摘要
目的探讨1000例不同腰臀比(WHR)的多囊卵巢综合征(PCOS)患者中医证型分布、临床代谢差异及相关性研究。方法回顾性分析2014年7月—2018年7月黑龙江中医药大学附属第一医院妇科门诊临床科研信息一体化系统中1000例PCOS患者,根据WHR值分为A组(656例)和B组(344例),选取同期就诊的90例健康女性作为对照组(C组),分析A组和B组的中医证型分布,比较三组患者的一般临床特征、血清性激素及糖脂代谢指标,并分析PCOS患者WHR值与各实验室检测指标间的相关性。结果①收集1000例PCOS患者,WHR≥0.85者656例,其中脾虚痰湿证294例,所占比例最高为44.82%;WHR<0.85者344例,肾虚肝郁证159例,所占比例最高为46.22%。②三组患者一般临床特征比较:A组患者体质量指数(BMI)、腰围(WC)、臀围(HC)及WHR显著大于B组及C组,差异有统计学意义(P<0.05);A组患者多毛、黑棘皮、痤疮及溢脂发生率显著高于B及C组,B组患者多毛、黑棘皮、痤疮及溢脂发生率显著高于C组,差异有统计学意义(P<0.05)。③三组患者血清性激素水平比较:A组患者黄体生成素(LH)、LH/FSH、硫酸脱氢表雄酮(DHEAS)及性激素结合球蛋白(SHBG)值显著大于B组及C组,B组患者LH、LH/FSH、DHEAS及SHBG值显著大于C组,差异有统计学意义(P<0.05);A组及B组患者的睾酮(T)及雄烯二酮(AND)值显著大于C组,差异有统计学意义(P<0.05)。④三组患者糖脂代谢水平的比较:A组患者空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、载脂蛋白A(Apo-A)及载脂蛋白B(Apo-B)值显著大于B组及C组,B组患者FPG、FINS、HOMA-IR、TC、TG、LDL、Apo-A及Apo-B值显著大于C组,差异有统计学意义(P<0.05);A组患者高密度脂蛋白(HDL)值显著低于B组及C组,B组患者HDL值显著低于C组,差异有统计学意义(P<0.05)。⑤对PCOS组患者进行WHR和各项代谢指标的相关性分析结果显示:WHR与BMI、AND、FPG、FINS、HOMA-IR、TC、TG、LDL、Apo-B及Apo-B呈正相关,与LH、FSH、LH/FSH、T、DHEAS、SHBG、HDL及Apo-B/Apo-A呈负相关,其中WHR与BMI、LH、LH/FSH、SHBG、HOMA-IR、TG、LDL、Apo-A及Apo-B的相关性差异有统计学意义(P<0.05)。结论PCOS患者中医证型分布,WHR≥0.85者以脾虚痰湿证为主,WHR<0.85者以肾虚肝郁证为主。WHR高的PCOS患者,其BMI及多毛、黑棘皮、痤疮、溢脂发生率显著升高;且伴有较重的性激素及糖脂代谢紊乱。PCOS患者WHR与临床各代谢指标存在一定相关性,据此可指导临床进行早期并发症的预防。
Objective To investigate the distribution,clinical metabolic differences and correlation of TCM syndromes in 1000 patients with polycystic ovary syndrome(PCOS)with different waist-to-hip ratio(WHR).Methods A retrospective analysis of 1000 PCOS patients in the integrated system of clinical research information of gynecology outpatientclinic in the first affiliated hospital of heilongjiang university of traditional Chinese medicine from July 2014 to July 2018 was conducted.According to WHR values were divided into group A(n=656)and group B(n=344),selected in the same period of 90 cases of healthy women as control group(group C),analysis of group A and group B,TCM syndrome type distribution is of three groups of patients with clinical features commonly,serum sex hormone and glucose and lipid metabolism index,and analyze the PCOS patients with WHR value with the laboratory tests the correlation between indicators.Results①A total of 1000 PCOS patients were collected,and 656 patients with WHR greater than or equal to 0.85 were WHR.There were 344 cases with WHR<0.85,159 cases with kidney deficiency and liver depression,accounting for the highest proportion of 46.22%.②Comparison of general clinical characteristics of patients in the three groups:body mass index(BMI),waist circumference(WC),hip circumference(HC)and WHR of patients in group A were significantly greater than those in group B and group C,and the difference was statistically significant(P<0.05).The incidence of hypertrichosis,acanthosis,acne and lipid spillage in group A was significantly higher than that in group B and group C.The incidence of hypertrichosis,acanthosis,acne and lipid spillage in group B was significantly higher than that in group C,with statistically significant difference(P<0.05).③Serum sex hormone levels of patients in group A were significantly higher than those in group B and group C.LH,LH/FSH,DHEAS and SHBG in group B were significantly higher than those in group C(P<0.05).The values of testosterone(T)AND androstenedione(AND)in group A and group B were significantly higher than those in group C,and the difference was statistically significant(P<0.05).④Comparison of three groups of patients glucolipid metabolism:A group of patients with fasting plasma glucose(FPG),fasting insulin(FINS),insulin resistance index(HOMA-IR),total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),apolipoprotein B(Apo-A)and apolipoprotein B(Apo-B)value was significantly greater than group B and group C,group B patients FPG,FINS,HOMA IR,TC,TG,LDL,Apo-and Apo B value was significantly greater than group C,the difference was statistically significant(P<0.05);The HDL values of patients in group A were significantly lower than those in group B and group C,while those in group B were significantly lower than those in group C,with statistically significant differences(P<0.05).⑤Correlation analysis results of WHR and various metabolic indicators in patients in PCOS group showed that:WHR was positively correlated with BMI,AND,FPG,FINS,FINS,HOMA-IR,TC,TG,LDL,Apo-A and Apo-B,and was negatively correlated with LH,FSH,LH/FSH,T,DHEAS,SHBG,HDL and Apo-B/Apo-A.Conclusion The distribution of TCM syndromes in PCOS patients was dominated by spleen deficiency,phlegm and dampness syndrome in patients with WHR>0.85,and kidney deficiency and liver depression syndrome in patients with WHR<0.85.In patients with high WHR PCOS,the incidence of BMI,polytrichosis,acanthosis,acne and lipid spillage were significantly increased.And accompanied by heavy sex hormones and glucose lipid metabolic disorder.There is a certain correlation between WHR and clinical metabolic indicators in PCOS patients,which can guide clinical prevention of early complications.
作者
张美微
侯丽辉
李妍
ZHANG Mei-wei;HOU Li-hui;LI Yan(Reproductive and Genetic Medicine Center,Dalian Women andChildren Medicinal Center,Dalian Liaoning 116000;The First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin Heilongjiang 150040)
出处
《世界中西医结合杂志》
2020年第7期1180-1184,共5页
World Journal of Integrated Traditional and Western Medicine
基金
国家中医药行业科研专项(201207001)
国家自然科学青年基金项目(81704115)
国家自然科学基金青年基金(81503610)
国家中医临床研究基地业务建设第二批科研专项课题基金(JDZX2015056)
国家中医药管理局基金项目(JDZX2015058)
黑龙江省中医药管理局基金项目(2HY12-W008)
黑龙江省教育厅基金项目(12531651)
国家自然科学青年基金项目(81804139)。
关键词
多囊卵巢综合征
腰臀比
中医证型
Polycystic Ovarian Syndrome
Waist Hip Ratio
Syndrome of TCM
