以肾为本治疗多囊卵巢综合征研究进展

Research Progress of Kidney-Based Treatment of Polycystic Ovary Syndrome

多囊卵巢综合征(polycystic ovary syndrome, PCOS)的发生以肾虚为根本,与脾、肝两脏功能失调相关,治疗多以补肾为主,辅以健脾化痰,疏肝活血。多项基础及临床研究表明,中医以肾为本治疗PCOS效果显著,在调经助孕、改善患者卵巢及生殖、内分泌功能方面疗效显著且毒副作用小。但目前的研究仍存在一些不足:(1)鉴别诊断不充分。PCOS确诊前应综合患者临床症状、体征及辅助检查结果,排除先天性肾上腺皮质增生、皮质醇增多症、雄激素相关肿瘤、早发性卵巢功能不全、功能性下丘脑性闭经等疾病,因他病而致闭经者应当积极治疗原发病,避免漏诊和误诊。(2)目前中医对PCOS的病因病机尚未形成统一认识,目前治则治法多源于医家临床经验总结,受主观因素影响较大,标准化的证型规范及诊疗方案有待进一步完善。(3)中医治疗PCOS的临床研究较多,但普遍存在样本量小、观察周期短、设计不严谨及研究思路局限等问题,符合循证医学要求的高级别临床研究证据不足。今后需在西医治疗的基础上,深入研究PCOS的中医病因病机,开展高质量的临床研究,探索中医药治疗PCOS的有效性和稳定性,发挥中医辨证论治的特色和优势,为PCOS的中西医结合临床诊治提供更多理论和实践依据。

The occurrence of polycystic ovary syndrome(PCOS)is based on the kidney deficiency,and related to the dysfunction of the spleen and liver.The treatment is mainly to tonify the kidney,supplemented by invigorating the spleen and resolving phlegm,soothing the liver and promoting blood circulation.A large number of basic and clinical studies have shown that TCM treatment of PCOS based on the kidney is effective in regulating menstruation to assist pregnancy,improving the function of the patient's ovary and reproductive en-docrine system and so on,with few side effects.However,there are stll some shortcomings in the current research:(1)The differential diagnosis is insufficient.Before diagnosis of PCOS,clinical symptoms,signs and auxiliary test results should be combined to exclude congenital adrenal hyperplasia,hypercortisolism,androgen related tumors,early-onset ovarian insufficiency,functional hypothalamic a-menorrhea and other diseases.If amenorrhea is caused by the disease,the primary disease should be actively treated to avoid missed di-agnosis and misdiagnosis.(2)At present,TCM has not yet formed a unified understanding of the etiology and pathogenesis of PCOS.The current treatment methods are mostly derived from the clinical experience of doctors,and are greatly affected by subjective factors.The standardized syndrome type norms and diagnosis and treatment plans need to be further improved.(3)There are many clinical studies on the treatment of PCOS by TCM,but problems such as small sample size,short observation period,imprecise design and limit-ed research ideas generally exist,and high-level clinical evidence meeting the requirements of evidence-based medicine is insufficient.In the future,on the basis of Western medicine treatment,it is necessary to further study the etiology and pathogenesis of PCOS in TCM,carry out high-quality clinical studies,explore the effectiveness and stability of TCM treatment of PCOS,give play to the characteristics and advantages of TCM syndrome differentiation and treatment,and provide more theoretical and practical basis for the clinical diagnosis and treatment of PCOS in integrated traditional Chinese medicine and Western medicine.