ER基因多态性与月经过少中医证候及疗效的相关性研究
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摘要
月经过少中医是指月经周期基本正常,月经量明显减少,甚至点滴即净；又或者经期缩短不足2天,经量减少者,称为“月经过少”。一般认为经量少于30ml者可诊断此病。月经过少患者如不及时就诊有可发展成为闭经,并且严重的可发展成卵巢早衰,还可以影响孕卵在子宫内膜种植,导致反复流产、不孕等。故及早治疗本病对维持正常的生理功能、延缓衰老、保持生育能力有积极意义。
目的
1采用频数分析和聚类分析,探讨月经过少患者的中医证侯要素及中医证侯的分布特点,为月经过少中医证候学研究提供统计学的依据。
2采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析方法检测ERa基因多态性在月经过少及正常人群的分布情况,分析ERa Pvu Ⅱ、Xba Ⅰ基因及TA重复序列在中医不同证候间的分布情况,探讨ERa基因多态性与中医证候的相关性,寻找月经过少中医证侯的易感基因,为中医证候学提供分子生物学水平的依据。
3采用经阴道彩色多普勒超声观察月经过少与正常人群的子宫内膜厚度、形态、内膜血流情况,分析其与月经过少的相关性,并比较其与Pvu Ⅱ、Xba Ⅰ基因多态性的相关性。
4用香生调经饮治疗肾虚肝郁型月经过少,分析中药对月经过少的临床疗效,并分析ERa基因多态性对应证方药疗效的相关性,探讨ERa基因多态性与应证方药疗效的影响。
研究方法
1制定月经过少临床中医证候调查表,收集月经过少病例资料,采用频数分析和聚类分析方法统计月经过少中医证候,结合临床经验,确定月经过少中医证候分布,分析中医证侯要素及中医证侯的分布特点。
2采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析方法检测实验组及对照组患者的外周血ER基因1号内含子Pvu Ⅱ、Xba Ⅰ基因多态性,并采用基因测序法检测TA重复序列,比较月经过少组及正常人群的Pvu Ⅱ、Xba Ⅰ基因型、等位基因计数及基因单倍体的分布差异,分析ERa Pvu Ⅱ、Xba Ⅰ基因及TA重复序列在中医不同证候间的相关性。
3采用经阴道彩色多普勒超声观察月经过少与正常人群排卵期的子宫内膜厚度、形态、子宫内膜及内膜下血流情况,分析其与月经过少的相关性,并比较其与Pvu Ⅱ、XbaI基因多态性的相关性。
4用香生调经饮治疗肾虚肝郁型月经过少,从月经失血图、中医证候积分、主要中医证候等方面分析中药治疗月经过少的临床疗效,并从中医证候改变等方面分析ERa基因多态性与应证方药疗效的相关性。
结果
1通过对本课题的159例月经过少患者的聚类分析结果,并结合专业知识,得出中医证候分布特点为：肾虚肝郁证>肾虚血瘀证>气血不足证>肝肾不足证>肾虚痰湿证。
2对159例月经过少患者中医证候的频数分析,出现最多的证候是经前烦躁易怒、经前乳房胀痛、经血暗红、有血块、神疲乏力、腰膝酸软等。
3ERa Pvu Ⅱ基因型PP, Pp, pp及Xbal基因型XX, Xx, xx在实验组和对照组的频率分布经X2检验差异均有显著性(P<0.05)。实验组基因型的构成比分别为：PP 4ERa基因PvuⅡ和Xbal单倍体型在实验组和对照组的分布经Fisher法检验有统计学差异(P<0.01)。实验组ppxx基因型构成比高于对照组,经卡方检验有统计学差异(P<0.05)；实验组中ppxx构成比高于其它类型单倍体。
5ERa Pvu Ⅱ基因型PP, Pp, pp及Xbal基因型XX, Xx, xx在月经过少患者不同中医证候间的分布经Fisher确切概率法检验均有统计学差异(P<0.01)。pp和xx基因型的构成比均为：气血不足证<肝肾不足证<肾虚血瘀证<肾虚肝郁证<肾虚痰湿证,均有统计学差异(P<0.01)。P、p和X、x等位基因频率在不同中医证候间的频率分布均有显著性差异(P<0.05)。P等位基因构成比：肾虚痰湿证<肾虚肝郁证<肾虚血瘀证<肝肾不足证<气血不足证；X等位基因构成比：肾虚痰湿证=肾虚肝郁证<肾虚血瘀证<肝肾不足证<气血不足证。
6ERa基因PvuⅡ和Xbal单倍体型在月经过少患者不同中医证候间的分布经Fisher确切概率法检验有统计学意义(P<0.01); ppxx基因型单倍体的构成比：气血不足证<肝肾不足证<肾虚血瘀证<肾虚肝郁证<肾虚痰湿证,有统计学差异(P<0.01)。
7ERa基因TA重复序列等位基因在实验组和对照组分布差异有显著性(P<0.01)；实验组TA19等位基因频率高于对照组,差异有显著性(P<0.05),OR=6.176(1.396～27.322); TA重复序列基因型在在月经过少患者不同中医证候间的分布有统计学意义(P<0.01)。TA19等位基因型的构成比：肾虚痰湿证<肾虚肝郁证<肾虚血瘀证<肝肾不足证<气血不足证,经Fisher检验有统计学差异(P=0.019)。
