摘要
目的:观察加减苍附导痰汤对脾虚痰湿证多囊卵巢综合征(PCOS)代谢和受孕情况的影响。方法:将112例患者按随机数字表法分为对照组和观察组。两组均给予非药物干预措施,口服盐酸二甲双胍,500 mg/次,3次/d;口服炔雌醇环丙孕酮片,1片/次,1次/d,从月经第3~5天开始服用,连续服用21 d,共3个月经周期。对照组口服二陈丸,10 g/次,2次/d。观察组口服加减苍附导痰汤,1剂/d;两组疗程均为6个月经期周期(或至受孕后终止)。比较治疗前后腰臀比(WHR),体质量指数(BMI),胰岛素抵抗指数(HOMA-IR),胰岛β细胞功能(HOMA-β),甘油三酯(TG),低密度脂蛋白(LDL)和非高密度脂蛋白(nHDL)的升高情况;B超监测(6个月经期周期)排卵周期数、排卵率,人绒毛膜促性腺激素(HCG)日子宫内膜厚度、卵泡直径、宫颈黏液评分>8分和内膜形态A型率,记录月经恢复正常、妊娠和早期流产情况。检测治疗前后黄体生成素(LH),雌二醇(E2),卵泡刺激素(FSH),硫酸脱氢表雄酮(DHEAS),睾酮(T),抗苗勒管激素(AMH)水平、胰岛素样生长因子-1(IGF-1),瘦素(LP),脂联素(APN),生长分化因子-9(GDF-9)和肿瘤坏死因子-α(TNF-α)水平。结果:观察组WHR,BMI,HOMA-IR均低于对照组(P<0.05,P<0.01),HOMA-β高于对照组(P<0.01);观察组LDL,TG和nHDL升高率分别为19.61%(10/51),25.49%(13/51),23.53%(12/51),分别低于对照组的41.18%(21/51),47.06%(24/51),45.10%(23/51)(χ^(2)=5.607,χ^(2)=5.131,χ^(2)=5.263,P<0.05);观察组月经复常率为90.20%(46/51),高于对照组的72.55%(37/51)(χ^(2)=5.239,P<0.05);观察组排卵周期数多于对照组(P<0.01);观察组妊娠率为50.98%(26/51),高于对照组的31.37%(16/51)(χ^(2)=4.047,P<0.05);治疗后HCG日,观察组的子宫内膜厚度和卵泡直径均高于对照组(P<0.01),观察组宫颈黏液评分>8分为78.43%(40/51),高于对照组的56.86%(29/51)(χ^(2)=5.420,P<0.05),观察组内膜形态A型率为52.94%(27/51),高于对照组的31.37%(16/51)(χ^(2)=4.864,P<0.05);观察组AMH,E2DHEAS,LH,T,IGF-1,LP和TNF-α水平均低于对照组(P<0.01),APN和GDF-9水平均高于对照组(P<0.01)。结论:在常规西医干预的基础上,加减苍附导痰汤治疗脾虚痰湿症PCOS可调节患者异常代谢和生殖内分泌情况,改善了受孕情况,并能调节IGF-1,GDF-9,脂肪细胞因子和炎症因子的表达,改善排卵情况,提高了妊娠率。
Objective:To observe the effect of modified Cangfu Daotantang on metabolism and pregnancy in patients with spleen deficiency and phlegm-dampness type polycystic ovary syndrome(PCOS).Method:One hundred and twelve patients were randomly divided into control group and observation group according to the random number table.Both groups took non-pharmacological interventions,oral metformin hydrochloride,500 mg/time,3 times/day;oral ethinyl estradiol and cyproterone tablets,1 tablet/time,1 time/day,starting from the third to fifth day of menstruation and lasting for twenty-one days,for a total of 3 menstrual cycles.Patients in control group additionally took Erchen pills orally,10 g/time,2 times/day,while patients in observation group additionally took modified Cangfu Daotantang orally,1 dose/day.The course of treatment was six menstrual cycles in both groups(or termination after conception).The waist-to-hip ratio(WHR),body mass index(BMI),insulin resistance index(HOMA-IR),pancreaticβ-cell function(HOMA-β),triglycerides(TG),low-density lipoprotein(LDL)and non-high-density lipoprotein(nHDL)elevation after treatment were compared.The number of ovulation cycles monitored by B-ultrasound(6 menstrual cycles),ovulation rate,human chorionic gonadotropin(HCG)day endometrial thickness,follicle diameter,cervical mucus score>8 points and endometrial morphology type A rate were measured and recorded.The recovery of menstruation,pregnancy and early miscarriage were recorded.Luteinizing hormone(LH),estradiol(E2),follicle stimulating