基于“化痰祛湿”探讨苍术导痰汤对多囊卵巢综合征肠道菌群的影响

An analysis of the effect of the Cangzhu Daotan decoction on intestinal flora of patients with poly cystic ovary syndrome based on dissipating phlegm and eliminating dampness

目的:利用16S rDNA测序技术探讨苍附导痰汤对多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)患者性激素水平、胰岛素抵抗和肠道菌群的影响。方法:选取24例痰湿型PCOS患者作为研究对象,给予苍附导痰汤治疗3个月经周期,检测患者治疗前后性激素水平、抗苗勒氏管激素(Anti-mullerian Hormone,AMH)、胰岛素抵抗指数(Homeostasis Model Assessment-Insulin Resistance,HOMA-IR),用16S rDNA扩增子测序技术对肠道菌群进行分析。结果:苍附导痰汤能明显降低PCOS患者血清性激素的促黄体生成素(Luteinizing Hormone,LH)、雄激素(Testosterone,T)和HOMA-IR(P <0.01,P <0.05);增加菌群多样性,在门水平,上调厚壁菌门、软壁菌门、放线菌门、蓝藻菌门和黏胶球形菌门相对丰度,下调拟杆菌门、变形菌门、互养菌门和梭菌门相对丰度下降;上调小杆菌属等相对丰度,尤以光岗菌属、乳酸菌属、双歧杆菌属和嗜黏蛋白阿克曼氏菌相对丰度增加显著(P <0.01);下调普氏菌属、拟杆菌属、普拉梭菌属、毛螺菌、粪副拟杆菌、考拉杆菌属、嗜血杆菌属和梭菌属相对丰度(P <0.01);下调革兰氏阴性菌,增加革兰氏阳性菌相对丰度(P <0.05)。结论:苍术导痰汤丸通过调节肠道菌群丰度和多样性,上调革兰氏阳性菌相对丰度,下调革兰氏阴性菌丰度,改善菌群多样性,降低HOMA-IR、LH水平和T,达到治疗PCOS的目的。

Objective:To investigate the effects of the Cangfu Daotan decoction( 苍附导痰汤) on sex hormone levels,insulin resistance and intestinal flora in patients with poly cystic ovary syndrome(PCOS) by 16S rDNA sequencing technology.Methods:A total of 24 patients with phlegm-damp syndrome PCOS were selected as the research subjects and were treated with the Cangzhu Daotan decoction for 3 menstrual cycles.The levels of sex hormones,anti-mullerian hormone(AMH) and homeostasis model assessment-insulin resistance(HOMA-IR) were detected.Results:The Cangzhu Daotan decoction could significantly reduce the levels of luteinizing hormone(LH),tastosterone(T) and HOMA-IR in serum of PCOS patients(P<0.01,P<0.05).At the phylum level,the relative abundance of firmicutes,tenericutes,actinobacteria,cyanobacteria and lentisphaerae was up-regulated,while the relative abundance of bacteroidetes,proteobacteria,syntrophs and fusobacteria was down-regulated.The relative abundance of dialister was upregulated,and the relative abundance of mitsuokella,lactobacillus,bifidobacterium and akkermansia mucinophilus was significantly increased especially(P<0.01).In particular,Prevotella,Bacteroides,Faecalibacterium,Lachnospira,Parabacteroides,Phascolarctobacterium,Haemophilus and Fusobacterium were down-regulated(P<0.01).The relative abundance of Gram-positive bacteria was increased by down-regulating Gram-negative bacteria(P<0.05).Conclusion:The Cangzhu Daotan decoction can regulate the abundance and diversity of intestinal microbiota,up-regulate the relative abundance of Gram-positive bacteria,down-regulate the abundance of Gram-negative bacteria,improve the diversity of microbiota,reduce HOMA-IR,LH and T,and achieve the goal of the treatment of PCOS.