8实验组与对照组子宫内膜厚度、形态及内膜血流均具有统计学意义(P<0.01)。但是与ERa基因PvuⅡ和Xbal的基因多态性的频率分布、基因计数分布等的相关性检验均无统计学意义。
9通过对比治疗前后月经失血图,中医证候评分的变化,评价香生调经饮治疗月经过少的有效率达到72.5%,在中医证候方面,乳房胀痛总有效率达到90%,少腹胀痛总有效率达到88.89%,腰膝酸软总有效率达到80%,经色暗红总有效率达到78.57%。对子宫内膜下血流有改善作用,由37.5%提高到65%,有统计学意义。
结论
1月经过少聚为5类比较符合临床实践,5类中医证候分布特点为：肾虚肝郁证>肾虚血瘀证>气血不足证>肝肾不足证>肾虚痰湿证,以虚实夹杂最为多见。
2月经过少出现频数最多的证候是：经前烦躁易怒、经前乳房胀痛、经血暗红、有血块、神疲乏力、腰膝酸软、四肢不温。
3ERa基因多态性PvuⅡ和XbaⅠ与月经过少存在相关性,其p和x等位基因可能是其危险因素；pp基因型和xx基因型可能是其易感基因多态性之一；ppxx基因型可能是其潜在危险基因单倍体。
4在月经过少患者中,ERa基因多态性与月经过少中医证候存在相关性,p和x等位基因、pp型和xx型可能是虚实夹杂证月经过少的易感因素,尤其是肾虚为主,兼有肝郁、血瘀者。ppxx基因型可能是月经过少虚实夹杂证的潜在危险易感单倍体之一。
5ERa基因多态性TA重复序列与月经过少存在相关性,TA重复19次可能是其易感因素之一。
6月经过少患者与正常人群比较,部分患者子宫内膜偏薄、形态欠佳、血流信号欠丰富,但是与ER α基因多态性比较无相关性。
7香生调经饮治疗肾虚肝郁型月经过少的有效率达到72.5%,另外对子宫内膜下血流有较明显的改善作用。
Hypomenorrhea:themenstrual cycleis normal,duration andamount of menses are reduced. It may develop amenorrhea or premature ovarian failure if the hypomenorrhea does not treated in time,and it may lead to Habitual abortion or infertility.So it is important to treat hypomenorrhea in time.
Objective
1Based on frequency analysis and cluster analysis,study the distribution law of TCM syndromes of the hypomenorrhea.Further to provide a statistical basis for the hypomenorrhea of TCM syndromes.
2The present study was undertaken to find out the variations in the estrogen receptor-a gene polymorphisms in susceptibility to hypomenorrhea with polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).To find out the relation to risk of the hypomenorrhea of TCM syndromes and the estrogen receptor-a gene PvuⅡ (rs2234693) and Xbal (rs9340799) and TA repeat ((TA)n). Further to provide the molecular biology basis for the hypomenorrhea of TCM syndromes.
3Thepresent case-controlstudywas examinedthevariations of the endometrial thickness and endometrial morphology and endometrial blood flow in hypomenorrhea by Transvaginal color Doppler ultrasound. Examined the associations between them and the estrogen receptor-a gene PvuII and Xbal and (TA)n.
