二甲双胍联合膈下逐瘀汤干预阴道菌群对肥胖型多囊卵巢综合征不孕患者的临床疗效  

Clinical Effect of Metformin Combined with Gexiazhuyu Decoction on Vaginal Flora in Obese Infertile Patients with Polycystic Ovary Syndrome

作　　者：姜晓琳 张丽娜[3] 蓝志明[4] 李顺民[1] JIANG Xiao-Lin;ZHANG Li-Na;LAN Zhi-Ming;LI Shun-Min(Department of Nephrology,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,China;TCM Innovation Engineering Technology Center of Liaoning University of Traditional Chinese Medicine,Shenyang 110847,China;Experimental teaching center of Liaoning University of traditional Chinese Medicine,Shenyang 110847,China;Infection management department of Shenzhen Hospital of traditional Chinese Medicine.Shenzhen 518033,China)

机构地区：[1]深圳市中医院肾病研究室,广东深圳518033 [2]辽宁中医药大学中医药创新工程技术中心,沈阳110847 [3]辽宁中医药大学教学实验中心,沈阳110847 [4]深圳市中医院感染管理科,广东深圳518033

出　　处：《中国药物经济学》2022年第5期71-75,83,共6页China Journal of Pharmaceutical Economics

基　　金：辽宁省教育厅科学计划项目(L202038);沈阳市科技计划项目(18-013-0-74)。

摘　　要：目的探讨二甲双胍与膈下逐瘀汤联合用药治疗肥胖型多囊卵巢综合征(PCOS)不孕症患者的疗效,并观察记录患者的免疫功能、阴道菌群变化及其妊娠情况。方法选取2017年9月至2019年11月深圳市中医院妇科门诊收治的肥胖型PCOS不孕症患者130例(118例顺利完成临床研究),随机分为对照组60例与观察组58例。对照组患者给予二甲双胍单药治疗,观察组患者在对照组基础上采用膈下逐瘀汤,连续进行为期3个月的治疗。比较两组患者治疗前后胰岛素抵抗指标C肽、空腹血浆胰岛素(FINS)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)、叉头框蛋白P3(Fox P3)、转化生长因子-β_(1)(TGF-β_(1))、白细胞介素-17(IL-17)、白细胞介素-10(IL-10)、阴道菌群的变化情况,并统计患者的妊娠率。结果治疗后两组患者TGF-β_(1)、IL-10与Fox P3的m RNA表达水平明显高于治疗前(P<0.05),且观察组TGF-β_(1)、IL-10与Fox P3的m RNA表达水平高于对照组(P<0.05);治疗后两组患者IL-17水平低于治疗前(P<0.05),且观察组IL-17水平低于对照组(P<0.05)。治疗后两组患者CP、FINS、HOMA-IR低于治疗前(P<0.05),且观察组CP、FINS、HOMA-IR低于对照组(P<0.05)。观察组排卵率及临床妊娠率高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者滴虫、假丝酵母菌检出率及菌群失调率、阴道清洁度(Ⅲ+Ⅳ度)低于治疗前(P<0.05),且观察组低于对照组(P<0.05)。结论膈下逐瘀汤联合二甲双胍可以显著改善胰岛素抵抗、调节T细胞免疫应答、纠正阴道微生物稳态失衡,对PCOS患者具有较好的疗效。Objictive To investigate the efficacy of metformin combined with Gexia Zhuyu Decoction in the treatment of obese infertile patients with polycystic ovary syndrome(PCOS),and to observe and record the changes of immune function,vaginal flora and pregnancy.Methods 130 obese infertile patients with PCOS(118 patients successfully completed the clinical study)treated in the gynecological clinic of Shenzhen Hospital of traditional Chinese medicine from September 2017 to November 2019 were randomly divided into 60 cases in the control group and 58 cases in the observation group.The control group patients were given metformin,the observation group were given Gexia Zhuyu decoction,they were treated 3 months.Before and after treatment,we observed the changes of T cell immune response(Foxp3,TGF-β_(1),IL-17,and IL-10),insulin resistance(CP,FINS,HOMA-β,HOMA-IR),vaginal flora indexes,and statistics of pregnancy.Results After the treatment,the TGF-β_(1)、IL-10,and Foxp3 mRNA level were higher than before treatment in both groups(P<0.05),and the observation group were higher than control group(P<0.05).After the treatment,the level of IL-17 in both groups was lower than that before treatment(P<0.05),and the level of IL-17 in the observation group was lower than that in the control group(P<0.05).After the treatment,CP、FINS、HOMA-IR were lower than before treatment in both groups(P<0.05),and the observation group were lower than control group(P<0.05).The rate of ovulation and pregnancy in the observation group were higher than control group(P<0.05).After the treatment,Trichomonas,Candida detection rate and flora imbalance rate,vaginal cleanliness(Ⅲ+Ⅳ)in the observation group were lower than control group(P<0.05).Conclusion Gexia Zhuyu decoction decoction combined with metformin can significantly improve insulin resistance,regulate T cell immune response,and correct vaginal flora imbalance,which has a good effect on patients with polycystic ovary syndrome.

关 键 词：膈下逐瘀汤 二甲双胍 不孕 肥胖 多囊卵巢综合征 阴道菌群 

分 类 号：R711.75[医药卫生—妇产科学] R289.5[医药卫生—临床医学]