哈氏痰湿方治疗痰湿型多囊卵巢综合征的临床疗效及对血清Kisspeptin水平的影响

Clinical Efficacy of Hashi Tanshi Decoction(哈氏痰湿方)in Treatment of Phlegm-Dampness Type Polycystic Ovary Syndrome and Its Effect on Serum Kisspeptin Level

目的:探讨哈氏痰湿方治疗痰湿型多囊卵巢综合征(PCOS)的临床疗效及对血清Kisspeptin水平的影响。方法:选取痰湿型PCOS患者70例,按照随机数字表法分为对照组和观察组各35例。对照组予生活方式干预治疗,观察组在对照组基础上口服哈氏痰湿方,治疗3个月。比较两组自然月经发生率、体质量指数(BMI)、腰臀比(WHR)及治疗前后中医证候评分;检测治疗前后两组患者睾酮(T)、促黄体生成素(LH)、促卵泡激素(FSH),计算LH/FSH;检测治疗前后空腹血糖(FBG)、空腹胰岛素(FINS),计算稳态模型胰岛素抵抗指数(HOMA-IR);检测治疗前后甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清Kisspeptin水平;分析治疗前血清中Kisspeptin水平与其他指标的相关性。结果:治疗后观察组自然月经发生率高于对照组(P<0.05);两组中医证候评分、BMI均较治疗前降低,观察组WHR较治疗前降低(P<0.05),且观察组低于对照组(P<0.05);两组T、LH均较治疗前降低(P<0.05),且观察组T、LH、LH/FSH水平低于对照组(P<0.05);两组FINS、HOMA-IR均较治疗前降低,且观察组低于对照组(P<0.05);两组TC及LDL-C均较治疗前降低,仅观察组TG较治疗前降低(P<0.05);治疗后观察组TC、TG、HDL-C及LDL-C与对照组比较,差异无统计学意义(P>0.05)。治疗后观察组Kisspeptin水平低于对照组(P<0.05),治疗前两组患者Kisspeptin水平与T及LH水平呈正相关(P<0.05),与BMI、FINS、HOMA-IR、TG、TC、HDL-C、LDL-C无相关性(P>0.05)。结论:哈氏痰湿方联合生活方式干预可以改善痰湿型PCOS患者的月经情况,调节性激素水平及糖脂代谢等相关指标,降低血清Kisspeptin水平。调节Kisspeptin在血清中的表达可能是哈氏痰湿方治疗痰湿型PCOS的作用机制之一。

Objective:To investigate the clinical efficacy of Hashi Tanshi Decoction(哈氏痰湿方)in the treatment of phlegm-dampness type polycystic ovary syndrome(PCOS)and effect on serum Kisspeptin level.Methods:Total 70 patients with phlegm-dampness type PCOS were randomly divided into control group and observation group by using random number table method,with 35 patients in each group.The control group was given lifestyle intervention,and the observation group was given Hashi Tanshi Decoction orally on the basis of the treatment of the control group for 3 months.The incidence of natural menstruation,body mass index(BMI),waist-to-hip ratio(WHR)and traditional Chinese medicine(TCM)syndrome scores before and after treatment were compared between the two groups.Testosterone(T)and luteinizing hormone(LH),follicle stimulating hormone(FSH)were detected before and after treatment,and LH/FSH was calculated.Fasting blood glucose(FBG)and fasting insulin(FINS)were detected before and after treatment,homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.Triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and serum Kisspeptin levels were detected before and after treatment.The correlation between serum Kisspeptin levels and other indicators before treatment was analyzed.Results:After treatment,the incidence of spontaneous menstruation in the observation group was higher than that in the control group(P<0.05).TCM syndrome score,BMI in both groups were lower than those before treatment(P<0.05);the WHR in the observation group decreased compared to before treatment(P<0.05),and the observation group was lower than the control group(P<0.05).T and LH in both groups were lower than those before treatment(P<0.05),and T,LH and LH/FSH levels in the observation group were lower than those in the control group(P<0.05).FINS and HOMA-IR in both groups were lower than those before treatment,and the observation group was lower than the control group(P<0.05).TC and LDL-C in both groups were lower than those before treatment,and TG in the observation group was lower than that before treatment(P<0.05).After treatment,there was no significant difference in TC,TG,HDL-C and LDL-C between the observation group and the control group(P>0.05).After treatment,Kisspeptin level in the observation group was lower than that in the control group(P<0.05),Kisspeptin level was positively correlated with T and LH levels in the two groups before treatment(P<0.05),but it was not correlated with BMI,FINS,HOMA-IR,TG,TC,HDL-C and LDL-C(P>0.05).Conclusions:Hashi Tanshi Decoction combined lifestyle intervention can improve the menstrual conditions,regulate hormone levels,glucose and lipid metabolism and reduce serum Kisspeptin level in patients with phlegm-dampness type PCOS.Regulating Kisspeptin expression in serum may be one of the mechanisms of Hashi Tanshi Decoction in treating phlegm-dampness type PCOS.