高雄激素血症对肾虚肝郁证多囊卵巢综合征的影响研究
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摘要
目的:通过比较不同水平雄激素状态下及不同HA表型的肾虚肝郁证多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)患者的临床及生化特征,探索出肾虚肝郁证PCOS伴/不伴HA及不同HA表型的肾虚肝郁证PCOS患者的临床特征,为疾病的个性化治疗和远期并发症的预防提供依据。方法:268例肾虚肝郁证PCOS患者,分为A组(肾虚肝郁证PCOS+HA)151例及B组(肾虚肝郁证PCOS+non-HA)117例;根据T及AND的值将肾虚肝郁证PCOS+HA组分为3组:Ⅰ组(单纯高T)、Ⅱ组(单纯高AND)及Ⅲ组(高T+AND组),比较各组的临床及生化特征。结果:(1)A组的臀围及FINS值小于B组, WHR、LH、LH/FSH、T、E_2、P、PRL、DHEAS、AND、TG、FT_4、痤疮及溢脂发生率均大于B组,差异有统计学意义(P<0.05);(2)Ⅰ组的AND值小于Ⅱ组及Ⅲ组,TG值大于Ⅲ组;Ⅱ组的多毛发生率高于Ⅰ组,HDL值大于Ⅲ组,FT_4值大于Ⅰ组及Ⅲ组;Ⅰ组及Ⅱ组的LH/FSH、T值大于Ⅲ组,痤疮发生率低于Ⅲ组。结论:(1)肾虚肝郁证PCOS合并HA患者性激素及糖脂代谢紊乱较重;(2)不同HA表型的肾虚肝郁证PCOS患者的代谢特征存在差异:肾虚肝郁证PCOS伴高T患者脂代谢紊乱较重;肾虚肝郁证PCOS伴高AND患者其甲状腺激素水平紊乱较重;肾虚肝郁证PCOS伴高T+AND患者其性激素代谢紊乱较重。
Objective: By comparing the clinical and biochemical features of different level of androgen condition and different HA phenotypes of kidney deficiency-liver stagnation type of PCOS, to explore its clinical and biochemical features, providing personalized treatment for disease and the reference for the prevention of long-term complication. Methods: We collected 268 cases of patients diagnosed with kidney deficiency-liver stagnation type of PCOS from October 2016 to March 2018. There were 151 cases of kidney deficiency-liver stagnation type of PCOS with HA and 117 cases of kidney deficiency-liver stagnation type of PCOS with non-HA. According to T and AND, kidney deficiency-liver stagnation type of PCOS with non-HA can be divided into three groups, then comparing the clinical and biochemical characteristics of each group. Results:(1)The HC and FINS of group A were smaller than that of the group B. WHR, LH, LH/FSH, T, E_2, P, PRL, DHEAS, AND, TG, FT_4, incidence of acne and excess fat were greater than those of group B(P<0.05).(2)The AND of group Ⅰ was less than that of group Ⅱ and group Ⅲ. TG was greater than that of group Ⅲ. The group Ⅱ's incidence of hairy was higher than that of group Ⅰ. HDL was greater than that of group Ⅲ. FT_4 was greater than that of group Ⅰ and group Ⅲ. LH/FSH and T of group Ⅰ and Ⅱ were higher than those of group Ⅲ. The incidence of acne was lower than that of Ⅲ group(P<0.05). Conclusions:(1)The patients with kidney deficiency-liver stagnation type of PCOS+HA have serious sex hormone and glucose lipid metabolic disorders.(2)There are differences in metabolic characteristics of kidney deficiency-liver stagnation type of PCOS patients with different HA phenotypes: kidney deficiency-liver stagnation type of PCOS with high T patients have serious lipid metabolism disorder; kidney deficiency-liver stagnation type of PCOS with high AND patients have serious thyroid hormone metabolism disorder; kidney deficiency-liver stagnation type of PCOS with high T+AND patients have serious sex hormone metabolism disorder.
