营养治疗联合穴位埋线治疗肥胖型多囊卵巢综合征临床观察
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摘要
目的观察营养治疗并艾塞那肽联合穴位埋线治疗肥胖型多囊卵巢综合征(polycystic ovary syndrome,PCOS)的临床效果。方法选择2013年5月—2016年5月收治的肥胖型PCOS 120例,剔除临床资料不完整者,最终入选90例,随机分为对照组与观察组,每组各45例。两组均予营养治疗+二甲双胍+艾塞那肽,观察组在此基础上予穴位埋线。两组均连续治疗3个月,比较治疗前后体重指数(body mass index,BMI)、腰臀比(waist-to-hipratio,WHR)、血脂[甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)]、血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]、激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌激素(E2)、睾酮(T)]水平变化,记录排卵、妊娠及不良反应情况。结果与本组治疗前比较,两组治疗后FPG、2 h PBG、FINS、HOMA-IR、TG、LDL-C、TC、BMI、WHR、LH、LH/FSH、E2、T均降低,HDL-C、FSH均升高,差异有统计学意义(P <0. 05);与对照组比较,观察组治疗后FPG、2 h PBG、FINS、HOMA-IR、TG、LDL-C、TC、BMI、WHR、LH、LH/FSH、E2、T均显著下降,HDL-C、FSH均显著升高,差异有统计学意义(P <0. 05)。对照组、观察组排卵率分别为68. 89%(31/45)、82. 22%(37/45);随访1年,对照组、观察组妊娠率分别为42. 22%(19/45)、62. 22%(28/45),比较差异均有统计学意义(P <0. 05)。两组不良反应发生率比较差异无统计学意义(P=0. 267)。结论营养治疗并艾塞那肽联合穴位埋线治疗通过改善肥胖型PCOS患者的糖脂代谢与外周激素水平,以提高排卵率与妊娠率。
Objective To observe the clinical effect of nutritional therapy and exenatide combined with acupoint catgut embedding(ACE) in the treatment of obese polycystic ovary syndrome(PCOS). Methods A total of120 cases of obese PCOS infertility admitted to our hospital from May 2013 to May 2016 were selected,and 90 cases were selected after excluding incomplete clinical data. They were randomly divided into control group and observation group,with 45 cases in each group. Both groups were given nutrition therapy + metformin + exenatide therapy,while the observation group was given catgut embedding at acupoints on this basis. Both groups were treated continuously for 3 months. The changes of body mass index(BMI),waist-to-hip ratio(WHR),blood lipid [triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),and total cholesterol(TC) ],blood glucose [fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPBG),fasting plasma insulin(FINS),and homeostasis model-insulin resistance(HOMA-IR) ],and hormone [follicle-stimulating hormone(FSH),luteinizing hormone(LH),estrogen(E2),and testosterone(T) ]were compared before and after treatment,and ovulation,pregnancy(followed up for 1 year) and adverse reactions were recorded. Results Compared with those before treatment,FPG,2 hPBG,FINS,HOMA-IR,TG,LDL-C,TC,BMI,WHR,LH,LH/FSH,E2,and T were decreased,whereas HDL-C and FSH were increased after treatment,and the difference was statistically significant(P < 0. 05). Compared with the control group,FPG,2 hPBG,FINS,HOMA-IR,TG,LDL-C,TC,BMI,WHR,LH,LH/FSH,E2,and T in the observation group were decreased significantly after treatment,while HDL-C and FSH were increased significantly,and the difference was statistically significant(P < 0. 05). The ovulation rate was 68. 89 %(31/45) in the control group and 82. 22 %(37/45) in the observation group. They were followed up for one year. and the pregnancy rate of control group and observation group was 42. 22 %(19/45)and 62. 22 %(28/45) respectively,suggesting significant difference(P < 0. 05). There was no significant difference in the incidence of adverse reactions between the two groups(P = 0. 267). Conclusion Nutrition therapy and exenatide combined with catgut embedding at acupoints can improve ovulation rate and pregnancy rate by improving glucose and lipid metabolism and peripheral hormone levels in obese PCOS patients.
