加味苍附导痰汤治疗脾虚痰湿型多囊卵巢综合征胰岛素抵抗的临床研究

Clinical Study on Modified Cangfu Daotan Decoction in the Treatment of Insulin Resistance ofPolycystic Ovary Syndrome with Spleen Deficiency and Phlegm Dampness

目的观察加味苍附导痰汤治疗脾虚痰湿型多囊卵巢综合征胰岛素抵抗(PCOS-IR)的临床研究。方法选取60例脾虚痰湿型PCOS-IR患者,按随机数字表法分为对照组和观察组各30例。对照组予口服优思悦,观察组在对照组的基础上联合口服加味苍附导痰汤,疗程为连续3个月经周期。比较2组疗效、中医证候积分、不良反应发生率,胰岛素抵抗指数(HOMA-IR),血清性激素促黄体生成激素(LH)、雌二醇(E2)、睾酮(T),血清胰岛素样生长因子-1(IGF-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)含量。结果观察组总有效率为90.00%,优于对照组66.67%(P<0.05);观察组不良反应发生率为6.66%,低于对照组13.33%(P>0.05);与治疗前比较,治疗后2组中医证候积分、HOMA-IR、血清LH、E2、T、IGF-1、IL-6、TNF-α含量均降低(P<0.05);治疗后2组比较,观察组中医证候积分、HOMA-IR、血清E2、T、IGF-1、IL-6含量较对照组均降低(P<0.05),血清LH、TNF-α含量较对照组有降低趋势(P>0.05)。结论加味苍附导痰汤治疗脾虚痰湿型PCOS-IR可下调IGF-1、IL-6水平,纠正胰岛素抵抗状态,抑制炎症反应,调节血清性激素异常分泌,改善临床症状。

Objective:To observe the clinical study on modified Cangfu Daotan Decoction in the treatment of insulin resistance(PCOS-IR)of polycystic ovary syndrome with spleen deficiency and phlegm dampness.Methods:60 PCOS-IR patients with spleen deficiency and phlegm dampness were selected and divided into control group and observation group,30 cases each group,according to random number table method.The control group was given oral Yousiyue and the observation group was added the modified Cangfu Daotan Decoction on the basis of the control group.The course of treatment was 3 consecutive menstrual cycles.The curative effect,TCM syndrome score,incidence of adverse reactions,insulin resistance index(HOMA-IR),serum sex hormone luteinizing hormone(LH),estradiol(E2)and testosterone(T)as well as the contents of serum insulin-like growth factor-1(IGF-1),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were compared between the two groups.Results:The total effective rate of the observation group was 90.00%,which was better than that of the control group(66.67%),(P<0.05).The incidence of adverse reactions in the observation group was 6.66%,which was lower than that in control group(13.33%),(P>0.05).Compared with those before treatment,TCM syndrome score,HOMA-IR,serum LH,E2,T,IGF-1,IL-6 and TNF-αcontents in the 2 groups were decreased after treatment(P<0.05).After treatment,TCM syndrome score,HOMA-IR,serum E2,T,IGF-1 and IL-6 contents in the observation group were lower than those in the control group(P<0.05),and serum LH and TNF-αcontents were lower than those in the control group(P>0.05).Conclusion:Modified Cangfu Daotan Decoction for PCOS-IR patients with spleen deficiency and phlegm dampness can down-regulate IGF-1 and IL-6 levels,correct insulin resistance,inhibit inflammation,regulate abnormal secretion of serum sex hormone and improve clinical symptoms.