中药对多囊卵巢综合征患者糖脂代谢异常和生殖内分泌的调节作用

1、中药对多囊卵巢综合征患者糖脂代谢异常和生殖内分泌的调节作用 08-10-17 11:38:00 作者：赵虹 王幸儿 包文斐编辑：studa20【摘要】 目的探讨比较中药、二甲双胍及口服避孕药复方醋酸环丙孕酮（达因35）对多囊卵巢综合征（pcos）患者胰岛素抵抗、糖脂代谢异常和生殖内分泌的调节作用。方法将100例PCOS患者分成中药组40例和西药组60例，后者又随机分为二甲双胍组和达因35组各30例。观察3组患者治疗前后排卵恢复情况；比较体重指数、血清睾酮、空腹血糖、空腹胰岛素水平、血脂指标；稳态模型法测定的胰岛素抵抗指数。结果中药组、二甲双胍组和达因35组分别有36、26、25例患者完成整个治

2、疗疗程,排卵率为33%、20%和16%。中药组明显高于二甲双胍组和达因35组，和达因35组比差异有统计学意义（P0.01）；中药组治疗后空腹胰岛素、睾酮、低密度脂蛋白水平、稳态模型法测定的胰岛素抵抗指数、均下降，与治疗前比，差异有统计学意义（P0.05）；与达因35组比差异有统计学意义（P0.05）。结论中药对PCOS患者有改善胰岛素抵抗、降低低密度脂蛋白与恢复排卵和降低雄激素的作用。 【关键词】 多囊卵巢综合征 胰岛素抵抗 糖脂代谢 内分泌Abstract：Objective To compare the efficacy of Chinese traditional medicine,me

3、tformin and cyproterone on reducing insulin resistance,improve metabolic status of glucose and lipid and raise ovulation rate in women with polycysitic ovarian syndrome.Methods 100 women with PCOS were divided into three groups：40 patients chosen to be treated by Chinese traditional medicine.The res

4、t were randomly divided into two groups which both contain 30 patients.One group is treated by metformin while another one is treated by cyproterone.Total 87 patients finished the treatment of three months.Basal body temperature （BBT）,body mass index,total testosterone,fasting serum insulin and bloo

5、d sugar levels as well as lipid spectrum were measured and compared among all the patients before and after treatment.Results No significant difference is found in the baseline characteristics among three groups before treatment.In Chinese traditional medicine group, 90 （3640）patients finished the t

6、reatment，and 33 （1236）patients ovulated.In metformin group,86 （2630）patients finished the treatment，and 19 （526）patients ovulated.In cyproterone group,83 （2530）patients finished the treatment，and 16（4/25）patients ovulated.Ovulation rate was significantly higher in Chinese traditional medicine group

7、than those in metformin and cyproterone groups .There was significant difference between Chinese traditional medicine group and cyproterone group（P0.01）.Significant difference was also found in Chinese traditional medicine group：after treatment the patients body mass index,total testosterone，serum f

8、asting insulin,lowdensity lipoprotein and the homeostasis model assessment index of insulin resistance descent significantly before treatments（P0.05）.Conclusion The Chinese traditional medicine can raise ovulation rate,significantly reduce insulin resistance,LDLC and total testosterone of polycysiti

9、c ovarian syndromed patients.Key words：polycysitic ovarian syndrome；insulin resistance；glucose lipid metabolism;endorine 多囊卵巢综合征（polycysitic ovarian syndrome,PCOS）是目前临床最为常见的妇科内分泌疾病，发病率为5%10%，且有不断上升趋势。临床表现多样化，如月经失调、不孕、肥胖、多毛，远期可并发糖尿病、冠心病、子宫内膜癌等。中医药治疗PCOS恢复月经效果肯定，但对患者体内存在的胰岛素抵抗（insulin resistance，IR）与血

10、糖、血脂紊乱的调节作用临床报道较少见。本研究旨在观察养阴益气活血中药周期性治疗对PCOS患者机体代谢紊乱（包括胰岛素抵抗）、高雄激素血症和排卵的影响，为临床治疗提供依据。1 临床资料 以2006年1月至2007年6月在浙江中医药大学附属第一医院妇科门诊就诊的PCOS患者100名作为研究对象，年龄1835岁，排除高泌乳素血症、甲状腺疾病、柯兴氏综合征等其他内分泌疾病，近3月内未用激素类药物治疗。PCOS诊断按2003年鹿特丹会议的修正诊断：排卵过少或不排卵；高雄激素血症或有雄激素过多的临床表现；超声检查确定有多囊卵巢，即每侧卵巢至少有10个以上直径0.05）。2.3 给药方法中药组于月经或黄体酮撤退性出血后第5天开始服药，按中医人工周期进行，经期第514天主方：枸杞子、阿胶珠、制黄精、旱连草、补骨脂、女贞子、地骨皮、麦冬、南沙参、北沙参、紫河车、生地、生白芍各10g，黄芪30g,甘草6g。经期第1420天在原方药中加柴胡、路路通各10g,丹参20g，经期第2028天去柴胡、路路通、丹参、地骨皮，加桑寄生20g、熟地30g。经期第28天起（排除患者受孕可能后）主方：红花、川牛膝各10g，炒当归、葛根各20g，紫石英30g，服药57d。如无月经来潮加服安宫黄体酮片剂，5粒/d，共服5d，经期停药，共治疗3个周期。二甲双胍组于月经或黄体酮撤退性出血后第5天开始，餐后半小时口服二甲双胍片