Objective To observe the clinical effect of nutritional therapy and exenatide combined with acupoint catgut embedding(ACE) in the treatment of obese polycystic ovary syndrome(PCOS). Methods A total of120 cases of obese PCOS infertility admitted to our hospital from May 2013 to May 2016 were selected,and 90 cases were selected after excluding incomplete clinical data. They were randomly divided into control group and observation group,with 45 cases in each group. Both groups were given nutrition therapy + metformin + exenatide therapy,while the observation group was given catgut embedding at acupoints on this basis. Both groups were treated continuously for 3 months. The changes of body mass index(BMI),waist-to-hip ratio(WHR),blood lipid [triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),and total cholesterol(TC) ],blood glucose [fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPBG),fasting plasma insulin(FINS),and homeostasis model-insulin resistance(HOMA-IR) ],and hormone [follicle-stimulating hormone(FSH),luteinizing hormone(LH),estrogen(E2),and testosterone(T) ]were compared before and after treatment,and ovulation,pregnancy(followed up for 1 year) and adverse reactions were recorded. Results Compared with those before treatment,FPG,2 hPBG,FINS,HOMA-IR,TG,LDL-C,TC,BMI,WHR,LH,LH/FSH,E2,and T were decreased,whereas HDL-C and FSH were increased after treatment,and the difference was statistically significant(P < 0. 05). Compared with the control group,FPG,2 hPBG,FINS,HOMA-IR,TG,LDL-C,TC,BMI,WHR,LH,LH/FSH,E2,and T in the observation group were decreased significantly after treatment,while HDL-C and FSH were increased significantly,and the difference was statistically significant(P < 0. 05). The ovulation rate was 68. 89 %(31/45) in the control group and 82. 22 %(37/45) in the observation group. They were followed up for one year. and the pregnancy rate of control group and observation group was 42. 22 %(19/45)and 62. 22 %(28/45) respectively,suggesting significant difference(P < 0. 05). There was no significant difference in the incidence of adverse reactions between the two groups(P = 0. 267). Conclusion Nutrition therapy and exenatide combined with catgut embedding at acupoints can improve ovulation rate and pregnancy rate by improving glucose and lipid metabolism and peripheral hormone levels in obese PCOS patients.
引文
[1]刘明慧,刘英,王树玉,等.控制性超排卵治疗对多囊卵巢综合征患者卵母细胞质量的影响[J].中国优生与遗传杂志,2014,22(1):97-99.
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[3]李荔,莫蕙,文斌,等.针灸联合二甲双胍治疗肥胖型多囊卵巢综合征不孕症的临床研究[J].中华中医药杂志,2014,29(7):2115-2119.
[4] 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.
[5]叶任高.内科学[M].北京:人民卫生出版社,2000:841.
[6]中国营养学会.中国居民膳食指南[M].北京:人民卫生出版社,2016:3-4.
[7]陶莉莉,王慧颖,陈小平,等.穴位埋线配合健脾祛痰中药对肥胖型多囊卵巢综合征患者糖脂代谢的影响[J].中医杂志,2010,51(3):239-242.
[8] Kelly C C,Lyall H,Petrie J R,et al. Low grade chronic inflammation in women with polycystic ovarian syndrome[J]. J Clin Endocrinol Metab,2001,86(6):2453-2455.
[9]李朝英,杨淑娟,李雪娇,等.职业紧张对多囊卵巢综合征发病风险影响的病例对照研究[J].现代预防医学,2017,44(12):2138-2143.
[10]黄胜辉,张晓銮.经阴道超声对诊断多囊卵巢综合征的临床应用价值探究[J].吉林医学,2016,37(7):1670-1671.
[11] Malik S M,Traub M L. Defining the role of bariatric surgery in polycystic ovarian syndrome patients[J].World J Diabetes,2012,3(4):71-79.
[12] Atallah R,Filion K B,Wakil S M,et al. Long-term effects of 4 popular diets on weight loss and cardiovascular risk factors:a systematic review of randomized controlled trials[J]. Circ Cardiovasc Qual Outcomes,2014,7(6):815-827.
[13]王宇,姜明霞,许琦,等.低碳水化合物饮食对非酒精性脂肪肝肥胖患者的影响[J].东南国防医药,2015,17(1):5-7,25.
[14]吴秀芳,王迎,陈琛.肥胖型多囊卵巢综合征不孕患者内分泌特点[J].现代仪器与医疗,2017,23(4):47-48,51.
[15] Czyzewska-Majchrzak L,Grzelak T,Kramkowska M,et al. The use of low-carbohydrate diet in type 2diabetes-benefits and risks[J]. Ann Agric Environ Med,2014,21(2):320-326.
[16]李雪侠,陈刚,王锋.二甲双胍联合利格列汀治疗多囊卵巢综合征62例疗效观察[J].山东医药,2015,55(33):65-67.
[17]许生花,杨静秀,陈霞,等.二甲双胍联合克罗米芬门诊治疗多囊卵巢的疗效观察[J].中外医疗,2016,35(25):122-123.
[18]孙文善.微创埋线:技术现状与发展趋势[J].中医外治杂志,2008,17(2):3-5.
[19]桑霞,陶莉莉,张玉珍,等.多囊卵巢综合征临床证型证候分布特点的初步研究[J].河南中医学院学报,2008,23(2):42-43,45.
[20]贾丽娜,康学智,李亚明,等.温经汤对持续光照雌性大鼠卵巢周期的调节作用[J].中医药信息,2017,34(4):41-44.