4To find out the efficacy of Chinese Traditional Medicine over the hypomenorrhea. Analysisthe variationsof theendometrial thicknessandendometrial morphologyand endometrialbloodflow after treatment.Studythe associationsbetween the efficacyof Chinese Traditional Medicine and the estrogen receptor gene PvuⅡ and XbaⅠ and (TA)n.
Methods
1The presentstudy based on the questionnairesabouttheTCM syndromes of hypomenorrhea from159cases. Studythedistribution law of TCM syndromesof the hypomenorrhea with frequency analysis and cluster analysis.
2The present case-control study was undertaken to find out the variations in the estrogen receptor-agene polymorphisms in susceptibility to hypomenorrhea with polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).To find out the relation to risk of the hypomenorrhea of TCM syndromes and the estrogen receptor-α gene PvuⅡ and Xbal and (TA)n.
3The present case-control study was examined the variations of the endometrial thickness and endometrial morphology and endometrial blood flow in hypomenorrhea by Transvaginal color Doppler ultrasound. Examined the associations between they and the estrogen receptor-α gene PvuⅡ and Xbal and (TA)n.
4To find out the efficacy of Chinese Traditional Medicine over the hypomenorrhea. Analysis the variations of the endometrial thickness and endometrial morphology and endometrial blood flow after treatment. Study the associations between the efficacy of Chinese Traditional Medicine and the estrogen receptor-gene PvuⅡ and Xbal and (TA)n.
Results
1The cluster analysis showed the distribution characteristics of TCM syndromes of hypomenorrhea from159case were follows:the kidney deficiency and liver stagnation syndrome>the kidney deficiency and blood stasis syndrome>the Qi and blood deficiency syndrome>the liver kidney deficiency syndrome>the kidney deficiency and phlegm dampness syndrome.
2The Analysis of frequency showed the distribution laws of TCM syndromes of hypomenorrhea from159case were follows:the most symptoms of premenstrual irritability, premenstrual breast pain, blood black-red and with clots, lassitude, soreness and weakness of waist and knees.
3The differences of genotype frequencies of ESR1rs2234693PP/Pp/pp genotype carriers between hypomenorrhea patients and general population were statistically significant (P<0.05). The ESR1rs9340799XX/Xx/xx genotype carriers were statistically significant too (P<0.05). The genotype frequencies of ESR1were as follows:PP 4The differences of single nucleotide polymorphism frequencies of ESR1were statistically significant (P<0.05) between hypomenorrhea patients and general population. The study showed that the single nucleotide polymorphism frequencies of ESR1ppxx were more susceptibility to hypomenorrhea.
5The differences of genotype frequencies of ESR1rs2234693PP/Pp/pp genotype carriers were statistically significant (P<0.05) among the different TCM syndromes of hypomenorrhea. The ESR1rs9340799XX/Xx/xx genotype carriers were statistically significant too (P<0.05). The study showed that the genotype frequencies of ESRl pp and xx genotype were as follows: the kidney deficiency and phlegm dampness syndrome>the kidney deficiency and liver stagnation syndrome>the kidney deliciency and blood stasis syndrome>the liver kidney deficiency syndrome>the Qi and blood deficiency syndrome. The differences were statistically significant(P <0.01). The differences of allele frequencies of ESRl P/p and X/x genotype carriers were statistically significant (P<0.05) among the different TCM syndromes of hypomenorrhea. The study showed that the genotype frequencies of ESRl P allele were as follows: the Qi and blood deficiency syndrome>the liver kidney deficiency syndrome>the kidney deficiency and blood stasis syndrome>the kidney deficiency and liver stagnation syndrome>the kidney deficiency and phlegm dampness syndrome. The study showed that the genotype frequencies of ESRl X allele were as follows: the Qi and blood deficiency syndrome>the liver kidney deficiency syndrome> the kidney deficiency and blood stasis syndrome> the kidney deficiency and liver stagnation syndrome=thekidney deficiency and phlegm dampness syndrome.
6The differences of single nucleotide polymorphism frequencies of ESRl carriers were statistically significant (P<0.01) among the different TCM syndromes of hypomenorrhea. The study showed that the single nucleotide polymorphism frequencies of ESRlwere as follows: the kidney deficiency and phlegm dampness syndrome>thc kidney deficiency and liver stagnation syndrome>the kidney deficiency and blood stasis syndrome> the liver kidney deficiency syndrome>the Qi and blood deficiency syndrome.The differences were statistically significant(P<0.01).