Objective: By comparing the clinical and biochemical features of different level of androgen condition and different HA phenotypes of kidney deficiency-liver stagnation type of PCOS, to explore its clinical and biochemical features, providing personalized treatment for disease and the reference for the prevention of long-term complication. Methods: We collected 268 cases of patients diagnosed with kidney deficiency-liver stagnation type of PCOS from October 2016 to March 2018. There were 151 cases of kidney deficiency-liver stagnation type of PCOS with HA and 117 cases of kidney deficiency-liver stagnation type of PCOS with non-HA. According to T and AND, kidney deficiency-liver stagnation type of PCOS with non-HA can be divided into three groups, then comparing the clinical and biochemical characteristics of each group. Results:(1)The HC and FINS of group A were smaller than that of the group B. WHR, LH, LH/FSH, T, E_2, P, PRL, DHEAS, AND, TG, FT_4, incidence of acne and excess fat were greater than those of group B(P<0.05).(2)The AND of group Ⅰ was less than that of group Ⅱ and group Ⅲ. TG was greater than that of group Ⅲ. The group Ⅱ's incidence of hairy was higher than that of group Ⅰ. HDL was greater than that of group Ⅲ. FT_4 was greater than that of group Ⅰ and group Ⅲ. LH/FSH and T of group Ⅰ and Ⅱ were higher than those of group Ⅲ. The incidence of acne was lower than that of Ⅲ group(P<0.05). Conclusions:(1)The patients with kidney deficiency-liver stagnation type of PCOS+HA have serious sex hormone and glucose lipid metabolic disorders.(2)There are differences in metabolic characteristics of kidney deficiency-liver stagnation type of PCOS patients with different HA phenotypes: kidney deficiency-liver stagnation type of PCOS with high T patients have serious lipid metabolism disorder; kidney deficiency-liver stagnation type of PCOS with high AND patients have serious thyroid hormone metabolism disorder; kidney deficiency-liver stagnation type of PCOS with high T+AND patients have serious sex hormone metabolism disorder.
引文
[1] PARVIN L,ZOHREH M,DONYA F,et al.Insulin resistance and endocrine-metabolic abnormalities in polycystic ovarian syndrome:Comparison between obese and non-obese PCOS patients[J].Int J Reprod Biomed (Yazd),2016,14(4):263-270.
[2] 基于美国国立卫生研究院1990标准诊断的PCOS患者高雄激素血症的发生率[英]/Huang……//Fertil Steril,2010,93(6):1938-1941.
[3] 廖彩韵,梁晓燕.多囊卵巢综合征的病理生理[J].广东医学,2013,34(1):9-11.
[4] 管慧敏,雷磊.近代名老中医治疗多囊卵巢综合征中医证型及用药规律分析[J].湖南中医杂志,2016(3):153-155.
[5] 耿东,郭蓉娟.基于现代文献的焦虑症中医证候研究[J].北京中医药大学学报,2013(7):484-487.
[6] 张晨,赵婷,王伟杰,等.从郁论治多囊卵巢综合征思路浅析[J].江苏中医药,2016(3):9-11.
[7] 金春兰,吴中朝,赵吉平.从肝论治多囊卵巢综合征探讨[J].辽宁中医杂志,2015,416:1379-1381.
[8] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome[J].Fertil Steril,2004,81(1):19-25.
[9] 国家中医药管理局医政司.24个专业105个病种中医临床路径(试行)[S].北京:国家中医药管理局,2012:532-533.
[10] Azziz R,Carmina E,Dewailly D,et al.The Androgen Excess and PCOS Society criteria forthe polycystic ovary syndrome:the complete task force report[J].Fertil Steril,2009,91(2):456-488.
[11] 李艳琼.四种雄激素指标对诊断多囊卵巢综合征的临床意义[J].黑龙江医学,2015,39(12):1346-1348.
[12] 仲万霞,郑大伟,曲中玉,等.汉族多囊卵巢综合征患者各雄激素指标的临床意义分析[J].生殖与避孕,2014,34(10):830-837.
[13] 李美芝.妇科内分泌学[M].北京:人民军医出版社,2001:199.
[14] Escobar-Morreale HF,Luque-Ramirez M,San Millan JL.The molecular genetic basis of functional hyperandrogenism and the polycystic ovary syndrome[J].Endocr Rev,2005,26(2):251-282.
