针刺对不同糖耐量状态多囊卵巢综合征患者血管内皮功能的影响

Effect of acupuncture on vascular endothelial function in patients of polycystic ovary syndrome with different glucose tolerance status

目的:观察针刺对糖耐量异常(IGT)与正常糖耐量(NGT)多囊卵巢综合征(PCOS)患者血管内皮功能的影响。方法:根据糖耐量情况将140例PCOS患者分为IGT组(70例,脱落11例)、NGT组(70例,脱落9例)。两组均采用全周期针刺,针刺中脘、关元、气海、天枢等穴,隔日1次,每周3次,连续治疗3个月。于治疗前后比较两组中医症状评分、胰岛素抵抗指标[空腹血糖(FPG)、2 h血糖(2hPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]及血管内皮相关因子[不对称二甲精氨酸(ADMD)、内皮素1(ET-1)、丙二醛(MDA)、一氧化氮(NO)],并进行组内肥胖与非肥胖亚组比较。结果:两组治疗后中医症状评分、ADMD、ET-1、MDA均降低(P<0.05),NO升高(P<0.05),IGT组患者治疗后FPG、2hPG、FINS、HOMA-IR均降低(P<0.05)、IGT组以上指标改善幅度均大于NGT组(P<0.05)。两组内肥胖亚组治疗后血清ADMD、ET-1、MDA均降低(P<0.05),NO升高(P<0.05);IGT组肥胖亚组血清ADMD、ET-1、MDA、NO改善幅度大于非肥胖组(P<0.05);NGT组肥胖亚组血清ET-1、MDA、NO改善幅度大于非肥胖亚组(P<0.05)。结论:针刺能改善PCOS患者血管内皮功能,且在改善程度上IGT患者优于NGT患者,肥胖患者优于非肥胖患者。

Objective To observe the effect of acupuncture on vascular endothelial function in patients of polycystic ovary syndrome(PCOS) with impaired glucose tolerance(IGT) and normal glucose tolerance(NGT). Methods A total of 140 patients with PCOS were divided into an IGT group(70 cases, 11 dropped off) and a NGT group(70 cases, 9 cases dropped off). The patients in the two groups were treated with full-cycle acupuncture at Zhongwan(CV 12), Guanyuan(CV 4),Qihai(CV 6), Tianshu(ST 25), etc. once every other day, 3 times a week, for 3 months. Before and after treatment, TCM symptom score, insulin resistance index [including fasting plasma glucose(FPG), 2-hour blood glucose(2 hPG), fasting serum insulin(FINS), homeostasis model assessment of insulin resistance(HOMA-IR)] and vascular endothelial related factors [including asymmetric dimethylarginine(ADMD), endothelin-1(ET-1), malondialdehyde(MDA), nitric oxide(NO)] were compared between the two groups;in addition, the obese subgroup and non-obese subgroup of the two groups were further compared. Results Compared before treatment, the TCM symptom scores, ADMD, ET-1 and MDA after treatment were decreased(P<0.05), and NO was increased(P<0.05) in the two groups;FPG, 2 hPG, FINS and HOMA-IR after treatment were decreased in the IGT group(P<0.05), the improvement of the above indexes in the IGT group was more significant than that in the NGT group(P<0.05). After treatment, the serum levels of ADMD, ET-1 and MDA were decreased(P<0.05), and NO was increased(P<0.05) in the obese subgroup. In the IGT group, the improvement of serum ADMD, ET-1, MDA and NO in the obese subgroup was more significant than that in the non-obese subgroup(P<0.05). In the NGT group, the improvement of ET-1, MDA and NO in the obese subgroup was more significant than that in the non-obese subgroup(P<0.05). Conclusion Acupuncture could improve vascular endothelial function in PCOS patients,IGT patients have better efficacy than NGT patients, and obese patients have better efficacy than non-obese patients.