7Thedifferencesof theestrogen receptor-α TA repeat((TA)n)werestatistically significant(P<0.01) between hypomenorrhea patients and general population. The study showed that the ESRl (TA)19were more susceptibility to hypomenorrhea. the differences werestatistically significant(P<0.05). The risk of ESR1(TA)19cause hypomenorrhea measured as odds ratio (OR) equal to6.176.The differences of ESRl(TA)n carriers were statistically significant (P<0.01) among the different TCM syndromes of hypomenorrhea. The study showed that the ESRl (TA)19were as follows: the Qi and blood deficiency syndrome>the liver kidney deficiencysyndrome thekidney deficiency andblood stasis syndrome>the kidney deficiency and liver stagnation syndrome>the kidney deficiency and phlegm dampness syndrome. The differences were statistically significant(P<0.01).
8The study showed that the variations of the endometrial thickness and endometrial morphology and endomelrial blood flow in hypomenorrhea patients and general population were statistically significant (P<0.01).But the differences about they and theestrogen receptor-α gene PvuⅡ and XbaⅠ and (TA)n were non-significant.
9The efficacy of hypomenorrhea therapy with Chinese Traditional Medicine were was achieved in72.5%, in100%of patients with Hypochondrium pain, in90%of patients with premenstrual breast pain, in88.89%of patients with the lower abdomen pain,and in80%of patients with soreness and weakness of waist and knees.Under Chinese Traditional Medicine therapy improving of endometrial blood flow was achieved in65%,The differences were statistically significant.
Conclusion
1The study showed the distribution characteristics of TCM syndromes of hypomenorrhea were follows:the kidney deficiency and liver stagnation syndrome> kidney deficiency and blood stasis syndrome>Qi and blood deficiency syndrome> liver kidney deficiency syndrome> kidney deficiency and phlegm dampness syndrome.
2The distribution laws of TCM syndromes of hypomenorrhea were follows:the most symptoms of premenstrual irritability, premenstrual breast pain, blood black-red and with clots, lassitude, soreness and weakness of waist and knees.
3The results of the present study suggest that the ESR1rs2234693and rs9340799gene are associated with hypomenorrhea. Patients with low frequencies of the p allele and x allele were more likely to impede the hypomenorrhea.The study showed that the single nucleotide polymorphism frequencies of ESR1ppxx and ESR1pp genotype and xx genotype were more susceptibility to hypomenorrhea.
4The results of the present study suggest that the ESR1rs2234693and rs9340799gene are associated with the different TCM syndromes of hypomenorrhea.Patients with high frequencies of the p allele and x allele were more likely to respond to the hypomenorrhea with the excessive and the deficiency syndrome. especially kidney deficiency and blood stasis syndrome and the kidney deficiency and liver stagnation syndrome. The single nucleotide polymorphism frequencies of ESR1ppxx were more susceptibility to the hypomenorrhea with the excessive and the deficiency syndrome.
5The results of the present study suggest that the estrogen receptor-α TA repeat ((TA)n) are associated with the hypomenorrhea.the ESR1(TA)19were more susceptibility to hypomenorrhea.
6The results of the present study suggest that the variations of the endometrial thickness and endometrial morphology and endometrial blood flow are associated with the hypomenorrhea, but no significant correlation with the different TCM syndromes of hypomenorrhea.
7The efficacy of hypomenorrhea therapy with Chinese Traditional Medicine were was achieved in72.5%, it may obviously improve the endometrial blood flow.
