高三酰甘油-腰围表型与多囊卵巢综合征不孕患者基线特征和中医证型的关系  

Relationship of the hypertriglyceridemia-waist circumference phenotype with baseline characteristics and traditional Chinese medicine syndrome type in infertile women with polycystic ovary syndrome

作　　者：刘洋[1,2] 王宇[2,3] 葛航[1] 罗蓉 吴效科 马丽娜 都晓伟[1] 张蓓 LIU Yang;WANG Yu;GE Hang;LUO Rong;WU Xiaoke;MA Lina;DU Xiaowei;ZHANG Bei(Heilongjiang University of Chinese Medicine,Harbin 150040,China;First Affiliated Hospital,Heilongjiang University of Chinese Medicine,Harbin 150040,China;The Chinese University of Hong Kong,Hong Kong 999077,China;Jjiangxi Maternal and Child Health Hospital,Nanchang 430000,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Xuzhou Central Hospital,Xuzhou 221000,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]香港中文大学,中国香港999077 [4]江西省妇幼保健院,南昌430000 [5]山东中医药大学附属医院,济南250014 [6]徐州市中心医院,徐州221000

出　　处：《中华中医药杂志》2025年第2期861-866,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：2019年度黑龙江中医药大学科研基金项目-博士创新基金(No.2019BS09);黑龙江省中医药学会2022-2024年度青年人才托举工程项目(No.2022-QNRC1-02);黑龙江省中医药管理局2022年度中医药科研课题(No.ZHY2022-124);徐州市引进临床医学专家团队(No.2019TD005);黑龙江省卵巢疾病研究中心(No.LC2020R009);黑龙江省“头雁”团队-中西医结合妇科特色技术创新团队(No.黑政规[2019]2号)。

摘　　要：目的:全面探讨高三酰甘油-腰围(HTGW)表型与多囊卵巢综合征(PCOS)不孕的关系。方法:选择“针刺联合克罗米芬治疗多囊卵巢综合征不孕症患者”临床试验中基线较齐全患者共867例,其中三酰甘油和腰围正常组(NWNT组)232例,单纯高三酰甘油组(HTG组)53例,单纯高腰围组(EW组)336例,HTGW组246例。比较各组患者的中医证型分布情况,人口学特征,性激素、糖脂代谢及肝、肾功能水平。结果:HTGW组中医证型以脾虚痰湿证为主,为41.46%(102/246);HTGW组发生胰岛素抵抗(IR)率最高,为71.60%(174/243)。HTGW组体重、身体质量指数(BMI)、臀围、腰围(WC)、腰臀比(WHR)、收缩压、黑棘皮评分、游离雄激素指数(FAI)、空腹胰岛素(FIN)、空腹血糖(FBG)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、总胆固醇(TC)、载脂蛋白B(APOB)、低密度脂蛋白(LDL)、谷丙转氨酶(ALT)均较其他3组显著升高,性激素结合球蛋白(SHBG)、总胆汁酸(TBA)、总胆红素(TB)水平均较其他3组显著降低(P<0.01,P<0.05);EW组体重、BMI、臀围、WC、WHR、收缩压、舒张压、同型半胱氨酸(HCY)较HTG组和NWNT组显著升高,黄体生成素(LH)、LH/FSH较HTG组和NWNT组显著降低(P<0.01,P<0.05);HTG组臀围、FAI、FIN、HOMA-IR、TC、TG、APOB、LDL、乳酸脱氢酶(LDH)较NWNT组显著升高,SHBG、HDL较NWNT组显著降低(P<0.05,P<0.01)。多因素Logistic回归校正混杂因素后,HTGW与IR仍存在关联(OR=5.306,95%CI[2.807,10.028],P<0.01)。结论:PCOS不孕女性中HTGW表型多为脾虚痰湿证,表现出更严重的激素水平、糖脂代谢等紊乱情况。故在临床上应重视他们的血脂和WC控制,以方便临床施治。Objective:To comprehensively study the relationship between high triacylglycerol-waist circumference(HTGW)phenotype and polycystic ovary syndrome(PCOS)infertility.Methods:A total of 867 patients were selected from the clinical trial of‘Acupuncture combined with clomiphene for the treatment of infertility in patients with polycystic ovary syndrome'with a complete baseline,including 232 patients in the ormal waist-normal triglycerides(NWNT)group,336 patients in the normal waist-elevated triglycerides(HTG)group,and 53 patients in the enlarged waist-normal triglycerides(EW)group and 246 patients in the hypertriglyceridemic waist(HTGW)group.The distribution of traditional Chinese medicine syndrome types,demographic characteristics,sex hormones,glucose and lipid metabolism,liver and kidney function levels were compared among all groups.Results:The main traditional Chinese medicine syndrome type in the HTGW group was spleen deficiency with phlegm-dampness,accounting for 41.46%(102/246).The incidence of insulin resistance(IR)was the highest in the HTGW group,reaching 71.60%(174/243).The HTGW group had significantly higher body weight,body mass index(BMI),hip circumference,waist circumference(WC),waist-to-hip ratio(WHR),systolic blood pressure,acanthosis nigricans score,free androgen index(FAI),fasting insulin(FIN),fasting blood glucose(FBG),insulin resistance index(HOMA-IR),triglycerides(TG),total cholesterol(TC),apolipoprotein B(APOB),low-density lipoprotein(LDL),and alanine aminotransferase(ALT)compared with the other three groups(P<0.05),while the levels of sex hormone-binding globulin(SHBG),total bile acid(TBA),and total bilirubin(TB)were significantly lower than those in the other three groups(P<0.01,P<0.05).The EW group had significantly higher body weight,BMI,hip circumference,WC,WHR,systolic blood pressure,diastolic blood pressure,and homocysteine(HCY)than the HTG group and the NWNT group,while luteinizing hormone(LH)and LH/FSH were significantly lower than those in the HTG group and the NWNT group(P<0.01,P<0.0

关 键 词：多囊卵巢综合征 胰岛素抵抗 腰围 三酰甘油 

分 类 号：R271.9[医药卫生—中西医结合]