滋肾化痰调周法联合西医治疗对多囊卵巢综合征伴胰岛素抵抗患者性激素水平及糖脂代谢的影响

Effect of Zishen Huatan cycle-regulating therapy combined with western medicine on sex hormone level and glycolipid metabolism in patients with polycystic ovary syndrome with insulin resistance

目的观察滋肾化痰调周法治疗多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)的临床疗效及对患者性激素水平、糖脂代谢的影响。方法将120例PCOS伴IR患者按照随机数字表法分为3组,对照组40例予盐酸二甲双胍片+炔雌醇环丙孕酮片治疗,中药组40例予滋肾化痰调周法治疗,中西医结合组40例予滋肾化痰调周法+盐酸二甲双胍片+炔雌醇环丙孕酮片治疗。2组均治疗3个月,随访3个月。统计比较3组临床疗效,比较3组治疗前后月经情况、临床体征改善情况、卵巢体积及体质量指数(BMI)变化情况,比较3组治疗前后和随访时中医证候积分及黄体生成激素(LH)、卵泡刺激素(FSH)、睾酮(T)、性激素结合球蛋白(SHBG)、LH/FSH、空腹胰岛素(FINS)、空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)、脂联素(APN)水平变化情况。结果中药组及中西医结合组总有效率均高于对照组(P <0. 05)。治疗后,3组月经周期、经期、经量评分及痤疮、多毛、月经稀发发生率均较本组治疗前降低(P <0. 05),且中药组低于对照组(P <0. 05),中西医结合组低于对照组和中药组(P <0. 05)。中药组及中西医结合组治疗前后卵巢体积差值及BMI差值均大于对照组(P <0. 05)。治疗后及随访3个月时,对照组LH、FSH、LH/FSH,中药组和中西医结合组LH、FSH、LH/FSH、T及SHBG与本组治疗前比较差异均有统计学意义(P <0. 05),且中西医结合组与对照组、中药组同期比较差异有统计学意义(P <0. 05);中药组治疗后LH、LH/FSH、T、SHBG及随访3个月时LH、FSH、LH/FSH、T、SHBG与对照组同期比较差异均有统计学意义(P <0. 05)。治疗后及随访3个月时,对照组FPG、HOMA-IR均较本组治疗前降低(P <0. 05);中药组及中西医结合组FINS、FPG、HOMA-IR均较本组治疗前降低(P <0. 05),APN升高(P <0. 05),且中药组FINS、HOMA-IR低于对照组同期(P <0. 05),APN高于对照组同期(P <0. 05);中西医结合组FINS低于对照组同期(P <0. 05),HOMA-IR低于对照组及中药组同期(P <0. 05),APN高于对照组及中药组同期(P <0. 05)。结论滋肾化痰调周法联合西医治疗PCOS伴IR疗效确切,临床症状改善明显,并可有效调节患者性激素水平及糖脂代谢,值得临床推广。

Objective To observe the clinical effects of Zishen Huatan cycle-regulating therapy combined with western medicine on sex hormone level and glycolipid metabolism in patients with polycystic ovary syndrome (PCOS) with insulin resistance (IR).Methods 120 cases with PCOS and IR were divided into three groups according to the random number table method.40 cases in control group were treated by metformin hydrochloride tablets and ethinyl estradiol progesterone tablets.40 cases in Chinese medicine group were treated by Zishen Huatan cycle-regulating therapy.40 cases in integrated Chinese and western medicine group were treated by Zishen Huatan cycle-regulating therapy plus metformin hydrochloride tablets and ethinyl estradiol cyproterone tablets.Both groups were treated for 3 months and followed up for 3 months.The clinical efficacy of the three groups was compared statistically.The menstrual status,clinical signs,ovarian volume and body mass index (BMI) of the three groups were compared before and after treatment.The TCM syndrome scores,luteinizing hormone (LH),follicle stimulating hormone (FSH),testosterone (T),sex hormone binding globulin (SHBG),LH/FSH,fasting insulin (FINS),fasting blood glucose (FPG),insulin resistance index (HOMA-IR),adiponectin (APN) levels of the three groups were compared before and after treatment and during follow-up.Results The total effective rate of the Chinese medicine group and the integrated Chinese and western medicine group was higher than that of the control group (P<0.05).After treatment,the menstrual cycle,menstrual period,menstrual volume score and the incidence of acne,hirsutism and menstrual rarity in the three groups were lower than those in the group before treatment (P<0.05),and that in the Chinese medicine group was lower than that in the control group (P<0.05),and that in the integrated Chinese and western medicine group was lower than that in the control group and the Chinese medicine group (P<0.05).The difference of ovarian volume and BMI in the Chinese medicine group and the integrated Chinese and western medicine group before and after treatment were greater than those of the control group (P<0.05).After treatment and follow-up for 3 months,the levels of LH,FSH,LH/FSH in the control group,LH,FSH,LH/FSH,T and SHBG in the Chinese medicine group and the integrated Chinese and western medicine group were significantly different from those before treatment (P<0.05),and the levels of LH,LH/FSH,T and SHBG in the integrated Chinese and western medicine group were significantly different from those in the control group and the Chinese medicine group (P<0.05).After treatment,the levels of LH,LH/FSH,T,SHBG and the levels of LH,FSH,LH/FSH,T and SHBG at 3 months of follow-up in the Chinese medicine group were significantly higher than those in the control group (P<0.05).After treatment and follow-up for 3 months,FPG and HOMA-IR in control group were lower than those before treatment (P<0.05),the FINS,FPG,HOMA-IR in Chinese medicine group and integrated Chinese and western medicine group were lower than those in the group before treatment (P<0.05),APN was increased (P<0.05),and FINS and HOMA-IR in Chinese medicine group were lower than those in the control group (P<0.05),APN was higher than that in the control group (P<0.05).After treatment and follow-up for 3 months,FINS in the integrated traditional Chinese and western medicine group was lower than those in the control group (P<0.05),the HOMA-IR in the integrated traditional Chinese and western medicine group were lower than those in the control group and Chinese medicine group (P<0.05),and APN was higher than that in the control group and the Chinese medicine group (P<0.05).Conclusion The combination of Zishen Huatan cycle-regulating therapy combined with western medicine in the treatment of PCOS with IR is effective,the clinical symptoms are improved obviously,and the level of sex hormones and glycolipid metabolism can be effectively regulated.It is worthy of clinical promotion.