目的
1采用频数分析和聚类分析,探讨月经过少患者的中医证侯要素及中医证侯的分布特点,为月经过少中医证候学研究提供统计学的依据。
2采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析方法检测ERa基因多态性在月经过少及正常人群的分布情况,分析ERa Pvu Ⅱ、Xba Ⅰ基因及TA重复序列在中医不同证候间的分布情况,探讨ERa基因多态性与中医证候的相关性,寻找月经过少中医证侯的易感基因,为中医证候学提供分子生物学水平的依据。
3采用经阴道彩色多普勒超声观察月经过少与正常人群的子宫内膜厚度、形态、内膜血流情况,分析其与月经过少的相关性,并比较其与Pvu Ⅱ、Xba Ⅰ基因多态性的相关性。
4用香生调经饮治疗肾虚肝郁型月经过少,分析中药对月经过少的临床疗效,并分析ERa基因多态性对应证方药疗效的相关性,探讨ERa基因多态性与应证方药疗效的影响。
研究方法
1制定月经过少临床中医证候调查表,收集月经过少病例资料,采用频数分析和聚类分析方法统计月经过少中医证候,结合临床经验,确定月经过少中医证候分布,分析中医证侯要素及中医证侯的分布特点。
2采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析方法检测实验组及对照组患者的外周血ER基因1号内含子Pvu Ⅱ、Xba Ⅰ基因多态性,并采用基因测序法检测TA重复序列,比较月经过少组及正常人群的Pvu Ⅱ、Xba Ⅰ基因型、等位基因计数及基因单倍体的分布差异,分析ERa Pvu Ⅱ、Xba Ⅰ基因及TA重复序列在中医不同证候间的相关性。
3采用经阴道彩色多普勒超声观察月经过少与正常人群排卵期的子宫内膜厚度、形态、子宫内膜及内膜下血流情况,分析其与月经过少的相关性,并比较其与Pvu Ⅱ、XbaI基因多态性的相关性。
4用香生调经饮治疗肾虚肝郁型月经过少,从月经失血图、中医证候积分、主要中医证候等方面分析中药治疗月经过少的临床疗效,并从中医证候改变等方面分析ERa基因多态性与应证方药疗效的相关性。
结果
1通过对本课题的159例月经过少患者的聚类分析结果,并结合专业知识,得出中医证候分布特点为：肾虚肝郁证>肾虚血瘀证>气血不足证>肝肾不足证>肾虚痰湿证。
2对159例月经过少患者中医证候的频数分析,出现最多的证候是经前烦躁易怒、经前乳房胀痛、经血暗红、有血块、神疲乏力、腰膝酸软等。
3ERa Pvu Ⅱ基因型PP, Pp, pp及Xbal基因型XX, Xx, xx在实验组和对照组的频率分布经X2检验差异均有显著性(P<0.05)。实验组基因型的构成比分别为：PP
5ERa Pvu Ⅱ基因型PP, Pp, pp及Xbal基因型XX, Xx, xx在月经过少患者不同中医证候间的分布经Fisher确切概率法检验均有统计学差异(P<0.01)。pp和xx基因型的构成比均为：气血不足证<肝肾不足证<肾虚血瘀证<肾虚肝郁证<肾虚痰湿证,均有统计学差异(P<0.01)。P、p和X、x等位基因频率在不同中医证候间的频率分布均有显著性差异(P<0.05)。P等位基因构成比：肾虚痰湿证<肾虚肝郁证<肾虚血瘀证<肝肾不足证<气血不足证；X等位基因构成比：肾虚痰湿证=肾虚肝郁证<肾虚血瘀证<肝肾不足证<气血不足证。
6ERa基因PvuⅡ和Xbal单倍体型在月经过少患者不同中医证候间的分布经Fisher确切概率法检验有统计学意义(P<0.01); ppxx基因型单倍体的构成比：气血不足证<肝肾不足证<肾虚血瘀证<肾虚肝郁证<肾虚痰湿证,有统计学差异(P<0.01)。
7ERa基因TA重复序列等位基因在实验组和对照组分布差异有显著性(P<0.01)；实验组TA19等位基因频率高于对照组,差异有显著性(P<0.05),OR=6.176(1.396～27.322); TA重复序列基因型在在月经过少患者不同中医证候间的分布有统计学意义(P<0.01)。TA19等位基因型的构成比：肾虚痰湿证<肾虚肝郁证<肾虚血瘀证<肝肾不足证<气血不足证,经Fisher检验有统计学差异(P=0.019)。
8实验组与对照组子宫内膜厚度、形态及内膜血流均具有统计学意义(P<0.01)。但是与ERa基因PvuⅡ和Xbal的基因多态性的频率分布、基因计数分布等的相关性检验均无统计学意义。
9通过对比治疗前后月经失血图,中医证候评分的变化,评价香生调经饮治疗月经过少的有效率达到72.5%,在中医证候方面,乳房胀痛总有效率达到90%,少腹胀痛总有效率达到88.89%,腰膝酸软总有效率达到80%,经色暗红总有效率达到78.57%。对子宫内膜下血流有改善作用,由37.5%提高到65%,有统计学意义。
结论
1月经过少聚为5类比较符合临床实践,5类中医证候分布特点为：肾虚肝郁证>肾虚血瘀证>气血不足证>肝肾不足证>肾虚痰湿证,以虚实夹杂最为多见。
2月经过少出现频数最多的证候是：经前烦躁易怒、经前乳房胀痛、经血暗红、有血块、神疲乏力、腰膝酸软、四肢不温。
3ERa基因多态性PvuⅡ和XbaⅠ与月经过少存在相关性,其p和x等位基因可能是其危险因素；pp基因型和xx基因型可能是其易感基因多态性之一；ppxx基因型可能是其潜在危险基因单倍体。
4在月经过少患者中,ERa基因多态性与月经过少中医证候存在相关性,p和x等位基因、pp型和xx型可能是虚实夹杂证月经过少的易感因素,尤其是肾虚为主,兼有肝郁、血瘀者。ppxx基因型可能是月经过少虚实夹杂证的潜在危险易感单倍体之一。
5ERa基因多态性TA重复序列与月经过少存在相关性,TA重复19次可能是其易感因素之一。
6月经过少患者与正常人群比较,部分患者子宫内膜偏薄、形态欠佳、血流信号欠丰富,但是与ER α基因多态性比较无相关性。
7香生调经饮治疗肾虚肝郁型月经过少的有效率达到72.5%,另外对子宫内膜下血流有较明显的改善作用。
Hypomenorrhea:themenstrual cycleis normal,duration andamount of menses are reduced. It may develop amenorrhea or premature ovarian failure if the hypomenorrhea does not treated in time,and it may lead to Habitual abortion or infertility.So it is important to treat hypomenorrhea in time.
Objective
