|本期目录/Table of Contents|

[1]郑冬雪 刘新敏 赵一鸣.半夏泻心汤加减治疗多囊卵巢综合征胰岛素抵抗(脾虚胃热型)的时效关系研究[J].环球中医药,2017,10(02):220-224.[doi:10.3969/j.issn.1674-1749.2017.02.028]
点击复制

半夏泻心汤加减治疗多囊卵巢综合征胰岛素抵抗(脾虚胃热型)的时效关系研究()
     
分享到：

《环球中医药》[ISSN:1006-6977/CN:61-1281/TN]

卷:
第10卷
期数:
2017年02期
页码:
220-224
栏目:
临床报道
出版日期:
2017-01-06

文章信息/Info

Title:
-
作者:
郑冬雪 刘新敏 赵一鸣
100053 北京,中国中医科学院广安门医院妇科(郑冬雪、刘新敏); 上海第二军医大学中医系(赵一鸣)
Author(s):
-
关键词:
多囊卵巢综合征;  胰岛素抵抗;  半夏泻心汤;  脾虚胃热;  时效关系
Keywords:
-
分类号:
R242
DOI:
10.3969/j.issn.1674-1749.2017.02.028
文献标志码:
A
摘要:
目的 探讨半夏泻心汤加减治疗多囊卵巢综合征胰岛素抵抗(脾虚胃热型)的临床疗效、时效关系及安全性。方法 选择2014年6月至2015年12月就诊于中国中医科学院广安门医院妇科门诊,符合纳入标准及排除标准的脾虚胃热型多囊卵巢综合征胰岛素抵抗患者68例,以半夏泻心汤为基础方随证加减治疗6个月,分别检测治疗前、治疗3个月、治疗6个月空腹血糖、餐后1小时血糖(1 hour postprandial plasma glucose,P1h-PG)、餐后2小时血糖(2 hours postprandial plasma glucose,P2h-PG)和空腹胰岛素、餐后1小时胰岛素、餐后2小时胰岛素及空腹雌二醇、卵泡刺激素、黄体生成素、睾酮、催乳素、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、肌酐(creatinine,Cr)、尿素氮(urea nitrogen,BUN),统计治疗前、治疗3个月、治疗6个月月经周期评分、中医症状评分及治疗3个月、6个月妊娠率。结果(1)与治疗前相比,治疗3个月及6个月餐后2小时胰岛素及胰岛素曲线下面积均明显下降(P＜0.05),其中,治疗6月P2h-INS的下降幅度尤为显著(P＜0.01); 治疗6月P1h-PG、P2h-PG和葡萄糖曲线下面积较治疗前均降低(P＜0.05)。与治疗3个月相比,治疗6个月P2h-PG明显降低(P＜0.05)。(2)与治疗前相比,治疗3个月及治疗6个月黄体生成素水平均明显降低(P＜0.05); 治疗3个月卵泡刺激素、睾酮水平均无明显差异(P＞0.05),但治疗6个月均明显降低(P＜0.05),其中睾酮降低幅度更为显著(P＜0.01)。(3)治疗第一个3个月的妊娠率为13.21%,治疗第二个3个月的妊娠率为41.30%,两者比较有明显差异(P＜0.05)。(4)与治疗前相比,治疗3个月、6个月月经周期评分均明显降低(P＜0.01),但两者间相比无明显差异(P＞0.05)。(5)与治疗前相比,治疗3月、治疗6个月中医症状评分均明显降低(P＜0.05),其中治疗6月降低幅度更为显著(P＜0.01)。(6)与治疗前相比,治疗3个月、治疗6个月ALT、Cr、BUN均无明显变化(P＞0.05)。结论 半夏泻心汤加减能改善多囊卵巢综合征(脾虚胃热型)患者胰岛素敏感性及生殖内分泌状态,并存在时效关系; 该方能改善患者临床症状,促进自主月经的恢复,提高妊娠率,并存在时效关系,其改善作用可能与纠正胰岛素抵抗及生殖内分状态有关,具有一定的安全性。
Abstract:
-

参考文献/References:

