苍附导痰汤加减联合西医治疗对多囊卵巢综合征痰湿内阻型患者胰岛素抵抗指数、内脂素水平的影响
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摘要
目的观察苍附导痰汤加减联合西医治疗对多囊卵巢综合征(PCOS)痰湿内阻型患者胰岛素抵抗指数(HOMA-IR)、内脂素水平的影响。方法将90例PCOS痰湿内阻型患者按照随机数字表法分为2组。对照组45例予西医治疗;治疗组45例在对照组治疗基础上加用苍附导痰汤加减治疗。2组均治疗3个月经周期。比较2组治疗前后主要症状积分变化;比较2组治疗前后血脂指标总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)变化,2组治疗前后HOMA-IR、内脂素变化,2组治疗前后子宫内膜厚度、子宫螺旋动脉血流阻力指数(RI)变化;比较2组排卵率、妊娠率。结果 2组治疗后带下绵绵、月经后期、胸闷积分及总积分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后TC、TG、LDL-C均较本组治疗前降低(P<0.05),HDL-C升高(P<0.05);且治疗组TC、TG、LDL-C降低更明显(P<0.05),HDL-C升高更明显(P<0.05)。2组治疗后HOMA-IR、内脂素均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后子宫内膜厚度均较本组治疗前升高(P<0.05),RI降低(P<0.05);治疗组治疗后子宫内膜厚度高于对照组(P<0.05),RI低于对照组(P<0.05)。2组排卵率、妊娠率比较差异均有统计学意义(P<0.05),治疗组排卵率、妊娠率高于对照组。结论苍附导痰汤加减联合西医治疗PCOS痰湿内阻型,可改善患者临床症状和胰岛素抵抗,调节患者血脂水平,提高子宫内膜容受性,改善妊娠结局。
Objective To observe the clinical effects of Cangfu Daotan decoction combined with western medicine in the treatment of polycystic ovary syndrome(PCOS) with phlegm-dampness resistance type and its effect on insulin resistance index(HOMA-IR) and visfatin level. Methods 90 cases of phlegm-dampness resistance type PCOS patients were divided into two groups according to the random number table method. 45 patients in control group were treated by western medicine. 45 cases in treatment group were treated by Cangfu Daotan decoction on the basis of the control group. Both groups were treated for 3 menstrual cycles. The changes of clinical symptom score before and after treatment between the two groups were compared. The changes of blood lipid indicators [ total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)], insulin resistance index(HOMA-IR), visfatin, endometrial thickness, uterine spiral arterial blood flow resistance index(RI) before and after treatment in the two groups were compared. The ovulation rate and pregnancy rate between the two groups were compared. Results The scores of continuous leucorrhea, late menstruation and chest tightness after treatment in both groups were lower than those before treatment(P<0.05), and the decrease was more significant in the treatment group(P<0.05). After treatment, the levels of TC, TG and LDL-C in both groups were lower than those before treatment(P<0.05), HDL-C was increased(P<0.05), and the decrease was more significant in the treatment group(P<0.05), the increase of HDL-C was more obvious(P<0.05). After treatment, the levels of HOMA-IR and visfatin in both groups were lower than those before treatment(P<0.05), and the decrease was more significant in the treatment group(P<0.05). After treatment, the endometrial thickness in both groups were increased(P<0.05), and the RI was decreased(P<0.05). After treatment, the endometrial thickness of the treatment group was higher than that of the control group(P<0.05), and RI was lower than that of the control group(P<0.05).There were significant differences in ovulation rate and pregnancy rate between the two groups(P<0.05). The ovulation rate and pregnancy rate in the treatment group were higher than those in the control group. Conclusion Cangfu Daotan decoction combined with western medicine in the treatment of phlegm-dampness resistance type PCOS can improve the clinical symptoms and insulin resistance of patients, regulate the level of blood lipid, improve endometrial receptivity and improve pregnancy outcome.
Objective To observe the clinical effects of Cangfu Daotan decoction combined with western medicine in the treatment of polycystic ovary syndrome(PCOS) with phlegm-dampness resistance type and its effect on insulin resistance index(HOMA-IR) and visfatin level. Methods 90 cases of phlegm-dampness resistance type PCOS patients were divided into two groups according to the random number table method. 45 patients in control group were treated by western medicine. 45 cases in treatment group were treated by Cangfu Daotan decoction on the basis of the control group. Both groups were treated for 3 menstrual cycles. The changes of clinical symptom score before and after treatment between the two groups were compared. The changes of blood lipid indicators [ total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)], insulin resistance index(HOMA-IR), visfatin, endometrial thickness, uterine spiral arterial blood flow resistance index(RI) before and after treatment in the two groups were compared. The ovulation rate and pregnancy rate between the two groups were compared. Results The scores of continuous leucorrhea, late menstruation and chest tightness after treatment in both groups were lower than those before treatment(P<0.05), and the decrease was more significant in the treatment group(P<0.05). After treatment, the levels of TC, TG and LDL-C in both groups were lower than those before treatment(P<0.05), HDL-C was increased(P<0.05), and the decrease was more significant in the treatment group(P<0.05), the increase of HDL-C was more obvious(P<0.05). After treatment, the levels of HOMA-IR and visfatin in both groups were lower than those before treatment(P<0.05), and the decrease was more significant in the treatment group(P<0.05). After treatment, the endometrial thickness in both groups were increased(P<0.05), and the RI was decreased(P<0.05). After treatment, the endometrial thickness of the treatment group was higher than that of the control group(P<0.05), and RI was lower than that of the control group(P<0.05).There were significant differences in ovulation rate and pregnancy rate between the two groups(P<0.05). The ovulation rate and pregnancy rate in the treatment group were higher than those in the control group. Conclusion Cangfu Daotan decoction combined with western medicine in the treatment of phlegm-dampness resistance type PCOS can improve the clinical symptoms and insulin resistance of patients, regulate the level of blood lipid, improve endometrial receptivity and improve pregnancy outcome.
