初潮年龄与育龄期多囊卵巢综合征不孕患者中医证型和生殖内分泌特征的关系  

Relationship between the age at menarche and traditional Chinese medicine syndrome and reproductive endocrine characteristics of infertility patients with polycystic ovary syndrome in childbearing age

作　　者：葛航 常惠[2] 王宇[2] 刘洋[1] 马丽娜 刘承东 罗蓉 张蓓[5] 吴效科[2,6] GE Hang;CHANG Hui;WANG Yu;LIU Yang;MA Lina;LIU Chengdong;LUO Rong;ZHANG Bei;WU Xiaoke(Heilongjiang University of Chinese Medicine,Harbin 150000,China;First Affiliated Hospital,Heilongjiang University ofChinese Medicine,Harbin 150000,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Affiliated Hospital of Jiangsu University,Zhenjiang 212000,China;Xuzhou CentralHospital,Xuzhou 221000,China;Heilongjiang Provincial Hospital,Harbin 150000,China)

机构地区：[1]黑龙江中医药大学,哈尔滨150000 [2]黑龙江中医药大学附属第一医院,哈尔滨150000 [3]山东中医药大学附属医院,济南250014 [4]江苏大学附属医院,镇江212000 [5]徐州市中心医院,徐州221000 [6]黑龙江省医院,哈尔滨150000

出　　处：《中华中医药杂志》2024年第2期962-967,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：徐州市引进临床医学专家团队(No.2019TD005);国家自然科学基金青年科学基金项目(No.82004404);黑龙江省自然科学基金优秀青年项目(No.YQ2020H031)。

摘　　要：目的:探究不同月经初潮年龄多囊卵巢综合征(PCOS)不孕患者的中医证型、基线特征和生殖结局。方法:针刺联合克罗米芬治疗PCOS不孕症患者临床试验项目(PCOSAct)共纳入1 000例PCOS受试者,本研究选择其中927例未脱落患者,将月经初潮年龄进行四分位分组:A组(≤12岁)163例,B组(13岁)290例,C组(14岁)248例,D组(≥15岁)226例。基于基线水平比较各组间的中医证型、人体测量学指标、性激素、糖脂代谢水平、代谢综合征,以及干预后的妊娠结局差异。结果:D组患者诊断为肾虚型及肾虚肝郁型显著高于A组(P<0.05),A组患者诊断为痰湿型及B、C组诊断为脾虚痰湿型显著高于D组(P<0.05)。B、C、D组体重、身体质量指数(BMI)、腰围、臀围显著低于A组(P<0.01),B、D组腰臀比(WHR)显著低于A组(P<0.05,P<0.01)。C、D组载脂蛋白B(ApoB)显著低于A组(P<0.01,P<0.05),B、C、D组空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)显著低于A组(P<0.05,P<0.01)。D组发生代谢综合征、向心性肥胖,以及C组发生高甘油三酯率显著低于A组(P<0.05,P<0.01)。A组游离睾酮(FT)显著高于D组(P<0.05),性激素结合球蛋白(SHBG)显著低于D组(P<0.01),A、B组游离雄激素指数(FAI)显著高于D组(P<0.01,P<0.05),A、B、C组促黄体生成素(LH)和LH/FSH比(LFR)显著低于D组(P<0.01)。以上各指标在4组间均存在显著性差异(P<0.05,P<0.01)。校正干预措施后,4组间生殖结局比较,差异均无统计学意义。结论:月经初潮早的PCOS女性多为痰湿型,并伴有糖脂代谢紊乱;月经初潮较晚的PCOS女性多为肾虚肝郁型,伴有高LH及高LFR,但对生殖结局无显著性影响。Objective:To explore traditional Chinese medicine(TCM)syndromes,baseline characteries,and reproductive outcomes of infertility patients with polycystic ovary syndrome(PCOS)at different menarche ages.Methods:A total of 1000 PCOS subjects were enrolled in the clinical trial project of acupuncture and Clomiphene in the treatment of PCOS infertility patients (PCOSAct). A total of 927 patients who did not drop out were selected in this study and divided into four groups according to their age of menarche: 163 cases in group A (≤12 years old), 290 cases in group B (13 years old), 248 cases in group C (14 years old), and 226 cases in group D (≥15 years old). At baseline, the differences in TCM syndromes, anthropometric parameters, sex hormones, glucose and lipid metabolism levels, metabolic syndrome, and reproductive outcomes after intervention were compared among the four groups. Results: The patients diagnosed with kidney deficiency syndrome, and kidney deficiency and liver stagnation syndrome in group D were significantly higher than those in group A (P<0.05). The patients diagnosed with phlegm dampness syndrome in group A and the patients diagnosed with spleen deficiency and phlegm dampness syndrome in groups B and C were significantly higher than those in group D (P<0.05). The weight, body mass index (BMI), waist circumference and hip circumference of group B, C and D were significantly lower than those of group A (P<0.01). The waist-to-hip ratio (WHR) of group B and group C was significantly lower than that of group A (P<0.05, P<0.01). The levels of apolipoprotein B (ApoB) in groups C and D were significantly lower than those in group A (P<0.01, P<0.05). The fasting insulin (FINS) and HOMA-IR in group B, C and D were significantly lower than those in group A (P<0.05, P<0.01). The incidence of metabolic syndrome and central obesity in group D and hypertriglyceridemia in group C were significantly lower than those in group A (P<0.05, P<0.01). Free testosterone (FT) in group A was significantly higher than that i

关 键 词：多囊卵巢综合征 月经初潮 中医证型 代谢综合征 生殖结局 相关性 

分 类 号：R271.14[医药卫生—中医妇科学]