祛湿化痰方联合针刺治疗脾虚痰湿型多囊卵巢综合征疗效研究

Effect of Qushi Huatan recipe combined with acupuncture on spleen deficiency phlegm-dampness polycystic ovary syndrome

目的:探讨祛湿化痰方联合针刺治疗脾虚痰湿型多囊卵巢综合征(PCOS)的疗效及对血清miR-223、miR-181a的影响。方法:选取90例PCOS患者,随机分为对照组和观察组,每组45例。对比两组性激素、卵巢体积、中医症候积分、炎症因子、miR-223、miR-181a水平,分析miR-223、miR-181a与炎症因子的相关性,以及miR-223、miR-181a对PCOS治疗后1年内未妊娠的预测价值。结果:观察组治疗后FSH、LH、T水平低于对照组(均P<0.01)。观察组治疗后卵巢体积小于对照组(P<0.01)。观察组治疗后食欲不振、腹胀、便溏、神疲乏力积分低于对照组(均P<0.01)。观察组治疗后IL-1β、IL-6、TNF-α水平低于对照组(均P<0.01)。观察组治疗后血清miR-223水平低于对照组,miR-181a水平高于对照组(均P<0.01)。血清miR-223水平与IL-1β、IL-6、TNF-α呈正相关,miR-181a水平与IL-1β、IL-6、TNF-α呈负相关(均P<0.01)。观察组妊娠率高于对照组(P<0.01)。miR-223、IL-6为治疗后1年内未妊娠的独立危险因素(OR=2.184,3.180,P<0.01),miR-181a为独立保护因素(OR=0.268,P<0.01)。miR-223、miR-181a及二者联合预测的AUC分别为0.837、0.811、0.934,二者联合预测优于各自单独预测效能(Z=7.168、9.376,P<0.01)。结论:祛湿化痰方联合针刺能调节PCOS患者性激素水平,缩小卵巢体积,降低中医症候积分,抑制炎症反应,降低血清miR-223水平,升高miR-181a水平,miR-223、miR-181a均是PCOS治疗后1年内未妊娠的独立影响因素,二者对治疗后未妊娠有较好的预测价值。

Objective:To investigate the curative effect of Qushi Huatan recipe combined with acupuncture on spleen deficiency phlegm-dampness polycystic ovary syndrome(PCOS)and its influence on serum miR-223 and miR-181a.Methods:A total of 90 patients with PCOS were selected as the research objects.They were divided into observation group and control group randomly,with 45 cases in both groups.Sex hormone,ovarian volume,TCM syndrome score,inflammatory factors,miR-223 and miR-181a levels were compared between the two groups.The correlation between miR-223 and miR-181a and inflammatory factors was analyzed.To analyze the predictive value of miR-223 and miR-181a for non-pregnancy within one year after PCOS treatment.Results:After treatment,the levels of FSH,LH and T in the observation group were dramatically lower than those in the control group(all P<0.01).The ovarian volume in the observation group was smaller compared to the control group(all P<0.01).After treatment,the scores of anorexia,abdominal distension,loose stool and fatigue in the observation group were lower than those in the control group(all P<0.01).After treatment,the levels of IL-1β,IL-6 and TNF-αin observation group were lower than those in control group(all P<0.01).After treatment,the serum miR-223 level in the observation group was lower than that in the control group,and the serum miR-181a level was higher than that in the control group(all P<0.01).Serum miR-223 level was positively correlated with IL-1β,IL-6 and TNF-α,while miR-181a level was negatively correlated with IL-1β,IL-6 and TNF-α(all P<0.01).The pregnancy rate of observation group was higher than that of control group(P<0.01).miR-223 and IL-6 were independent risk factors for non-pregnancy within one year after treatment(OR=2.184,3.180,P<0.01),and miR-181a was independent protective factor(OR=0.268,P<0.01).The AUC of miR-223,miR-181a and the combined prediction was 0.837,0.811 and 0.934,respectively,and the combined prediction was superior to the single prediction(Z=7.168,9.376,P<0.01).Conclusion:Qushi Huatan recipe combined with acupuncture can regulate sex hormone levels in PCOS patients,reduce ovarian volume,reduce TCM syndrome score,inhibit inflammation,reduce serum miR-223 level and increase miR-181a level.Both miR-223 and miR-181a are independent influencing factors for non-pregnancy within one year after treatment.Both of them have good predictive value for non-pregnancy after treatment.