1Based on frequency analysis and cluster analysis,study the distribution law of TCM syndromes of the hypomenorrhea.Further to provide a statistical basis for the hypomenorrhea of TCM syndromes.
2The present study was undertaken to find out the variations in the estrogen receptor-a gene polymorphisms in susceptibility to hypomenorrhea with polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).To find out the relation to risk of the hypomenorrhea of TCM syndromes and the estrogen receptor-a gene PvuⅡ (rs2234693) and Xbal (rs9340799) and TA repeat ((TA)n). Further to provide the molecular biology basis for the hypomenorrhea of TCM syndromes.
3Thepresent case-controlstudywas examinedthevariations of the endometrial thickness and endometrial morphology and endometrial blood flow in hypomenorrhea by Transvaginal color Doppler ultrasound. Examined the associations between them and the estrogen receptor-a gene PvuII and Xbal and (TA)n.
4To find out the efficacy of Chinese Traditional Medicine over the hypomenorrhea. Analysisthe variationsof theendometrial thicknessandendometrial morphologyand endometrialbloodflow after treatment.Studythe associationsbetween the efficacyof Chinese Traditional Medicine and the estrogen receptor gene PvuⅡ and XbaⅠ and (TA)n.
Methods
1The presentstudy based on the questionnairesabouttheTCM syndromes of hypomenorrhea from159cases. Studythedistribution law of TCM syndromesof the hypomenorrhea with frequency analysis and cluster analysis.
2The present case-control study was undertaken to find out the variations in the estrogen receptor-agene polymorphisms in susceptibility to hypomenorrhea with polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).To find out the relation to risk of the hypomenorrhea of TCM syndromes and the estrogen receptor-α gene PvuⅡ and Xbal and (TA)n.
3The present case-control study was examined the variations of the endometrial thickness and endometrial morphology and endometrial blood flow in hypomenorrhea by Transvaginal color Doppler ultrasound. Examined the associations between they and the estrogen receptor-α gene PvuⅡ and Xbal and (TA)n.
4To find out the efficacy of Chinese Traditional Medicine over the hypomenorrhea. Analysis the variations of the endometrial thickness and endometrial morphology and endometrial blood flow after treatment. Study the associations between the efficacy of Chinese Traditional Medicine and the estrogen receptor-gene PvuⅡ and Xbal and (TA)n.
Results
1The cluster analysis showed the distribution characteristics of TCM syndromes of hypomenorrhea from159case were follows:the kidney deficiency and liver stagnation syndrome>the kidney deficiency and blood stasis syndrome>the Qi and blood deficiency syndrome>the liver kidney deficiency syndrome>the kidney deficiency and phlegm dampness syndrome.
