）, body mass index（BMI）, ovarian volume, antral follicle count,periodic ovuluation rates and pregnancy rates.[Result]（1）In PCOS patients,positive correlation was found between AngⅡ and PRA, luteinizinghormone（LH）, testosternoe（T） and LH/FSH ratio（P〈0.01）. There was no correlation between Ang Ⅱ and follicle stimulating hormone（FSH）,estradiol（E2）,fasting insulin（FINS）,IR and BMI（P〈0.05）.（2） Compared with pre-treatment, Ang Ⅱ, LH/FSH ratio T, antral follicle count and ovarian volume were significantly declined after treatment in both groups（P〈0.05 or P〈0.01）.（3）PRA, FBS, LH and IR were significantly declined in herb group after treatment（ P〈0.01）, but there was no significant change in Daine-35 group（P〉0.05）. BMI in herb group was lower after treatment, but reverse in Diane-35 group（ P〈0.01）. There were no differences of periodic ovuluation and pregnancy rates between two groups（P〈0.05）. [Conclusion]（1）These results may suggest that there is an important correlation between RAS and IR in patients with PCOS.（2）The efficiency of revised Baxian Decoction in improving the abnormal endocrine environment and inhibiting activation of RAS in PCOS patients with kidney-yang deficiency is almost the same with Diane-35. Especially, revised Baxian Decoction can decline the level of FBS, FINS, IR and BMI.