王氏益经汤联合常规疗法治疗多囊卵巢综合征肾虚痰湿证的疗效及对肠-脑轴调节作用

Wang's Yijing Decoction Combined with Conventional Therapy:Performance in Treating Polycystic Ovary Syndrome with Kidney Deficiency and Phlegm-dampness Syndrome and Regulating Effect on Intestine-brain Axis

目的:观察王氏益经汤联合常规疗法治疗多囊卵巢综合征(PCOS)肾虚痰湿证的疗效及对肠-脑轴的调节作用。方法:将山西白求恩医院妇科门诊的132例患者按随机按数字表分为对照组和观察组,各66例。对照组给予屈螺酮炔雌醇片和二甲双胍片治疗,观察组在对照组治疗的基础上加用王氏益经汤治疗。治疗3个月经期周期。进行治疗前后月经量、色、质、周期变化情况评分;治疗前后Rosenfield、多毛和肾虚痰湿证评分;治疗前后盆腔B超检查,比较双侧卵巢体积;检测治疗前后抗苗勒管激素(AMH)、雌二醇(E_(2))、促黄体生成素(LH)、促卵泡刺激素(FSH)、睾酮(T)、双氢睾酮(DHT)、性激素结合球蛋白(SHBG)水平,计算游离睾酮指数(FAI);检测治疗前后空腹胰岛素、空腹血糖,计算稳态模型胰岛素抵抗指数(HOMA-IR);检测治疗前后血清胃饥饿素、胰高血糖素样肽-1(GLP-1)、酪酪肽(PYY)水平和新鲜粪便中短链脂肪酸(SCFAs)水平。结果:治疗后,两组患者月经不调、Rosenfield、多毛和肾虚痰湿证评分降低(P<0.01),且观察组低于对照组(P<0.01)。治疗后,两组患者T、DHT、FAI、AMH、E_(2)、LH和FSH降低(P<0.01),SHBG水平升高(P<0.01),且观察组AMH、E_(2)、LH、T、DHT和FAI低于对照组,SHBG高于对照组(P<0.01)。治疗后,两组患者双侧卵巢体积和HOMA-IR下降(P<0.01),且观察组低于对照组(P<0.05,P<0.01)。治疗后,两组患者胃饥饿素、GLP-1、PYY和SCFAs升高(P<0.01),且观察组高于对照组(P<0.01)。观察组愈显率为65.57%(40/61),高于对照组的44.83%(26/58),差异有统计学意义(χ^(2)=5.180,P<0.05)。结论:王氏益经汤配合西医常规疗法治疗PCOS肾虚痰湿证能调节肠-脑轴,纠正了内分泌代谢紊乱和性激素,调整了月经周期,减轻了临床症状,有着较好的临床疗效。

Objective:To observe the therapeutic effect of Wang's Yijing decoction combined with conventional therapy on the treatment of polycystic ovary syndrome(PCOS)with kidney deficiency and phlegm-dampness syndrome and its regulating effect on the intestine-brain axis.Method:The 132 patients from the gynecological clinic of Shanxi Bethune Hospital were randomly assigned into a control group and an observation group,with 66 patients in each group.The patients in the control group were treated with drospirenone and ethinylestradiol tablets and metformin tablets,and those in the observation group were administrated with Wang's Yijing decoction on the basis of the therapy in the control group.The treatment in both groups lasted for 3 menstrual cycles.The changes in menstrual blood volume,color,and texture,as well as that in the menstrual cycle before and after treatment were scored.Further,the Rosenfield,hirsutism,and kidney deficiency and phlegm-dampness syndrome were scored before and after treatment.Pelvic ultrasound was performed before and after treatment to compare the bilateral ovarian volume.The levels of anti-mullerian hormone(AMH),estradiol(E_(2)),luteinizing hormone(LH),follicle-stimulating hormone(FSH),testosterone(T),dihydrotestosterone(DHT),and sex hormone-binding globulin(SHBG)were measured before and after treatment,and the free androgen index(FAI)was calculated.After the fasting insulin and fasting blood glucose were examined before and after treatment,the homeostatic model assessment of insulin resistance(HOMA-IR)was calculated.The levels of ghrelin,glucagon-like peptide-1(GLP-1),peptide tyrosine-tyrosine(PYY)in serum and short-chain fatty acids(SCFAs)in fresh stool were measured before and after treatment.Result:The treatments in both groups lowered the scores of irregular menstruation,Rosenfield,hirsutism,and kidney deficiency and phlegm-dampness syndrome(P<0.01),and the scores in the observation group were lower than those in the control group(P<0.01).After treatment,the T,DHT,FAI,AMH,E_(2),LH,and FSH levels lowered(P<0.01),while the SHBG level elevated(P<0.01).In addition,the AMH,E_(2),LH,T,DHT,and FAI in the observation group were lower than those in control group,while the SHBG level presented an opposite trend(P<0.01).After treatment,the bilateral ovarian volume and HOMA-IR of the two groups decreased(P<0.01),and were lower in the observation group than in the control group(P<0.05,P<0.01).The treatments in both groups elevated the levels of ghrelin,GLP-1,PYY,and SCFAs(P<0.01),which were higher in the observation group than in the control group(P<0.01).After treatment,the recovery rate in the observation group was 65.57%(40/61),which was higher than 44.83%(26/58)in the control group(χ2=5.180,P<0.05).Conclusion:Wang's Yijing decoction combined with conventional western medicine treatment can regulate the intestine-brain axis,endocrine and metabolic disorders,and sex hormones,adjust the menstrual cycle,and alleviate clinical symptoms,demonstrating good clinical effect for the PCOS patients with kidney deficiency and phlegm dampness syndrome.