[1] Teede H,Deeks A,Moran L. Polycystic ovary syndrome:a complex condition with psychological,reproductive and metabolic manifestations that impacts on health across the lifespan[J].BMC Medicine,2010,8:41.
[2] Azziz R,Carmina E,Dewailly D,et al. Positions statement:criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome:an Androgen Excess Society guideline[J].J Clin Endocrinol Metab,2006,91:4237-4245.
[3] Fauser BC,Tarlatzis BS,Rebar RW,et al.Consensus on women's health aspects of polycystic ovary syndrome(PCOS):the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group[J]. Fertil Steril,2012,97(1):28-38.
[4] March WA,Moore VM,Willson KJ,et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria[J]. Hum Reprod,2010,25:544-551.
[5] Li R,Zhang Q,Yang D,et al. Prevalence of polycystic ovary syndrome in women in China:a large community-based study[J]. Hum Reprod,2013,7:1-8.
[6] Scott TK,Danalea VS,Alissa JR,et al. The Gut Microbiome Is Altered in a Letrozole-Induced Mouse Model of Polycystic Ovary Syndrome[J]. PLoS One,2016,11(1):e0146509.
[7] Azziz R,Carmina E,Dewailly D,et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome:the complete task force report[J].Fertil Steril,2009,91(2):456-488.
[8] Carmina E,Campagna AM,Lobo RA.A 20-year follow-up of young women with polycystic ovary syndrome[J].Obstet Gynecol,2012,119(2 Pt 1):263-269.
[9] Diamanti-Kandarakis E,Spritzer PM,Sir-Petermann T,et al. Insulin resistance and polycystic ovary syndrome through life[J]. Curr Pharm Des,2012,18(34):5569-5576.
[10] Azziz R,Marin C,Hoq L,et al. Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span[J].J Clin Endocrinol Metab,2005,90:4650-4658.
[11] Apridonidze T,Essah PA,Iuorno MJ,et al. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome[J].J Clin Endocrinol Metab,2005,90:1929-1935.
[12] Moran LJ,Misso ML,Wild RA,et al. Impaired glucose tolerance,type 2 diabetes and metabolic syndrome in polycystic ovary syndrome:a systematic review and meta-analysis[J].Hum Reprod Update,2010,16:347-363.
[13] Rong Li,Geng Yu,Dongzi Yang,et al. Prevalence and predictors of metabolic abnormalities in Chinese women with PCOS:a cross- sectional study[J]. BMC Endocr Disord,2014,14:76.
[14] Silchorozidou T,Overton C,Conway GS,et al. The pathophysiology of polycystic ovary syndrome[J]. Clin Endocrinol(Oxf),2004,60(1):1-17.
[15] 陈子江,石玉华,郭萌,等.大样本中国人PCOS临床特点分析[J].山东医药; 2008,48(11):4-6.
[16] 李昕,林金芳.肥胖型多囊卵巢综合征患者临床及内分泌代谢特征的研究[J].中华医学杂志,2005,85(46):3266-70.
[17] Goodman N F,Cobin R H,Walter F,et al. American association of clinical endocrinologists, American college of endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 1[J]. Endocrine Practice Official Journal of the American College of Endocrinology & the American Association of Clinical Endocrinologists,2015,21(11):1291-300.
[18] Suresh S,Vijayakumar T. Correlations of Insulin Resistance and Serum Testosterone Levels with LH:FSH Ratio and Oxidative Stress in Women with Functional Ovarian Hyperandrogenism[J]. Indian Journal of Clinical Biochemistry,2015,30(3):1-6.
[19] Alberti KG,Zimmet P,Shaw J. Metabolic syndrome-a new world-wide definition. A Consensus Statement from the International Diabetes Federation[J]. Diabet Med,2006,23(5):469-480.
[20] 赵冬妮,石玉华,陈子江.PCOS患者IR的临床评价[J].实用妇产科杂志,2010,26(8):563-566.
[21] Manfredi R,Kaspar B,Enrico C,et al. How should we manage atherogenic dyslipidemia in women with polycystic ovary syndrome?[J]. American Journal of Obstetrics & Gynecology,2008,198(1):1-5.
[21] 刘新敏,刘睿,艾莉,等. 基于血清异常激素的多囊卵巢综合征中医证候研究[J]. 环球中医药,2013,6(1):12-15.
[22] 刘睿. 多囊卵巢综合征中医药辨证论治疗效研究[D].北京:北京中医药大学,2013.
[23] The Rotterdam ESHER/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[J]. Hum Reprod,2004,19(1):41-47.
[24] 廖二元,超楚生.内分泌学[M].北京:人民卫生出版社,2001:1425-1426.
[25] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[26] 季绍良.中医诊断学[M].北京:人民卫生出版社,2002:99-174.
[27] 刘新敏,郑冬雪,程冉. 清胃健脾法治疗超重并胰岛素抵抗型多囊卵巢综合征52例[J]. 世界中医药,2016,11(3):418-421.
[28] 赵冬妮,石玉华,陈子江.PCOS患者胰岛素抵抗的临床评价[J].实用妇产科杂,2010,26(8):563-566.