引文
[1] 乔杰,李蓉,李莉,等.多囊卵巢综合征流行病学研究[J].中国实用妇科与产科杂志,2013,29(11):849-852.
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[3] Dewailly D,Hieronimus S,Mirakian P,et al.Polycystic ovary syndrome(PCOS)[J].Ann Endocrinol(Paris),2010,71(1):8-13.
[4] 谷伟军.多囊卵巢综合征的诊断和治疗国内外指南解读[J].药品评价,2016,13(3):5-8,31.
[5] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:39.
[6] 王慧颖,林喧.加减苍附导痰汤调控痰湿阻滞型多囊卵巢综合征患者子宫内膜容受性研究[J].湖南中医药大学学报,2014,34(6):31-34.
[7] 尹倩,侯丽辉,葛军,等.补肾化痰方对肥胖型多囊卵巢综合征不孕患者子宫内膜容受性的影响[J].世界中西医结合杂志,2015,10(11):1541-1544,1558.
[8] 陈素平.达英-35联合二甲双胍治疗多囊卵巢综合征致不孕的临床疗效分析[J].深圳中西医结合杂志,2014,24(11):92-93.
[9] 任丽娜,郭丽红,马文珠,等.针刺治疗多囊卵巢综合征:随机对照试验的系统综述和Meta分析[J].针刺研究,2014,39(3):238-246.
[10] 韩芸,董英,钟秀驰,等.参芪胶囊改善多囊卵巢综合征患者子宫内膜容受性的临床研究[J].中国中医基础医学杂志,2016,22(9):1208-1210.
[11] 骆世存,许志芃,彭小鹏.苍附导痰丸加减对多囊卵巢综合征大鼠卵巢形态及性激素水平的影响[J].中医药信息,2014,31(3):118-120.
[12] 江帆,李萍,沙艳伟,等.多囊卵巢综合征临床干预前后血清内脂素变化及相关因素研究[J].中国妇幼保健,2016,31(4):695-698.
[13] 郑小敏,华宙佳,丁彩飞.苍附导痰汤加减方对痰湿型多囊卵巢综合征合并胰岛素抵抗患者生殖内分泌及糖代谢的影响[J].浙江中西医结合杂志,2013,23(3):216-217.
[14] 胡红,叶秀英,韩小轶,等.经阴道彩色多普勒超声对针灸联合加减苍附导痰汤治疗肥胖型多囊卵巢综合征的评价[J].中国中西医结合影像学杂志,2015,13(4):358-360,408.
[15] 张炜.苍附导痰丸加减治疗多囊卵巢综合征42例临床观察[J].中医药导报,2013,19(11):101-102.
[2] 余红英,熊燕.年龄及BMI对多囊卵巢综合征患者胰岛素抵抗和糖脂代谢的影响[J].山东医药,2016,56(1):66-68.
[3] Dewailly D,Hieronimus S,Mirakian P,et al.Polycystic ovary syndrome(PCOS)[J].Ann Endocrinol(Paris),2010,71(1):8-13.
[4] 谷伟军.多囊卵巢综合征的诊断和治疗国内外指南解读[J].药品评价,2016,13(3):5-8,31.
[5] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:39.
[6] 王慧颖,林喧.加减苍附导痰汤调控痰湿阻滞型多囊卵巢综合征患者子宫内膜容受性研究[J].湖南中医药大学学报,2014,34(6):31-34.
[7] 尹倩,侯丽辉,葛军,等.补肾化痰方对肥胖型多囊卵巢综合征不孕患者子宫内膜容受性的影响[J].世界中西医结合杂志,2015,10(11):1541-1544,1558.
[8] 陈素平.达英-35联合二甲双胍治疗多囊卵巢综合征致不孕的临床疗效分析[J].深圳中西医结合杂志,2014,24(11):92-93.
[9] 任丽娜,郭丽红,马文珠,等.针刺治疗多囊卵巢综合征:随机对照试验的系统综述和Meta分析[J].针刺研究,2014,39(3):238-246.
[10] 韩芸,董英,钟秀驰,等.参芪胶囊改善多囊卵巢综合征患者子宫内膜容受性的临床研究[J].中国中医基础医学杂志,2016,22(9):1208-1210.
[11] 骆世存,许志芃,彭小鹏.苍附导痰丸加减对多囊卵巢综合征大鼠卵巢形态及性激素水平的影响[J].中医药信息,2014,31(3):118-120.
[12] 江帆,李萍,沙艳伟,等.多囊卵巢综合征临床干预前后血清内脂素变化及相关因素研究[J].中国妇幼保健,2016,31(4):695-698.
[13] 郑小敏,华宙佳,丁彩飞.苍附导痰汤加减方对痰湿型多囊卵巢综合征合并胰岛素抵抗患者生殖内分泌及糖代谢的影响[J].浙江中西医结合杂志,2013,23(3):216-217.
[14] 胡红,叶秀英,韩小轶,等.经阴道彩色多普勒超声对针灸联合加减苍附导痰汤治疗肥胖型多囊卵巢综合征的评价[J].中国中西医结合影像学杂志,2015,13(4):358-360,408.
[15] 张炜.苍附导痰丸加减治疗多囊卵巢综合征42例临床观察[J].中医药导报,2013,19(11):101-102.
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