【作者】 吴淑玲；

【导师】 陶莉莉；

【作者基本信息】 广州中医药大学 ， 中医妇科学， 2008， 硕士

【摘要】 目的多囊卵巢综合征(polycystic ovary syndrome,PCOS)是以雄激素过多及长期无排卵为特征,是育龄妇女常见的一种极为复杂的内分泌及糖代谢异常所致的病理状态,发病率为5%～10%。最近认识到PCOS不仅涉及生殖系统,而且是一种代谢综合征,常发生高胰岛素血症(High Insulin,HI)、高血脂、糖尿病和心血管疾病,在治疗上涉及月经失调、生育问题、内膜增生、远期代谢合并征等多学科问题。PCOS患者中大约50%超重或肥胖,该型患者代谢紊乱发病率明显高于非肥胖型,而且程度也重于非肥胖型患者。然而肥胖型PCOS患者的治疗仍相当棘手。中医学认为“脾虚不运,痰湿阻滞”为肥胖之根本,现代研究表明这也是PCOS患者胰岛素抵抗(insulinresistance,IR)和代谢紊乱发生的重要病理基础。近年来随着对PCOS病因病机研究的不断深入,学者们发现PCOS患者不仅存在脂肪量的增多,同时还存在脂肪细胞因子分泌的异常,脂肪中分泌的多种激素信号调节分子与PCOS导致的代谢紊乱及内分泌紊乱存在一定的关系。本组主要通过观察痰湿证PCOS肥胖患者的体重指数(body mass index,BMI)、月经异常、痤疮及多毛评分情况,同时检测促卵泡激素(follicle-stimulating hormone,FSH)、促黄体激素(luteinizing hormone,LH)、睾酮(testosterone,T)、空腹血糖(fasting serumglucose,FPG)、空腹胰岛素(fasting serum insulin,FINS)、瘦素、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),计算胰岛素敏感指数(insulin insentiveindex,ISI),并以痰湿肥胖体质妇女及非肥胖妇女为对照,旨在探讨痰湿证PCOS肥胖患者血清瘦素、TNF-α水平与IR的关系。方法选择2007年1月～2008年1月就诊于广州中医药大学第一附属医院妇科门诊及广东省第二中医院针灸减肥门诊就诊,确诊为痰湿证且肥胖的PCOS患者22例,平均年龄27.55岁。选择同期来针灸门诊减肥的年龄匹配的痰湿肥胖体质者20例(肥胖对照组),及前来体检的健康非肥胖妇女(非肥胖对照组)20例作为对照组。观察指标:1、观察并记录所有研究对象的一般情况,测量身高、体重,计算BMI,同时记录月经异常(月经稀发或闭经)、痤疮及多毛评分情况。2、检测指标所有研究对象均于月经第3~5天(PCOS闭经者B超检查无优势卵泡)晨,空腹抽取肘静脉血8ml,检测FSH、LH、T、FPG、FINS、瘦素、TNF-α。计算ISI,计算方法:ISI=1/(FINS×FPG),ISI＜0.021为IR。结果1、痤疮评分在痰湿PCOS组明显高于肥胖对照组及非肥胖对照组(P＜0.05),在肥胖对照组、非肥胖对照组之间比较,差异无显著性(P＞0.05)。多毛评分在痰湿PCOS组、肥胖对照组明显高于非肥胖对照组(P＜0.05),在痰湿PCOS组、肥胖对照组之间比较,差异无显著性(P＞0.05)。2、LH在痰湿PCOS组明显高于肥胖对照组及非肥胖对照组(P＜0.05),在肥胖对照组及非肥胖对照组间比较,差异无显著性(P＞0.05);FSH、LH/FSH在三组妇女间比较,差异无显著性(P＞0.05);T在痰湿PCOS组明显高于肥胖对照组及非肥胖对照组(P＜0.05),在肥胖对照组、非肥胖对照组之间比较,差异无显著性(P＞0.05)。3、FPG在三组之间比较差异无显著性(P＞0.05);FINS在痰湿PCOS组明显高于肥胖对照组及非肥胖对照组(P＜0.05),在肥胖对照组明显高于非肥胖对照组(P＜0.05);ISI在痰湿PCOS组明显低于肥胖对照组及非肥胖对照组(P＜0.05),在肥胖对照组明显低于非肥胖对照组(P＜0.05)。4、血清瘦素、TNF-α在痰湿PCOS组明显高于肥胖对照组及非肥胖对照组(P＜0.05),在肥胖对照组明显高于非肥胖对照组(P＜0.05)。5、痰湿证PCOS肥胖患者瘦素水平与BMI呈显著正相关关系;与ISI呈显著负相关关系。TNF-α水平与BMI呈显著正相关关系;与ISI呈显著负相关关系。结论1、痰湿证PCOS肥胖患者具备HA、HI、IR。2、痰湿证PCOS肥胖患者瘦素、TNF-α水平升高,与IR的发生关系密切。更多还原