[15] Matsumoto T,Sakari M,Okada M,et al.The androgen receptor in health and disease[J].Annu Rev Physiol,2013,75:201-224.
[16] Castelo-Branco C,Steinvarcel F,Osorio A,et al.Atherogenic metabolic metabolic profile in PCOS patients:role of obesity and hyperandrogenism[J].Gynecol Endocrinol,2010,26(10):736-742.
[17] Fruzzetti F,Perini D,Lazzarini V,et al.Adolescent girls with polycystic ovary syndrome showing different phenotypes have a different metabolic profile associated with increasing androgen levels[J].Fertil Steril,2009,92(2):626-634
[18] 庄燕燕,夏飞,周卫琴,等.487例不孕女性甲状腺功能筛查结果分析[J].中国血液流变学杂志,2015,26(1):74-77.
[19] 赵纯,刘晓光,李秀玲,等.在体外受精-胚胎移植中多囊卵巢综合征患者卵巢高反应临床预测指标的探讨[J].南京医科大学学报(自然科学版),2014,34(12):1733-1736.
[2] 基于美国国立卫生研究院1990标准诊断的PCOS患者高雄激素血症的发生率[英]/Huang……//Fertil Steril,2010,93(6):1938-1941.
[3] 廖彩韵,梁晓燕.多囊卵巢综合征的病理生理[J].广东医学,2013,34(1):9-11.
[4] 管慧敏,雷磊.近代名老中医治疗多囊卵巢综合征中医证型及用药规律分析[J].湖南中医杂志,2016(3):153-155.
[5] 耿东,郭蓉娟.基于现代文献的焦虑症中医证候研究[J].北京中医药大学学报,2013(7):484-487.
[6] 张晨,赵婷,王伟杰,等.从郁论治多囊卵巢综合征思路浅析[J].江苏中医药,2016(3):9-11.
[7] 金春兰,吴中朝,赵吉平.从肝论治多囊卵巢综合征探讨[J].辽宁中医杂志,2015,416:1379-1381.
[8] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome[J].Fertil Steril,2004,81(1):19-25.
[9] 国家中医药管理局医政司.24个专业105个病种中医临床路径(试行)[S].北京:国家中医药管理局,2012:532-533.
[10] Azziz R,Carmina E,Dewailly D,et al.The Androgen Excess and PCOS Society criteria forthe polycystic ovary syndrome:the complete task force report[J].Fertil Steril,2009,91(2):456-488.
[11] 李艳琼.四种雄激素指标对诊断多囊卵巢综合征的临床意义[J].黑龙江医学,2015,39(12):1346-1348.
[12] 仲万霞,郑大伟,曲中玉,等.汉族多囊卵巢综合征患者各雄激素指标的临床意义分析[J].生殖与避孕,2014,34(10):830-837.
[13] 李美芝.妇科内分泌学[M].北京:人民军医出版社,2001:199.
[14] Escobar-Morreale HF,Luque-Ramirez M,San Millan JL.The molecular genetic basis of functional hyperandrogenism and the polycystic ovary syndrome[J].Endocr Rev,2005,26(2):251-282.
[15] Matsumoto T,Sakari M,Okada M,et al.The androgen receptor in health and disease[J].Annu Rev Physiol,2013,75:201-224.
[16] Castelo-Branco C,Steinvarcel F,Osorio A,et al.Atherogenic metabolic metabolic profile in PCOS patients:role of obesity and hyperandrogenism[J].Gynecol Endocrinol,2010,26(10):736-742.
[17] Fruzzetti F,Perini D,Lazzarini V,et al.Adolescent girls with polycystic ovary syndrome showing different phenotypes have a different metabolic profile associated with increasing androgen levels[J].Fertil Steril,2009,92(2):626-634
[18] 庄燕燕,夏飞,周卫琴,等.487例不孕女性甲状腺功能筛查结果分析[J].中国血液流变学杂志,2015,26(1):74-77.
[19] 赵纯,刘晓光,李秀玲,等.在体外受精-胚胎移植中多囊卵巢综合征患者卵巢高反应临床预测指标的探讨[J].南京医科大学学报(自然科学版),2014,34(12):1733-1736.