痰壅胞宫的病因病机研究（3）
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摘要
目的：探究痰湿型不孕症患者体质特征及中药苍附导痰汤对痰湿型不孕症患者瘦素水平、BMI及子宫内膜厚度的影响。检测db/db小鼠糖脂代谢和生殖功能状况，对其子宫内膜内瘦素信号传导及调控方式进行了初步研究。
方法：动物实验是通过对db/db小鼠及同窝正常小鼠于每日早上8时，连续进行两个周期的阴道细胞涂片以判断子宫内膜周期性变化，于动情间期进行瘦素刺激实验。同时记录小鼠体重以及子宫和周围脂肪垫的重量。取眼眶血，离心，血清留待测定葡萄糖、胰岛素、低密度脂蛋白胆固醇、E2、F SH、LH。测定子宫内膜各关键信号蛋白的免疫组化定位表达。临床研究是比较痰湿型不孕患者与健康者BMI、雌二醇、孕酮、瘦素、子宫内膜厚度，并对痰湿型不孕患者服用苍附导痰汤治疗前后BMI、雌二醇、孕酮、瘦素、子宫内膜厚度进行比较。
结果：动物实验的db/db小鼠血脂代谢情况明显异常于野生型小鼠，表现为高血糖、高血胰岛素、高血脂，而子宫萎缩，无动情周期和黄体，促性腺激素和性激素水平降低。其临床特征符合痰湿型不孕症。子宫内膜瘦素信号传递障碍影响胚胎着床是不孕的重要原因。子宫内膜JAK2的表达与OB-Rb保持一致，OB-Rb是激活JAK2的主要蛋白。SOCS3和PIAS3不仅仅是参与瘦素信号传导。痰湿型不孕症病机为痰壅胞宫，而痰壅胞宫的现代生物学基础是子宫内膜瘦素信号传导障碍。临床实验表明痰湿不孕患者有肥胖、高瘦素水平及子宫内膜较薄的特点。苍附导痰汤有降低BMI值，调整瘦素水平和子宫内膜厚度的作用。
结论：瘦素水平可影响子宫内膜厚度。中药苍附导痰汤可降低BMI值从而减肥，调节瘦素水平和子宫内膜厚度从而改善受孕条件，增加受孕机会。
Objective: To explore the constitution of phlegm-damp type infertility patients and the action mechanism of Cang-Fu-Dao-Tan Tang. To detecting the db/db mice glycolipid metabolism and generate function and to searching for the signal conduction of leptin in mouse's endometrium.
Method: Adult, female C57BL/6J mice (Jackson Laboratory, Bar Harbor, ME) were used in these studies. Litter mate wide types (B6.Cg-m +/+ Lepr~(db)), as well as diabetic (db/db) mutant genotypes, were matched for the experiment. All mice were housed one per cage, under controlled environmental conditions (23C). After two weeks, the vaginal smear was done at 8'oclock every morning. Then, all the mice were executed, the uterus were collected for the detection of the expression of JNK2, STAT3, P-STAT3, SOCS3 and OB-Rb. The serum was reserved for the assay of the glucose, insulin, LDL-c, E2, P, FSH and LH. Before that, all mice were injected leptin (two hours before). The weight of each mouse, their ovary and their fat pads were also recorded. We compared the BMI E_2 corporin leptin thickness of endometrium between patient and healthy ones first. Then compared the BMI E_2 corporin leptin thickness of endometrium of before and behind treatment.
Results: All the db/db mice showed the same profile of the glucose and fat metabolism which were hyperglycemia, hyperinsulinemia and hyperlipidemia, significantly higher than the groups of wide types. Moreover, they were acyclic (i.e., persistent diestrus) and anovulatory (i.e., lack of ovarian luteinization), uterus depauperated and diminished steroidogenic capacity. It's clinical feature consistent with the phlegm-damp type infertility. The important reason of infertile was that the obstacle of signal conduction of lepin in endometria influence embryo nidation.The expression of JAK2 in endometrium was in conformity with OB-Rb, and OB-Rb was the main proteinum to activating JAK2.The SOCS3 and PIAS3 were not only participating in signal conduction of leptin. The pathogenesis of the phlegm-damp type infertility was phlegm obstruct the uterus, and the modern biology foundation of phlegm obstruct the uterus were the obstacle of signal conduction of lepin in endometria.The phlegm-damp type infertility patients had the characteristic of obesity,high level leptin, thin endometrium. The Cang-Fu-Dao-Tan Tang could reduce weight, could adjust the level of leptin and the thickness of endometrium.
