多囊卵巢综合征证候特征与超声下卵巢形态学及血流动力学参数的相关性研究

Correlation between pattern features of polycystic ovary syndrome and ovarian morphological and hemodynamic parameters under ultrasonography

目的探讨多囊卵巢综合征(PCOS)证候特征与超声下卵巢形态学及血流动力学参数的相关性。方法将300例PCOS患者根据证候分为4组,肾虚组62例,脾虚痰湿组104例,肝郁血瘀组54例,阳明浊热组80例。采集患者一般资料,包括年龄、初潮年龄、病史、体质量指数(BMI)。经阴道或直肠进行超声检查,检测卵巢体积、卵泡数量及最大卵泡直径。选择卵巢髓质内最粗大动脉,检测其血流阻力指数(RI)和血流搏动指数(PI)。对4组PCOS患者年龄、初潮年龄、病史及BMI进行比较。对4组PCOS患者卵巢形态学特征进行比较,包括卵巢体积、卵泡数量、最大卵泡直径。对4组PCOS患者卵巢血流动力学特征进行比较,包括RI、PI。结果4组患者在年龄、初潮年龄及BMI方面比较,差异均无统计学意义(P>0.05)。病史肾虚组较阳明浊热组缩短,差异有统计学意义(P<0.05)。卵巢体积肾虚组较脾虚痰湿组、肝郁血瘀组、阳明浊热组均减小,差异均有统计学意义(P<0.05);肝郁血瘀组较脾虚痰湿组、阳明浊热组均减小,差异均有统计学意义(P<0.05);脾虚痰湿组与阳明浊热组比较,差异无统计学意义(P>0.05)。卵泡数量肾虚组较脾虚痰湿组、阳明浊热组均减少,差异均有统计学意义(P<0.05),与肝郁血瘀组比较,差异无统计学意义(P>0.05);肝郁血瘀组较脾虚痰湿组、阳明浊热组均减少,差异均有统计学意义(P<0.05);脾虚痰湿组、阳明浊热组比较,差异无统计学意义(P>0.05)。最大卵泡直径肾虚组较脾虚痰湿组、肝郁血瘀组、阳明浊热组均减小,差异均有统计学意义(P<0.05);脾虚痰湿组、肝郁血瘀组、阳明浊热组3组比较,差异均无统计学意义(P>0.05)。卵巢RI、PI肾虚组较肝郁血瘀组、阳明浊热组均降低,差异均有统计学意义(P<0.05),较脾虚痰湿组升高,差异均有统计学意义(P<0.05);脾虚痰湿组较肝郁血瘀组、阳明浊热组均降低,差异均有统计学意义(P<0.05);肝郁血瘀组、阳明浊热组比较,差异均无统计学意义(P>0.05)。结论4组PCOS患者卵巢形态学及血流动力学各有特点,可为中医临床辨证提供依据。

Objective To explore the correlation between the pattern features of polycystic ovary syndrome(PCOS)and ovarian morphological and hemodynamic parameters under ultrasonography.Methods A total of 300 patients with PCOS were assigned to 4 groups according to pattern identification,with 62 cases in the kidney deficiency(KD)group,104 cases in the spleen deficiency leading to phlegm dampness(SPPD)group,54 cases in the liver stagnation and blood stasis(LSBS)group and 80 cases in Yangming Zhuore group.General data of the patients were collected,including age,menarche age,medical history and body mass index(BMI).Ultrasonography was performed via the vagina or rectum to detect ovarian volume,follicle volume and maximum follicle diameter.The blood flow resistance index(RI)and blood flow pulsation index(PI)of the thickest artery in the ovarian medulla were measured.The age,menarche age,medical history and BMI in the 4 groups of PCOS patients were compared.The morphological characteristics of ovaries in 4 groups of PCOS patients were compared,including the ovarian volume,follicle volume,and maximum follicle diameter.The ovarian hemodynamic characteristics of 4 groups of PCOS patients were compared,including RI and PI.Results There was no significant difference in age,menarche age and BMI among the four groups(P>0.05).The medical history was significantly shortened in the KD group than in the Yangming Zhuore group(P<0.05).The ovarian volume was significantly smaller in the KD group than in the SPPD group,LSBS group,and Yangming Zhuore group(P<0.05);the ovarian volume was significantly smaller in the LSBS group than in SPPD group and Yangming Zhuore group(P<0.05);there was no significant difference between SPPD group and Yangming Zhuore group(P>0.05).The follicle volume was significantly lower in the KD group than in the SPPD group and Yangming Zhuore group(P<0.05);there was no significant difference as compared with LSBS group(P>0.05);the follicle volume was significantly lower in the LSBS group than SPPD group and Yangming Zhuore group(P<0.05);there was no significant difference between the SPPD group and Yangming Zhuore group(P>0.05).The maximum follicle diameter was significantly smaller in the KD group than in the SPPD group,LSBS group,and Yangming Zhuore group(P<0.05);there was no significance between the SPPD group,LSBS group and Yangming Zhuore group(P>0.05).The RI and PI of the ovary were significantly lower in the KD group than in the LSBS group and Yangming Zhuore group(P<0.05),and significantly higher in the KD group than in the SPPD group(P<0.05);the RI and PI of the ovary were significantly lower in the SPPD group than in the LSBS group and Yangming Zhuore group(P<0.05);there was no significant difference between the LSBS group and Yangming Zhuore group(P>0.05).Conclusion The ovarian morphology and hemodynamics of the 4 groups of PCOS patients have their own characteristics,which can provide reference for clinical pattern differentiation.