多囊卵巢综合征患者胰岛素抵抗与中医体质的相关研究

Study on the correlation between insulin resistance and TCM constitution in patients with polycystic ovary syndrome

目的探讨不同稳态模型胰岛素抵抗指数(HOMA-IR)的多囊卵巢综合征(PCOS)患者中医体质分布规律,为实现中医“治未病”,辨体、辨病、辨证相结合治疗PCOS提供参考依据。方法通过临床科研一体化系统录入PCOS患者841例,根据《中医体质分类与判定》判定中医体质类型,测定空腹血糖及空腹胰岛素水平,计算HOMA-IR,根据HOMA-IR分为HOMA-IR<1.66组、1.66≤HOMA-IR<2.69组、HOMA-IR≥2.69组,观察各组中医体质类型分布情况。结果841例PCOS患者中医体质以痰湿质(24.02%)、气虚质(22.24%)为主,其次为血瘀质(14.74%)、湿热质(13.20%)和平和质(10.46%)。HOMA-IR<1.66组148例,1.66≤HOMA-IR<2.69组200例,HOMA-IR≥2.69组493例。PCOS患者9种中医体质在不同HOMA-IR分组中分布均存在明显差异(P均<0.05);HOMA-IR<1.66组前3位依次为痰湿质、血瘀质和平和质;1.66≤HOMA-IR<2.69组前3位依次为气虚质、血瘀质、痰湿质;HOMA-IR≥2.69组前3位依次为痰湿质、气虚质、湿热质。结论PCOS患者胰岛素抵抗的发生率较高,胰岛素抵抗与中医体质间存在联系,在临床治疗中,辨体与辨病、辨证相结合能够更好地预防疾病的发展。

Objective It is to explore the traditional Chinese medical constitution distribution of polycystic ovary syndrome(PCOS)patients with different homeostasis model of insulin resistance index(HOMA-IR),in order to provide the reference for the“treatment of disease”in Chinese medicine,the treatment of PCOS by combining constitution differentiation,disease differentiation and syndrome differentiation.Methods 841 patients with PCOS were enrolled in the clinical research integration system,and their types of TCM constitution were diagnozed according to the TCM Constitution and Judgment,the levels of fasting blood glucose and fasting insulin were determined,HOMA-IR was calculated and the patients were classified into HOMA-IR<1.66 group,1.6≤HOMA-IR<2.69 group,HOMA-IR≥2.69 group according to HOMA-IR.The distribution of TCM constitution types in each group were observed.Results Among the 841 patients with PCOS,the constitution of TCM was mainly phlegm-dampness(24.02%)and Qi-deficiency(22.24%),followed by blood stasis(14.74%),dampness-heat(13.20%)and the moderate(10.46%).There were 148 cases in HOMA-IR<1.66 group,200 cases in 1.66≤HOMA-IR<2.69 group,493 cases in HOMA-IR≥2.69 group.There were significant differences in the distribution of 9 TCM constitutions in different HOMA-IR groups in PCOS patients(P<0.05),the top 3 constitutions in HOMA-IR<1.66 group were phlegm-dampness,blood stasis and the moderate,in 1.66≤HOMA-IR<2.69 group were Qi deficiency,bloody stasis and phlegm-dampness,in HOMA-IR≥2.69 were phlegm-dampness,Qi-deficiency and dampness-heat.Conclusion The incidence of insulin resistance is higher in patients with PCOS.There is a relationship between insulin resistance and TCM constitution.The combination of constitution differentiation,disease differentiation and syndrome differentiation can prevent the development of disease more effectively in clinic.