青春期PCOS患者内分泌、代谢指标与中医证型的相关性研究

Correlation between Endocrine and Metabolic Indexes and TCM Syndromes in Patients with Adolescent Polycystic Ovary Syndrome

目的:探讨青春期PCOS患者内分泌、代谢指标与中医证型的相关性。方法:根据中医辨证对120例青春期PCOS患者进行中医分型(肾虚型、肝郁型、痰湿型、血瘀型),测定其内分泌、代谢指标,分析这些临床指标与4组中医证型的相关性。结果:4组患者血清FSH、LH、空腹血糖、总胆固醇、AMH组间差异无统计学意义(P>0.05);4组患者血清LH/FSH、睾酮(T)、空腹胰岛素(FINS)、稳态胰岛素指数(HOMA-IR)、甘油三酯、载脂蛋白B、ApoB/ApoA1、LDL、HDL、ApoA1组间差异有统计学意义(P<0.05):(1)血瘀型组、肾虚型组的LH/FSH水平明显高于痰湿组;(2)肝郁型组的睾酮T水平明显高于肾虚型组、血瘀型组;(3)痰湿型组的FINS、HOMA-IR显著高出肾虚型组、血瘀型组,肝郁型组的FINS、HOMA-IR显著高于肾虚型组;(4)痰湿型组的甘油三酯、载脂蛋白B、ApoB/ApoA1均显著高于其他3个证型组;(5)痰湿型组的LDL水平明显高于肝郁型组;(6)痰湿型组的HDL水平明显低于其余3个证型组;(7)痰湿型组的ApoA1明显低于肾虚型组。结论:青春期PCOS患者的临床内分泌、代谢指标与中医证型间具有一定相关性:代谢指标异常主要与痰湿证有关,睾酮T值升高主要与肝郁证有关,LH/FSH值升高主要与血瘀证、肾虚证有关。

Objective： To explore the relevance between clinical endocrine and metabolic indexes and TCM syndromes in adolescent PCOS patients. Methods： According to TCM syndrome differentiation,120 cases of adolescent PCOS patients of clinical collection were divided into four groups（kidney deficiency type, liver depression type, phlegm-damp type and blood stasis type）. The endocrine and metabolic indexes were determined, and these clinical indexes were analyzed with four TCM syndromes. Results： There was no significant difference in serum FSH, LH, FPG, total cholesterol and AMH between the four groups of TCM syndromes of adolescent PCOS patients（P〉 0.05）. The serum LH/FSH, testosterone（T）, Fasting insulin（FINS）, steady state insulin index（HOMA-IR）, triglyceride, ApoB, ApoB/ApoA1, LDL, HDL, ApoA1 were markedly different（P〈 0.05）：（1） The level of LH/FSH in blood stasis group and kidney deficiency group was markedly higher than that in phlegm-dampness group;（2） The level of testosterone T in the liver-stagnated liver-qi stagnation group was markedly higher than that in the kidney-deficiency type group and the blood-stasis type group;（3） The FINS and HOMA-IR of the phlegm-dampness group were significantly higher than those of the kidney deficiency group and the blood stasis group.The FINS and HOMA-IR of the liver-stagnation group were significantly higher than those of the kidney deficiency group;（4） The triglyceride, ApoB, ApoB/ApoA1 were markedly higher than those of the other three syndromes groups;（5） LDL of phlegm-dampness group was markedly higher than that of liver depression group;（6） HDL level of phlegm-dampness group was markedly lower;（7） ApoA1 in phlegm-dampness group was markedly lower than that in kidney-deficiency group. Conclusion： There are some correlations between the clinical endocrine and metabolic indexes of adolescents with PCOS. The abnormality of metabolic index is mainly related to the phlegm and dampness syndrome. The increase of testosterone T is mainly related to the syndrome of liver depression. The increase of LH/FSH ratio is related to blood Blood stasis syndrome and kidney deficiency syndrome.