肥胖与代谢综合征对多囊卵巢综合征患者中医体质分布及代谢的影响  

Effects of obesity and metabolic syndrome on distribution and metabolism of traditional Chinese medicine constitution in PCOS patients

作　　者：潘紫萌 侯丽辉[2] 孙淼[2] 王颖[2] 李威[2] 吴开明[2] 徐芳[3] 匡洪影[3] PAN Zi-meng;HOU Li-hui;SUN Miao;WANG Ying;LI Wei;WU Kai-ming;XU Fang;KUANG Hong-ying(Heilongjiang University of Chinese Medicine,Harbin 150040,China;First Affiliated Hospital,Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学,哈尔滨150040 [2]黑龙江中医药大学附属第一医院,哈尔滨150040 [3]黑龙江中医药大学附属第一医院妇科二科

出　　处：《中华中医药杂志》2022年第3期1656-1661,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金青年科学基金项目(No.81804138,No.81904235,No.82004401);黑龙江省中医药科研项目(No.ZHY2020-106,No.ZHY2020-101);黑龙江省普通高校青年创新人才培养计划项目(No.2018RCQ03);2018年黑龙江省博士后科研启动金(No.LBHQ18119)。

摘　　要：目的:探究多囊卵巢综合征(PCOS)患者不同肥胖和代谢综合征(MS)存在状态下的中医体质分布及性激素和糖脂的代谢差异。方法:依据不同的肥胖及MS存在状态,将PCOS患者分为单纯MS组(1组)、非肥胖非MS组(2组)、肥胖伴MS组(3组)和单纯肥胖组(4组),进行各组间临床特征的差异性及相关性分析。结果:共纳入939例PCOS患者:2组539例(57.4%),4组173例(18.4%),3组135例(14.4%),1组92例(9.8%)。气虚质所占比例中3组(53例,39.3%)显著高于2组(154例,28.6%)和4组(47例,27.2%)(P<0.01);痰湿质所占比例中3组(12例,8.9%)和4组(13例,7.5%)显著高于2组(20例,3.7%)(P<0.05)。1组的年龄显著高于其他3组(P<0.01),但PRL值低于2组(P<0.01),FAI值低于3组(P<0.01)。2组较其他3组具有高LH/FSH、SHBG和ApoA(P<0.01),但黑棘皮评分、FAI、FINS、HOMA-IR、TC、LDL-C及ApoB值较低(P<0.01),且LH值高于3组及4组(P<0.01)。3组较4组具有高FINS和ApoB(P<0.01),但低SHBG和ApoA(P<0.01);4组较1组具有高ApoA及低ApoB(P<0.01)。1组与年龄、E2/T和HOMA-IR间存在正相关(P<0.01,P<0.05);与E2和FINS间存在负相关(P<0.05)。2组与初潮年龄、多毛评分、LH和AND间存在正相关(P<0.05);与年龄、黑棘皮评分、FINS和LDL-C间存在负相关(P<0.01,P<0.05)。3组与气虚质、痰湿质、年龄、黑棘皮评分、DHEAS和LDL-C间存在正相关(P<0.01,P<0.05);与多毛评分和ApoA间存在负相关(P<0.01)。4组与黑棘皮评分、HOMA-IR和FINS间存在正相关(P<0.01);与FAI和ApoA间存在负相关(P<0.05,P<0.01)。结论:临床中应予以PCOS患者中存在的不同肥胖和MS的状态特别关注,注意到肥胖的PCOS患者(伴或不伴MS)存在较为严重的糖脂代谢紊乱情况,而年龄增长和IR的升高对伴有MS的非肥胖PCOS患者的可能影响也不容忽视。Objective: To explore the differences about the constitution of traditional Chinese medicine of sex hormones and glycolipid metabolism in different states of obesity and metabolic syndrome in PCOS. Methods: Based on different status of obesity and MS, PCOS patients who met the inclusion criteria were divided into MS alone group(group 1), non-obese nonMS group(group 2), obesity with MS group(group 3), and obese alone group(group 4), and the differences and correlations of clinical characteristics between each group were analyzed. Results: A total of 939 patients with PCOS were included in the statistics. The order is as following: 539 cases(57.4%) in group 2 173 cases(18.4%) in group 4 135 cases(14.4%) in group 3,and 92 cases(9.8%) in group 1. The proportion of qi deficiency constitution in the groups 3(53 cases, 39.3%) are higher than that in the groups 2(154 cases, 28.6%) and group 4(47 cases, 27.2%)(P<0.01);the proportion of phlegm-dampness constitution in groups 3(12 cases, 8.9%) and in groups 4(13 cases, 7.5%) were higher than that in groups 2(20 cases, 3.7%)(P<0.05). Age was significantly higher in group 1 than other 3 groups(P<0.01), but PRL was lower than that in group 2(P<0.01) and FAI were lower than that in group 3(P<0.01). Compared with the other three groups, group 2 has high LH/FSH, SHBG and ApoA(P<0.01), but the black acanthus score, FAI, FINS, HOMA-IR, TC, LDL-C and ApoB were lower(P<0.01), and the LH was higher than the group 3 and group 4(P<0.01). Compared with group 4, group 3 has higher FINS and ApoB(P<0.01), but lower SHBG and ApoA(P<0.01). The group 4 had higher ApoA and lower ApoB than group 1(P<0.01). Group 1 was positively correlated with age, E2/T and HOMA-IR(P<0.01, P<0.05);negatively correlated with E2 and FINS(P<0.05). There were positive correlations between the group 2 with age at first menarche, hirsute score, LH and AND(P<0.05);and negative correlations with age, black acanthus score,FINS and LDL-C(P<0.01, P<0.05). There were positive correlations between the group 3 and qi deficie

关 键 词：肥胖 代谢综合征 多囊卵巢综合征 中医体质 性激素 糖脂代谢 

分 类 号：R271.9[医药卫生—中西医结合]