健脾补肾活血方治疗多囊卵巢综合征胰岛素抵抗47例  

Clinical effect of spleen-strengthening,kidney-tonifying,and blood-activating prescription in treatment of polycystic ovary syndrome-insulin resistance:An analysis of 47 cases

作　　者：王雪宁 孙嘉兴 安晓飞[1] WANG Xuening;SUN Jiaxing;AN Xiaofei(The Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《湖南中医杂志》2024年第3期9-14,共6页Hunan Journal of Traditional Chinese Medicine

基　　金：全国西学中骨干人才培训项目(2019-44)。

摘　　要：目的:观察健脾补肾活血方治疗脾肾两虚、痰湿瘀阻型多囊卵巢综合征胰岛素抵抗(PCOS-IR)的临床疗效和安全性。方法:将100例脾肾两虚、痰湿瘀阻型PCOS-IR患者随机分为治疗组和对照组,每组各50例。对照组采用生活方式指导联合二甲双胍治疗,治疗组在对照组的基础上予以健脾补肾活血方治疗,2组均治疗12周。观察2组综合疗效,中医证候积分,胰岛素抵抗指标[空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HOMA-β)、定量胰岛素敏感性检测指数(QUICKI)、李光伟指数、Bennett胰岛素敏感性指数(Bennett ISI)],糖脂代谢指标[空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)],体质量(BMI),性激素指标[黄体生成素(LH)、卵泡刺激素(FSH)、LH/FSH、雌二醇(E2)、血清总睾酮(TT)、性激素结合球蛋白(SHBG)、游离雄激素指数(FAI)、血清游离睾酮(cFT)],月经周期评分及不良反应发生情况。结果:治疗过程中脱落5例,最终治疗组纳入47例,对照组纳入48例。总有效率治疗组为93.6%(44/47),对照组为77.1%(37/48),2组比较,差异有统计学意义(P<0.05)。治疗后治疗组中医证候积分、胰岛素抵抗各项指标、FPG、LDL-C、BMI、TT、FAI、月经周期评分均较治疗前改善(P<0.05),且其中医证候积分、FINS、HOMA-IR、QUICKI、李光伟指数、BMI、月经周期评分改善程度均优于对照组(P<0.05)。2组均未发生严重不良反应,药物安全性良好。结论:健脾补肾活血方联合西医常规疗法能有效改善脾肾两虚、痰湿瘀阻型PCOS-IR患者胰岛素敏感性、糖脂代谢紊乱、中医证候及月经不调。Objective:To investigate the clinical effect and safety of spleen-strengthening,kidney-tonifying,and blood-activating prescription in the treatment of spleen-kidney deficiency and phlegm-dampness stasis of polycystic ovary syndrome-insulin resistance(PCOS-IR).Methods:A total of 100 patients with spleen-kidney deficiency and phlegmdampness stasis of PCOS-IR were randomly divided into treatment group and control group,with 50 patients in each group.The patients in the control group received lifestyle guidance and metformin,and those in the treatment received spleen-strengthening,kidney-tonifying,and blood-activating prescription in addition to the treatment in the control group;the course of treatment was 12 weeks for both groups.The two groups were observed in terms of overall response,traditional Chinese medicine(TCM)syndrome score,insulin resistance indices(fasting insulin[FINS],Homeostasis Model Assess-ment of Insulin Resistance[HOMA-IR],homeostasis model assessmentβ-cell function,quantitative insulin sensitivity check index[QUICKI],insulin sensitivity index(ISI)proposed by Li Guangwei,and Bennett ISI,glucose and lipid metabolic markers(fasting plasma glucose[FPG],total cholesterol,triglyceride,low-density lipoprotein cholesterol[LDL-C],and high-density lipoprotein cholesterol[HDL-C]),body mass index(BMI),sex hormone indicators(luteinizing hormone[LH],follicle-stimulating hormone[FSH],LH/FSH ratio,estradiol,serum total testosterone[TT],sex hormone-binding globulin,free androgen index[FAI],and serum calculated free testosterone),menstrual cycle score,and adverse reactions.Results:Five patients were lost to follow-up during treatment,and finally there were 47 patients in the treatment group and 48 patients in the control group.There was a significant difference in overall response rate between the treatment group and the control group[93.6%(44/47)vs 77.1%(37/48),P<0.05].After treatment,the treatment group had significant improvements in TCM syndrome score,insulin resistance indices,FPG,LDL-C,BMI,TT,FAI,and menst

关 键 词：多囊卵巢综合征 胰岛素抵抗 脾肾两虚、痰湿瘀阻型 中西医结合疗法 健脾补肾活血方 

分 类 号：R271.917.5[医药卫生—中西医结合]