hormone(FSH),dehydroepiandrosterone sulfate(DHEAS),testosterone(T),anti-Müllerian hormone(AMH)levels,and insulin before and after treatment-Like growth factor-1(IGF-1),leptin(LP),adiponectin(APN),growth differentiation factor-9(GDF-9)and tumor necrosis factor-α(TNF-α)levels were detected.Result:WHR,BMI and HOMA-IR levels of the observation group were lower than those of the control group(P<0.05,P<0.01).HOMA-βlevel was higher than that in the control group(P<0.01).The increase rates of LDL,TG,and nHDL in the observation group were 19.61%(10/51),25.49%(13/51),23.53%(12/51),respectively,lower than 41.18%(21/51),47.06%(24/51),45.10%(23/51)respectively in the control group(χ^(2)=5.607,χ^(2)=5.131,χ^(2)=5.263,P<0.05).The menstrual recovery rate in the observation group was 90.20%(46/51),higher than 72.55%(37/51)in the control group(χ^(2)=5.239,P<0.05).The observation group had more ovulation cycles than the control group(P<0.01).The pregnancy rate in the observation group was 50.98%(26/51),higher than 31.37%(16/51)in the control group(χ^(2)=4.047,P<0.05).On HCG day after treatment,the endometrial thickness and follicle diameter in the observation group were better than those in the control group(P<0.01).The proportion of patients with cervical mucus score>8 points was 78.43%(40/51)in the observation group,higher than 56.86%(29/51)in the control group(χ^(2)=5.420,P<0.05).The intimal morphology type A rate in the observation group was 52.94%(27/51),higher than 31.37%(16/51)in the control group(χ^(2)=4.864,P<0.05).The levels of AMH,E2,DHEAS,LH,T,IGF-1,LP and TNF-αin the observation group were lower than those in the control group(P<0.01),while the APN and GDF-9 levels were superior to those in the control group(P<0.01).Conclusion:On the basis of conventional western medicine intervention,modified Cangfu Daotantang can regulate abnormal metabolism and reproductive endocrine in patients with PCOS,improve conception,and regulate the expression of IGF-1,GDF-9,adipocytokines and inflammatory factors,improve ovulation and improve pregnancy rate.
作者
谢蓬蓬
曾蕾
余璟玮
傅艳红
XIE Peng-peng;ZENG Lei;YU Jing-wei;FU Yan-hong(Guangzhou Women and Children's Medical Center,Guangzhou 511400,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Panyu Maternal and Child Care Service Centre of Guangzhou,Guangzhou 511400,China;Maternal and Child Health Hospital of Huadu District in Guangzhou,Guangzhou 510800,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2021年第14期87-92,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金青年科学基金项目(81804135)。
关键词
多囊卵巢综合征
不孕
脾虚痰湿证
苍附导痰汤
代谢异常
胰岛素样生长因子-1
生长分化因子-9
polycystic ovary syndrome
infertility
spleen deficiency and phlegm dampness syndrome
Cangfu Daotantang
metabolic abnormalities
insulin-like growth factor-1
growth differentiation factor-9