相似文献/References:

[1]苏恒香 刘雁峰 赵岑等.多囊卵巢综合征在女性各生理阶段病机特点概述[J].环球中医药,2014,7(01):63.
　SU Heng xiang,LIU Yan feng,ZHAO Ceng,et al.Overview on the pathomechanism features of PCOS in each physiological stage in females[J].,2014,7(02):63.
[2]张永兴 李静云.温肾祛痰调周法与西药结合治疗多囊卵巢综合征45例[J].环球中医药,2014,7(03):222.
[3]刘新敏,刘睿,艾莉,等.基于血清异常激素的多囊卵巢综合征中医证候研究[J].环球中医药,2013,6(01):12.
　LIU Xin min,LIU Rui,AI li,et al.Research of polycystic ovarian syndrome TCM syndromes based on serum abnormal hormones[J].,2013,6(02):12.
[4]胡敏,张跃辉,侯丽辉,等.多囊卵巢综合征“冲任停滞”的内涵探讨[J].环球中医药,2013,6(02):111.
[5]刘新敏,赵一鸣.降胃气在治疗多囊卵巢综合征中的作用[J].环球中医药,2014,7(05):357.
[6]马兰,刘新敏.多囊卵巢综合征高雄激素血症的中医药治疗进展[J].环球中医药,2012,5(08):633.
　MA Lan,LIU Xin-min..Progress on treatment of PCOS with hyperandrogenism with traditional Chinese medicine[J].,2012,5(02):633.
[7]王秀霞,宋玉林.中药治疗多囊卵巢综合征所致不孕的研究进展[J].环球中医药,2012,5(10):797.
　MWANG Xiu xia,SONG Yu lin..Research progress of treatment of infertility resulted from PCOS with TC[J].,2012,5(02):797.
[8]朱秀芬 王惠琴.近5 年多囊卵巢综合征临床研究进展[J].环球中医药,2014,7(06):497.
　ZHU Xiu fen,WANG Hui qin..Progress of polycystic ovary syndrome in the past five years of clinical studies: a clinical research[J].,2014,7(02):497.
[9]辛喜艳 李东 郭佳 刘承 姬晓兰.多囊卵巢综合征中医证候特征及中医药治疗思路评述[J].环球中医药,2015,8(06):679.[doi: A doi:10.3969/j.issn.1674-1749.2015.06.010]
　XIN Xi-yan,LI Dong,GUO Jia,et al.A brief summary of TCM syndromes characteristics and treatment ideas on polycystic ovary syndrome[J].,2015,8(02):679.[doi: A doi:10.3969/j.issn.1674-1749.2015.06.010]
[10]史梅莹,赵燕,王天芳.多囊卵巢综合征375例病性类证候要素分布 特点[J].环球中医药,2015,8(05):571.[doi:10.3969/j.issn.16741749.2015.05.015]
[11]蔡云 许昕.益肾祛浊方对PCOS 模型大鼠胰岛素抵抗及性激素的影响[J].环球中医药,2017,10(06):550.[doi:10.3969/j.issn.1674-1749.2017.06.003]
　CAI Yun,XU Xin..Effects of Yishen Quzhuo decoction on insulin resistance and hormones of rats with PCOS[J].,2017,10(02):550.[doi:10.3969/j.issn.1674-1749.2017.06.003]

备注/Memo

备注/Memo:
基金项目: 国家自然科学基金(81072839)
作者简介: 郑冬雪(1990- ),女,硕士,住院医师。研究方向:多囊卵巢综合症的中医治疗及实验研究。E-mail:zheng_dongx@163.com
通信作者: 刘新敏(1968- ),女,博士,主任医师。研究方向:多囊卵巢综合症的中医治疗及实验研究。E-mail:beijingliuxm@163.com
更新日期/Last Update: 2017-02-06