【作者】 姚晶萍；

【导师】 王秀霞； 吴效科；

【作者基本信息】 黑龙江中医药大学 ， 中医妇科学， 2006， 博士

【摘要】 目的:通过临床研究观察苍附导痰汤加减联合二甲双胍对痰湿型闭经并胰岛素抵抗患者的治疗,观察治疗组和对照组治疗前后月经、痤疮、黑棘皮、多毛、BBT以及血激素水平的变化,探讨苍附导痰汤对痰湿型闭经的疗效及机理。 方法:本研究采用对照研究,按纳入标准选择痰湿型闭经并胰岛素抵抗患者60例,于治疗前后检测血激素水平,计算胰岛素敏感指数观察治疗前后临床表现与中医症候改善情况。 结果:(1)两组治疗前后闭经、痤疮、黑棘皮、BBT单相有显著差异,(P<0.05),治疗组优于对照组,多毛治疗前后两组差异无统计学意义,(2)血清激素水平治疗前后差异显著,其中FSH水平治疗前后及两组差异无统计学意义。(3)胰岛素抵抗患者在治疗后两组均较治疗前有所减少,治疗组好于对照组,(4)WHR、BMI治疗后较治疗前有所降低,治疗组好与对照组。 结果:1.苍附导痰汤加味可以明显改善痰湿型闭经并胰岛素抵抗患者的临床症状。2.苍附导痰汤加味对痰湿型闭经并胰岛素抵抗患者的FG评分情况改善不明显。对黑棘皮征有改善作用。3.苍附导痰汤加味可以明显改善痰湿型闭经并胰岛素抵抗患者激素水平。4.苍附导痰汤加味可以明显改善痰湿型闭经并胰岛素抵抗患者肥胖指数。5.苍附导痰汤加味可以明显改善痰湿型闭经并胰岛素抵抗患者胰岛素敏感性降低的指数,减轻胰岛素抵抗。6.苍附导痰汤加味可以明显改善痰湿型闭经中医证侯。7.苍附导痰汤加味治疗痰湿型闭经并胰岛素抵抗患者有很好的综合疗效,是具有中医特色和疗效优势的治疗思路,临床疗效确切。8.二甲双胍对治疗痰湿型闭经并胰岛素抵抗患者有一定作用,但疗效不如苍附导痰汤加味联合二甲双胍。更多还原

【Abstract】 Polycystic ovary syndrome is a common female internal secretion disease. It not only appears as an endocrine disease and also is a reproductive barrier. It is found out that polycystic ovary syndrome is closely related to insulin resistance. However, all existing researches concentrate to insulin function target organization, including skeletal muscles, fat and liver except ovary. It is inaccurate to assume that ovary function barrier is due to low insulin blood sickness barrier. Moreover, ovary junction barrier only exists in multi-pouches ovary syndrome patient, but not common in Type 2 diabetic patients. The glycometabolism of polycystic ovary syndrome patient is exceptionally related to insulin resistance and ovary function barrier. Ovary is the fundamental function unit of female reproduction. It involves insulin and signal protein and metabolism enzymes. Therefore this research has been established in vitro ovary insulin resistance model. It expresses the gonadotrophic hormone signal conduction and the insulin signal conduction in reciprocity. In vivo, it is a long-term chronic pathology process. With tritium sign examination cell and insulin resistance, the research stresses on gonadotrophic Hormone signed conduction reciprocity.On the foundation, troglitazone is taken as the positive control medicine. With the use of Chinese herbal medicine, insulin is more sensitive. In the research, dexamethasone is used in pig ovary granular cells. Together with tritium, the cell absorbs less glucose.Thus insulin resistance is established. With medicines-troglitazone, metformin, berberin, and diadzein, more glucose is absorbed. This improves the insulin resistance.Ovary granular cell excretes estradiol and progesterone. RT-PCR and Western Blot technology are used to discuss insulin signal transmission way, relating to glucose absorption. The main theme is on insulin resistance and ovary function. The Findings are:1.Using dexamethasone, level of insulin glucose transportation proteins Glut-4 mRNA remarkedly drops. Use of troglitazone, metformin, berberin and daidziein, Glut-4 mRNA level remains high. Absorption of glucose improves.2.When ovary granular cell has insulin resistance, IRS-A m RNA reduces. Use of Troglitazone, metformin, berberin and diadzein improves the IRS-1 mRNA.3.The peroxide enzyme body multiplication activation acceptor increases when there is insulin resistance. Use of troglitazone, metformin, berberin and daidzein reduces it.4.Akt, also known as protein activating enzyme B(PKB) is the serine protein activating enzyme. Akt is a PI-3K circuit essential member which relates to glucose synthesis and transportation. When there is insulin resistance, Akt M RNA drops. This does not affect after use of troglitzone, metformin, berberin and daidzein. 5.PI-3K is one kind of lipid activating enzyme of insulin metabolism. P1-3K P85 and PI-3KP110 are main ones. In insulin resistance, the protein expression drops. Use of troglitazone, metformin, berberin and daidzein improves it.6.P450 arom protein is closely related to a gene. This is an important aromatized enzyme transforms and catalyzes androgen and estrin. In insulin resistance, the P450arom protein and the P450arom gene are very high. Use of troglitazone, metformin, berberin and daidzein reduces them.7.After use of dexamethasone for a long time, the insulin growth factor ILGF-IR of overy drops. It is improved with use of troglitazone, metformin, berberin and daidzein. In Conclusion:In dexamethasone , it reduces PPAR y protein. It also reduces Glut4mRNA and the protein expression level hindering glucose transportation protein production. It lowers the level of insular signal transmission main protein IRS-1. Where there is insulin resistance, P450 arom mRNA rises. Thus estrin level elevated. This causes reproduction barrier. The use of troglitazone, metform, berberin and daidzein improves all these. Lastly, troglitazone is withdrawn clinically because of high liver toxicity. It is only used in vitro as its effect is very good. The remaining Chinese herbal medicines are useful too, namely, Daiazein extract of gegen, Huang qin from berberin and salvia miltiorrhiza alkone from saliva miltiorrhiza.更多还原