[21]单鸿,吴雁翔.肥胖型与非肥胖型多囊卵巢患者的内分泌特点及临床治疗[J].当代医学,2016,22(10):57-58.
[22] Zhai H L,Wu H,Xu H,et al. Trace glucose and lipid metabolism in high androgen and high-fat diet induced polycystic ovary syndrome rats[J]. Reprod Biol Endocrinol,2012,10:5.
[23]王静,沈山梅.超重、肥胖多囊卵巢综合征患者医学营养治疗研究进展[J].中国临床医生,2013,41(5):18-19.
[24]杨兰,甘君学.针灸治疗多囊卵巢综合征临床研究进展[J].针灸临床杂志,2013,29(2):70-72.
[2]孙宇,沈山梅,胡明玥,等.艾塞那肽对脱氢表雄酮诱导的PCOS大鼠胰岛素抵抗及炎症因子水平的影响[J].山东医药,2015,55(40):24-26.
[3]李荔,莫蕙,文斌,等.针灸联合二甲双胍治疗肥胖型多囊卵巢综合征不孕症的临床研究[J].中华中医药杂志,2014,29(7):2115-2119.
[4] 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.
[5]叶任高.内科学[M].北京:人民卫生出版社,2000:841.
[6]中国营养学会.中国居民膳食指南[M].北京:人民卫生出版社,2016:3-4.
[7]陶莉莉,王慧颖,陈小平,等.穴位埋线配合健脾祛痰中药对肥胖型多囊卵巢综合征患者糖脂代谢的影响[J].中医杂志,2010,51(3):239-242.
[8] Kelly C C,Lyall H,Petrie J R,et al. Low grade chronic inflammation in women with polycystic ovarian syndrome[J]. J Clin Endocrinol Metab,2001,86(6):2453-2455.
[9]李朝英,杨淑娟,李雪娇,等.职业紧张对多囊卵巢综合征发病风险影响的病例对照研究[J].现代预防医学,2017,44(12):2138-2143.
[10]黄胜辉,张晓銮.经阴道超声对诊断多囊卵巢综合征的临床应用价值探究[J].吉林医学,2016,37(7):1670-1671.
[11] Malik S M,Traub M L. Defining the role of bariatric surgery in polycystic ovarian syndrome patients[J].World J Diabetes,2012,3(4):71-79.
[12] Atallah R,Filion K B,Wakil S M,et al. Long-term effects of 4 popular diets on weight loss and cardiovascular risk factors:a systematic review of randomized controlled trials[J]. Circ Cardiovasc Qual Outcomes,2014,7(6):815-827.
[13]王宇,姜明霞,许琦,等.低碳水化合物饮食对非酒精性脂肪肝肥胖患者的影响[J].东南国防医药,2015,17(1):5-7,25.
[14]吴秀芳,王迎,陈琛.肥胖型多囊卵巢综合征不孕患者内分泌特点[J].现代仪器与医疗,2017,23(4):47-48,51.
[15] Czyzewska-Majchrzak L,Grzelak T,Kramkowska M,et al. The use of low-carbohydrate diet in type 2diabetes-benefits and risks[J]. Ann Agric Environ Med,2014,21(2):320-326.
[16]李雪侠,陈刚,王锋.二甲双胍联合利格列汀治疗多囊卵巢综合征62例疗效观察[J].山东医药,2015,55(33):65-67.
[17]许生花,杨静秀,陈霞,等.二甲双胍联合克罗米芬门诊治疗多囊卵巢的疗效观察[J].中外医疗,2016,35(25):122-123.
[18]孙文善.微创埋线:技术现状与发展趋势[J].中医外治杂志,2008,17(2):3-5.
[19]桑霞,陶莉莉,张玉珍,等.多囊卵巢综合征临床证型证候分布特点的初步研究[J].河南中医学院学报,2008,23(2):42-43,45.
[20]贾丽娜,康学智,李亚明,等.温经汤对持续光照雌性大鼠卵巢周期的调节作用[J].中医药信息,2017,34(4):41-44.
[21]单鸿,吴雁翔.肥胖型与非肥胖型多囊卵巢患者的内分泌特点及临床治疗[J].当代医学,2016,22(10):57-58.
[22] Zhai H L,Wu H,Xu H,et al. Trace glucose and lipid metabolism in high androgen and high-fat diet induced polycystic ovary syndrome rats[J]. Reprod Biol Endocrinol,2012,10:5.
[23]王静,沈山梅.超重、肥胖多囊卵巢综合征患者医学营养治疗研究进展[J].中国临床医生,2013,41(5):18-19.
[24]杨兰,甘君学.针灸治疗多囊卵巢综合征临床研究进展[J].针灸临床杂志,2013,29(2):70-72.