健脾化痰方结合二甲双胍治疗脾虚痰湿证多囊卵巢综合征合并胰岛素抵抗的临床研究  

Clinical Study on Jianpi Huatan Decoction(健脾化痰方)Combined with Metformin in Treating Polycystic Ovary Syndrome of Spleen Deficiency and Phlegm-Dampness Syndrome with Insulin Resistance

作　　者：周彤艺 杨正望[2] 周芳 张晓红[3] 李岚[4] 陈苇[4] 李建华 陈怀敏[2] ZHOU Tong-yi;YANG Zheng-wang;ZHOU Fang;ZHANG Xiao-hong;LI Lan;CHEN Wei;LI Jian-hua;CHEN Huai-min(Xiangtan Maternal and Child Health Hospital,Xiangtan Hunan 411100,China;he First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha Hunan 410007,China;The Second Affiliated Hospital of Hunan University of Chinese Medicine,Changsha Hunan 410005,China;Hunan University of Chinese Medicine,Changsha Hunan 410208,China)

机构地区：[1]湘潭市妇幼保健院,湖南湘潭411100 [2]湖南中医药大学第一附属医院,湖南长沙410007 [3]湖南中医药大学第二附属医院,湖南长沙410005 [4]湖南中医药大学,湖南长沙410208

出　　处：《中医药导报》2021年第11期95-99,共5页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：湖南省教育厅科学研究重点项目(18A214);国家区域中医妇科诊疗中心;湖南中医药大学高等学校“双一流”学科建设项目。

摘　　要：目的:探讨健脾化痰方结合二甲双胍治疗脾虚痰湿证多囊卵巢综合征(PCOS)合并胰岛素抵抗(IR)的临床疗效,评估其对脂联素(ADP)、游离脂肪酸(FFA)及内脂素水平表达的影响。方法:将60例PCOS-IR患者按随机数字表法分成对照组和治疗组各30例,对照组患者予盐酸二甲双胍缓释片口服,治疗组患者予健脾化痰方结合盐酸二甲双胍缓释片口服。3个月为1个疗程。比较两组患者治疗前后腰围(WC)、臀围(HC)、腰臀比(WHR)、血脂代谢、中医证候积分,运用酶联免疫吸附法测定ADP、FFA、内脂素水平。结果:治疗组中医证候疗效总有效率为96.67%(29/30),对照组中医证候疗效总有效率为70.00%(21/30)。治疗组患者中医证候疗效优于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者血清总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-C)均降低(P<0.01),高密度脂蛋白胆固醇(HDL-C)均上升(P<0.01),且治疗组患者治疗后HDL-C高于对照组(P<0.01);治疗后,治疗组患者ADP水平升高,FFA、内脂素水平降低,差异均有统计学意义(P<0.05),且治疗组患者治疗后ADP水平高于对照组,FFA、内脂素水平均低于对照组,差异均有统计学意义(P<0.05);治疗组患者治疗后WC、HC、WHR均下降(P<0.01),对照组患者治疗后WC、HC均下降(P<0.01),且治疗组患者治疗后WHR低于对照组(P<0.05);两组患者治疗后中医证候积分均较治疗前降低(P<0.01),且治疗组患者治疗后中医证候积分低于对照组(P<0.01)。结论:健脾化痰方结合二甲双胍治疗脾虚痰湿证多囊卵巢综合征合并胰岛素抵抗具有较好疗效,能改善患者症状、腰臀比和脂质代谢紊乱,改善内分泌状态,减轻体内负荷,使脂联素处于高水平表达。Objective: To investigate the clinical efficacy of Jianpi Huatan Decoction combined with metformin in the treatment of polycystic ovary syndrome(PCOS) of spleen deficiency and phlegm-dampness syndrome with insulin resistance(IR), and to evaluate its effect on the expression of adiponectin(ADP), free fatty acid(FFA) and visfatin. Methods: A total of 60 PCOS-IR patients were divided into a control group and a treatment group according to a random number table, with 30 cases in each group. The control group received metformin hydrochloride sustained-release tablets orally, and the treatment group received Jianpi Huatan Decoction combined with metformin hydrochloride sustained-release tablets orally. The course of treatment in both groups was 3 months. The waist circumference(WC), hip circumference(HC), waist-to-hip ratio(WHR), blood lipid metabolism, and TCM syndrome scores were compared between the two groups of patients before and after treatment.The levels of ADP, FFA, and visfatin were determined by enzyme-linked immunosorbent assay. Results: The total effective rate of TCM syndromes in the treatment group was 96.67%(29/30), and the total effective rate of TCM syndromes in the control group was 70.00%(21/30). The curative effect of TCM syndromes in the treatment group was better than that in the control group, and the difference was statistically significant(P <0.05). After treatment, the serum TC, TG and LDL-C of the two groups of patients decreased( P <0.01), and HDL-C increased(P<0.01), and the HDL-C of the treatment group was higher than that of the control group(P<0.01).After treatment, the ADP level of patients in the treatment group increased, and the levels of FFA and visfatin decreased, and the differences were statistically significant(P<0.05). The ADP level of patients in the treatment group was higher than that of the control group, and the levels of FFA and visfatin were lower than those of the control group, and the differences were statistically significant(P<0.05). The WC, HC, and WHR of the pati

关 键 词：多囊卵巢综合征 胰岛素抵抗 脾虚痰湿证 健脾化痰方 二甲双胍 脂联素 游离脂肪酸 内脂素 

分 类 号：R271.14[医药卫生—中医妇科学]