肥胖型PCOS伴胰岛素抵抗患者慢性低度炎症状态及补肾化痰方的干预作用研究

Study on the chronic low-grade inflammation in obese PCOS patients with insulin resistance and the interventional effect of Bushen Huatan Decoction

目的观察肥胖型多囊卵巢综合征(PCOS)伴胰岛素抵抗患者慢性低度炎症状态,探讨补肾化痰方的干预作用。方法前瞻性选择2020年1—10月黑龙江中医药大学附属第一医院妇科门诊诊治的肥胖型PCOS伴胰岛素抵抗患者70例,采用随机数字表法分成2组,对照组给予二甲双胍口服治疗,治疗组给予补肾化痰方联合二甲双胍口服治疗,2组均治疗3个月。对照组31例和治疗组35例完成研究。观察2组治疗前后的人体测量指标(体重、收缩压、舒张压、腰围、臀围、腰臀比)、糖脂代谢指标[空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)]、性激素指标[黄体生成激素(LH)、促卵泡生成素(FSH)、睾酮(T)、雄烯二酮(AND)、硫酸脱氢表雄酮(DHEAS)、性激素结合雄蛋白(SHBG)、LH/FSH]及炎症细胞因子[白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平。结果治疗3个月后,2组人体测量指标与治疗前比较及治疗后组间比较差异均无统计学意义(P均>0.05);2组FINS、HOMA-IR、TG、IL-2、IL-6、IL-8、TNF-α水平均明显降低(P均<0.05),SHBG水平均明显升高(P均<0.05),且治疗后治疗组TG水平明显低于对照组(P<0.05)。结论肥胖型PCOS伴胰岛素抵抗患者存在低度炎症反应;补肾化痰方虽未显示出明显降低炎症因子表达及升高血清SHGB水平作用,但可明显降低TG水平,能降低患者远期心血管疾病发生风险。

Objective It is to observe the chronic low-grade inflammation in obese polycystic ovary syndrome(PCOS)patients with insulin resistance and the interventional effect of Bushen Huatan Decoction on it.Methods Seventy obese PCOS patients with insulin resistance in the gynecological clinic of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from January to October 2020 were prospectively selected and divided into 2 groups by random number table method.The control group was given metformin by oral administration,and the treatment group was given Bushen Huatan Decoction combined with metformin by oral administration.Both groups were treated for 3 months.31 cases in the control group and 35 cases in the treatment group completed the study.The levels of anthropometric indicators(weight,systolic blood pressure,diastolic blood pressure,waist circumference,hip circumference,waist-to-hip ratio),glucose and lipid metabolism indicators[fasting blood glucose(FPG),fasting insulin(FINS),insulin resistance index(HOMA-IR),triacylglycerol(TG),total cholesterol(TC),high density lipoprotein(HDL),low density lipoprotein(LDL),apolipoprotein A(ApoA),apolipoprotein B(ApoB)],sex hormone indicators[luteinizing hormone(LH),follicle stimulating hormone(FSH),testosterone(T),androstenedione(AND),dehydroepiandrosterone sulfate(DHEAS),sex hormone binding androgen(SHBG),LH/FSH]and inflammatory cytokines[interleukin-2(IL-2),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]were observed before and after treatment in the two groups.Results After 3 months of treatment,there was no significant difference in anthropometric indicators between before and after treatment in each group and between the two groups before and after treatment(all P>0.05);the levels of FINS,HOMA-IR,TG,IL-2,IL-6,IL-8 and TNF-αwere significantly reduced(all P<0.05),and the levels of SHBG were significantly increased in the two groups(all P<0.05),and the TG level in the treatment group was significantly lower than that in the control group after treatment(P<0.05).Conclusion Obese PCOS patients with insulin resistance have low-grade inflammation.Although Bushen Huatan decoction does not significantly reduce the expression of inflammatory factors and increase serum SHGB levels,it can significantly reduce TG level and reduce the occurrence risk of long-term cardiovascular disease.