【Abstract】 ObjectivsPolycystic ovary syndrome(PCOS)is a common gynecologyical disease which can cause endocrinologic disorder and infertility in women of reproductive age,and its incidence is 5%～10%.It is also a kind of metabohsmsyndrome(MS),which has the feature of endocrinology such as High Insulin(HI),insulin resistance(IR),and can lead to Diabetes, Cardiovascular diseas.Nearly 50%patients of PCOS is obese,who is easy to occurrence MS, and the treatment is difficult.Acorrding to the theroy of Traditional Chinese Medicine,"dysfucnction of spleen and phlegm stagnation" is the basis of obesity,and modern medcin also certificate that it’ s the important patholoical basis of PCOS.Now scholars find that fat cytokines is disorder in patiets with PCOS. The study is to ivestigate the the correlation of leptin,Tumor necrosis factor(TNF)-αwith insulin resistance in patients with PCOS of phlegmatic hygrosis.MethodsThree groups were established,PHP group(22 cases with PCOS of phlegmatic hygrosis),OB group(20 cases with obese of phlegmatic hygrosis women),NOB group(20 cases with non-obese and healthy women).Condition of menstruation,acne,hairness Were observed,as the serum follicle-stimulating hormone(FSH),luteinizing hormone(LH), testosterone(T),fasting serum glucose(FPG),fasting serum insulin (FINS),leptin,TNF-αwere detected,and insulin sensitivity index(ISI), body mass index(BMI)were calculated.Results1.Acne score in PHP group was higher than that in OB group and NOB group(P＜0.05),and had no significant difference between the two controll group(P＞0.05).Hairness score in PHP group and OB group was was higher than that in NOB group(P＜0.05),and had no significant difference between PHP group and OB group(P＞0.05)2.LH,T in PHP group was higher than that in OB group and NOB group (P＜0.05),and had no significant difference between the two controll group(P＞0.05).FSH,LH/FSH had no significant difference in three groups (P＞0.05).3.FPG had no significant difference in three groups(P＞0.05).FINS in PHP group was higher than that in OB group and NOB group(P＜0.05), FINS in OB group was higher than that in NOB group(P＜0.05).ISI in PHP group was lower than that in OB group and NOB group(P＜0.05),ISI in OB group was lower than that in NOB group(P＜0.05).4.Leptin,TNF-αin PHP group was higher than that in OB group and NOB group(P＜0.05),Leptin,TNF-αin OB group was higher than that in NOB group(P＜0.05).5.Leptin,TNF-αhad direct ratio with BMI,as had negative ratio with ISI.Conclusions1.Obese patients with PCOS of phlegmatic hygrosis has the feature of endocrinology such as High Insulin(HI),insulin resistance(IR).2.Leptin,TNF-αincreases in obses patients with PCOS of phlegmatic hygrosis.Leptin,TNF-αhas close correlation with obesity and IR in obese patients with PCOS of phlegmatic hygrosis.更多还原