【作者】 孙萃；

【导师】 谈勇；

【作者基本信息】 南京中医药大学 ， 中医学， 2010， 硕士

【摘要】 目的探讨补肾化痰中药联合二甲双胍治疗多囊卵巢综合征伴胰岛素抵抗的临床疗效,通过比较中西药结合治疗组及西药二甲双胍对照组治疗前后患者的月经、痤疮、多毛、体重指数、腰臀比的改善情况及血清睾酮(T)、性激素结合球蛋白(SHBG)、雌二醇(E2)、黄体生成素(LH)、卵泡刺激素(FSH)、胰岛素敏感指数(INI)、稳态模型(HOMA-IR)、卵巢体积的变化及两组的排卵率及妊娠率,探讨补肾化痰序贯法结合二甲双胍治疗多囊卵巢综合征伴胰岛素抵抗的临床疗效。方法收集2009年4月至2010年4月江苏省中医院生殖医学科门诊就诊的40名PCOS伴胰岛素抵抗患者,按随机化原则分成中西药结合组(治疗组)20例,西药组(对照组)20例。中西药结合组予补肾化痰序贯法联合二甲双胍治疗,西药组以单纯二甲双胍治疗,在治疗前及治疗3个月后采集空腹静脉血,测定T、SHBG、E2、LH、FSH、FPG、FINS等。观察月经、痤疮、多毛、体重指数、腰臀比等症状改善情况,并记录两组的排卵及妊娠人数。结果中西药结合组治疗的总有效率(90%)明显高于西药组(60%),有显著性差异(P<0.05)；中西药结合组能有效改善患者的月经周期、多毛、肥胖症状,与西药组比较有显著性差异(P<0.05),在改善痤疮方面两组差异无显著性(P>0.05)；中西药结合组能有效改善患者胰岛素抵抗程度(INI, HOMA-IR),与西药组比较有显著性差异(P<0.05)；治疗后中西药结合组血清T、LH, LH/FSH水平明显低于西药组,SHBG水平明显高于西药组,有显著性差异(P<0.05)；中西药结合组明显缩小患者卵巢体积,与西药组比较有显著性差异(P<0.05)；中西药结合组排卵率高于西药组,有显著性差异(P<0.05),两组妊娠率差异无显著性(P>0.05)；此外,本课题的40例PCOS胰岛素抵抗患者其中22例为肥胖患者,18例为非肥胖患者,肥胖组与非肥胖组之间内分泌差异无显著性(P＞0.05),肥胖组患者卵巢体积明显大于非肥胖组,有显著性差异(P<0.05)；另本研究发现,INI与BMI无相关性(P>0.05), INI与WHR呈负相关(P<0.05),INI与SHBG呈正相关(P<0.05)。结论补肾化痰序贯法配合二甲双胍是治疗PCOS伴胰岛素抵抗的有效治法,中西药结合疗法明显改善患者胰岛素抵抗程度,降低患者T、LH、LH/FSH,升高SHBG,使患者月经周期规则、症状改善、排卵恢复。中西药结合组总疗效优于单纯西药治疗组。更多还原

【Abstract】 Objective This study is about the clinical study on the effect of traditional Chinese combined with western medicine in treating Polycystic ovary syndrome with insulin resistance. Through purely western medicine and traditional Chinese combined with western medicine therapy in women with polycystic ovary syndrome before and after treatment of symptoms due to menstruation, acne, hairness, body mass index,waist-hip ratio of Polycystic ovary syndrome and observated ovulation rate, pregnancy rate and the change of the levels in the serum of T, SHBG, E2, LH, FSH, INI, HOMA-IR and ovarian volume in order to explore the effect of traditional Chinese combined with western medicine in treating Polycystic ovary syndrome with insulin resistance.Method The choice conforms to this topic diagnosis standard research object 40 examples stochastically divides in to the experimental group 20 examples, the comparison group 20 examples. The experimental group uses kidney-nourishing and phlegm-resolving treatment of Chinese medicine union metformin.The comparison group uses metformin only. The information of patients’endocrine secretion was tested pretherapy and 3months after treatment. At the same time, we observed the improvement of clinical symptoms such as menstruation, acne, hairness, body mass index, waist-hip ratio and recorded the numbers of ovulation and pregnancy.Result The total efficiency (90%) of TCM combined with western medicine group was higher than western medicine group (60%), the difference was significant (P<0.05). TCM combined with western medicine group can effectively improve the patients’ menstrual cycle, hairness, obesity symptoms, superior to western medicine group (P<0.05), while there was no difference between two groups in improving acne (P> 0.05). TCM combined with western medicine group can effectively improve the circumstance of insulin resistance (INI, HOMA-IR), better than western medicine group (P<0.05). After treatment, serum T、LH, LH/FSH levels in TCM combined with western medicine group were significantly lower than western medicine group, SHBG levels were significantly higher than western medicine group (P<0.05). TCM combined with western medicine group can significantly shrunk patients’ ovarian volume, better than western medicine group (P<0.05). The ovulation rate of TCM combined with western medicine group was higher than western medicine group (P<0.05),while pregnancy rate was no difference between the two groups (P> 0.05). In addition,40 examples of PCOS subjects contained 22 examples of obese patients and 18 examples of non-obese patients. There was no difference in endocrine between obese and non-obese groups (P> 0.05). Ovarian volume of obesity group was significantly higher than non-obese group (P<0.05). It was also founded that INI and BMI had no correlation (P> 0.05), INI and WHR were negatively correlated (P<0.05), INI and SHBG were positively correlated (P<0.05).Conclusion Kidney-nourishing and phlegm-resolving treatment of Chinese medicine union metformin was a significant therapeutic principle of PCOS patients with insulin resistance. It could improve the circumstance of insulin resistance, reduce the level of T,LH, LH/FSH, increase the level of SHBG to regulate menstrual rules, recover ovulation, improve clinical symptoms. The therapeutic effect was better than the effect of using simple western medicine.更多还原