基于慢性炎症探讨中医药防治多囊卵巢综合征的研究进展

A review on the TCM prevention and treatment of PCOS based on chronic inflammation

多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)是一种遗传与非遗传并存的生殖内分泌代谢紊乱的疾病,以卵巢多囊样改变、排卵障碍、高雄激素血症(Hyperandrogenism,HA)为主要临床特征,常伴有胰岛素抵抗(Insulin Resistance,IR)、高胰岛素血症和糖脂代谢等内分泌紊乱,从远期并发症来看,PCOS与心血管疾病、糖尿病、子宫内膜癌、非酒精性脂肪性肝病等密切相关,严重影响患者的生活质量。近年来,慢性炎症导致PCOS,其发病机制受到广泛关注:核转录因子-κB途径的激活、氧化应激、肠道菌群失调、过多的脂肪组织均可引起炎症因子的释放,导致慢性炎症和内分泌紊乱,从而影响卵泡发育和排卵障碍,最终导致PCOS。慢性炎症状态无明显红肿热痛的局部和全身表现,而是表现为血浆中炎症因子如白细胞因子、C反应蛋白(C-reactive Protein,CRP)、肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)、白细胞介素(Interleukin,IL)-6、IL-10、IL-12、IL-18等水平升高2~4倍,所以改善慢性炎症对于治疗PCOS有着重要意义。临床研究表明,中医药在改善PCOS慢性炎症方面有着丰富的经验,在辨证论治的基础上,采取中医经典方、中药单体、中成药、针刺、针药联合、中西医结合等多种治疗方法。目前慢性炎症参与PCOS的具体机制尚不明确。文章围绕慢性炎症与PCOS的发病机制、中医药防治等方面进行综述,以期为中医药治疗PCOS慢性炎症提供借鉴。

Polycystic Ovary Syndrome(PCOS)is a genetic and non-genetic co-existing disorder of reproductive endocrine metabolism.PCOS is characterized by polycystic ovarian-like changes,ovulation disorders,hyperandrogenemia as the main clinical features,it is often accompanied with endocrine disorders such as insulin resistance,hyperinsulinemia and glucolipid metabolism,and in terms of long-term complications,PCOS is closely related to cardiovascular disease,diabetes mellitus,endometrial cancer and non-alcoholic fatty liver,which seriously affect the quality of life of patients.In recent years,chronic inflammation has led to PCOS,and its pathogenesis has attracted wide attention:activation of NF-κB pathway,oxidative stress,intestinal flora imbalance,and excessive adipose tissue can cause the release of inflammatory factors,leading to chronic inflammation and endocrine disorders,which affect follicle development and ovulation disorders,and eventually lead to PCOS.Chronic inflammation is without obvious local and systemic manifestations of redness,swelling,heat and pain.Instead,it is manifested as a 2-4-fold increase in the levels of plasma inflammatory factors,such as leukocyte factor,CRP,TNF-α,IL-6,IL-10,IL-12,IL-18 and other inflammatory factors.Therefore,ameliorating chronic inflammation is of great significance for the treatment of PCOS.Clinical studies have shown that TCM has rich experience in ameliorating chronic inflammation in PCOS,and various therapeutic approaches such as classical TCM formula,TCM monomer,TCM compound,acupuncture,combination of acupuncture and medicine,and combination of TCM and Western medicine are adopted on the basis of evidence-based treatment,and the specific mechanism of chronic inflammation involved in PCOS is still unclear.The article reviews the pathogenesis of chronic inflammation in PCOS and TCM prevention and treatment,in order to provide a reference for the treatment of chronic inflammation in PCOS in TCM.