Conclusion: The level of leptin influenced the thickness of endometrium.This study demonstrated that the Cang-Fu-Dao-Tan Tang can improve conception by reducing BMI, adjusting the level of leptin and the thickness of endometrium.
方法：动物实验是通过对db/db小鼠及同窝正常小鼠于每日早上8时，连续进行两个周期的阴道细胞涂片以判断子宫内膜周期性变化，于动情间期进行瘦素刺激实验。同时记录小鼠体重以及子宫和周围脂肪垫的重量。取眼眶血，离心，血清留待测定葡萄糖、胰岛素、低密度脂蛋白胆固醇、E2、F SH、LH。测定子宫内膜各关键信号蛋白的免疫组化定位表达。临床研究是比较痰湿型不孕患者与健康者BMI、雌二醇、孕酮、瘦素、子宫内膜厚度，并对痰湿型不孕患者服用苍附导痰汤治疗前后BMI、雌二醇、孕酮、瘦素、子宫内膜厚度进行比较。
结果：动物实验的db/db小鼠血脂代谢情况明显异常于野生型小鼠，表现为高血糖、高血胰岛素、高血脂，而子宫萎缩，无动情周期和黄体，促性腺激素和性激素水平降低。其临床特征符合痰湿型不孕症。子宫内膜瘦素信号传递障碍影响胚胎着床是不孕的重要原因。子宫内膜JAK2的表达与OB-Rb保持一致，OB-Rb是激活JAK2的主要蛋白。SOCS3和PIAS3不仅仅是参与瘦素信号传导。痰湿型不孕症病机为痰壅胞宫，而痰壅胞宫的现代生物学基础是子宫内膜瘦素信号传导障碍。临床实验表明痰湿不孕患者有肥胖、高瘦素水平及子宫内膜较薄的特点。苍附导痰汤有降低BMI值，调整瘦素水平和子宫内膜厚度的作用。
结论：瘦素水平可影响子宫内膜厚度。中药苍附导痰汤可降低BMI值从而减肥，调节瘦素水平和子宫内膜厚度从而改善受孕条件，增加受孕机会。
Objective: To explore the constitution of phlegm-damp type infertility patients and the action mechanism of Cang-Fu-Dao-Tan Tang. To detecting the db/db mice glycolipid metabolism and generate function and to searching for the signal conduction of leptin in mouse's endometrium.
Method: Adult, female C57BL/6J mice (Jackson Laboratory, Bar Harbor, ME) were used in these studies. Litter mate wide types (B6.Cg-m +/+ Lepr~(db)), as well as diabetic (db/db) mutant genotypes, were matched for the experiment. All mice were housed one per cage, under controlled environmental conditions (23C). After two weeks, the vaginal smear was done at 8'oclock every morning. Then, all the mice were executed, the uterus were collected for the detection of the expression of JNK2, STAT3, P-STAT3, SOCS3 and OB-Rb. The serum was reserved for the assay of the glucose, insulin, LDL-c, E2, P, FSH and LH. Before that, all mice were injected leptin (two hours before). The weight of each mouse, their ovary and their fat pads were also recorded. We compared the BMI E_2 corporin leptin thickness of endometrium between patient and healthy ones first. Then compared the BMI E_2 corporin leptin thickness of endometrium of before and behind treatment.
Results: All the db/db mice showed the same profile of the glucose and fat metabolism which were hyperglycemia, hyperinsulinemia and hyperlipidemia, significantly higher than the groups of wide types. Moreover, they were acyclic (i.e., persistent diestrus) and anovulatory (i.e., lack of ovarian luteinization), uterus depauperated and diminished steroidogenic capacity. It's clinical feature consistent with the phlegm-damp type infertility. The important reason of infertile was that the obstacle of signal conduction of lepin in endometria influence embryo nidation.The expression of JAK2 in endometrium was in conformity with OB-Rb, and OB-Rb was the main proteinum to activating JAK2.The SOCS3 and PIAS3 were not only participating in signal conduction of leptin. The pathogenesis of the phlegm-damp type infertility was phlegm obstruct the uterus, and the modern biology foundation of phlegm obstruct the uterus were the obstacle of signal conduction of lepin in endometria.The phlegm-damp type infertility patients had the characteristic of obesity,high level leptin, thin endometrium. The Cang-Fu-Dao-Tan Tang could reduce weight, could adjust the level of leptin and the thickness of endometrium.
Conclusion: The level of leptin influenced the thickness of endometrium.This study demonstrated that the Cang-Fu-Dao-Tan Tang can improve conception by reducing BMI, adjusting the level of leptin and the thickness of endometrium.
引文
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