2The Analysis of frequency showed the distribution laws of TCM syndromes of hypomenorrhea from159case were follows:the most symptoms of premenstrual irritability, premenstrual breast pain, blood black-red and with clots, lassitude, soreness and weakness of waist and knees.
3The differences of genotype frequencies of ESR1rs2234693PP/Pp/pp genotype carriers between hypomenorrhea patients and general population were statistically significant (P<0.05). The ESR1rs9340799XX/Xx/xx genotype carriers were statistically significant too (P<0.05). The genotype frequencies of ESR1were as follows:PP
5The differences of genotype frequencies of ESR1rs2234693PP/Pp/pp genotype carriers were statistically significant (P<0.05) among the different TCM syndromes of hypomenorrhea. The ESR1rs9340799XX/Xx/xx genotype carriers were statistically significant too (P<0.05). The study showed that the genotype frequencies of ESRl pp and xx genotype were as follows: the kidney deficiency and phlegm dampness syndrome>the kidney deficiency and liver stagnation syndrome>the kidney deliciency and blood stasis syndrome>the liver kidney deficiency syndrome>the Qi and blood deficiency syndrome. The differences were statistically significant(P <0.01). The differences of allele frequencies of ESRl P/p and X/x genotype carriers were statistically significant (P<0.05) among the different TCM syndromes of hypomenorrhea. The study showed that the genotype frequencies of ESRl P allele were as follows: the Qi and blood deficiency syndrome>the liver kidney deficiency syndrome>the kidney deficiency and blood stasis syndrome>the kidney deficiency and liver stagnation syndrome>the kidney deficiency and phlegm dampness syndrome. The study showed that the genotype frequencies of ESRl X allele were as follows: the Qi and blood deficiency syndrome>the liver kidney deficiency syndrome> the kidney deficiency and blood stasis syndrome> the kidney deficiency and liver stagnation syndrome=thekidney deficiency and phlegm dampness syndrome.
6The differences of single nucleotide polymorphism frequencies of ESRl carriers were statistically significant (P<0.01) among the different TCM syndromes of hypomenorrhea. The study showed that the single nucleotide polymorphism frequencies of ESRlwere as follows: the kidney deficiency and phlegm dampness syndrome>thc kidney deficiency and liver stagnation syndrome>the kidney deficiency and blood stasis syndrome> the liver kidney deficiency syndrome>the Qi and blood deficiency syndrome.The differences were statistically significant(P<0.01).
7Thedifferencesof theestrogen receptor-α TA repeat((TA)n)werestatistically significant(P<0.01) between hypomenorrhea patients and general population. The study showed that the ESRl (TA)19were more susceptibility to hypomenorrhea. the differences werestatistically significant(P<0.05). The risk of ESR1(TA)19cause hypomenorrhea measured as odds ratio (OR) equal to6.176.The differences of ESRl(TA)n carriers were statistically significant (P<0.01) among the different TCM syndromes of hypomenorrhea. The study showed that the ESRl (TA)19were as follows: the Qi and blood deficiency syndrome>the liver kidney deficiencysyndrome thekidney deficiency andblood stasis syndrome>the kidney deficiency and liver stagnation syndrome>the kidney deficiency and phlegm dampness syndrome. The differences were statistically significant(P<0.01).
8The study showed that the variations of the endometrial thickness and endometrial morphology and endomelrial blood flow in hypomenorrhea patients and general population were statistically significant (P<0.01).But the differences about they and theestrogen receptor-α gene PvuⅡ and XbaⅠ and (TA)n were non-significant.
9The efficacy of hypomenorrhea therapy with Chinese Traditional Medicine were was achieved in72.5%, in100%of patients with Hypochondrium pain, in90%of patients with premenstrual breast pain, in88.89%of patients with the lower abdomen pain,and in80%of patients with soreness and weakness of waist and knees.Under Chinese Traditional Medicine therapy improving of endometrial blood flow was achieved in65%,The differences were statistically significant.
Conclusion
1The study showed the distribution characteristics of TCM syndromes of hypomenorrhea were follows:the kidney deficiency and liver stagnation syndrome> kidney deficiency and blood stasis syndrome>Qi and blood deficiency syndrome> liver kidney deficiency syndrome> kidney deficiency and phlegm dampness syndrome.
2The distribution laws of TCM syndromes of hypomenorrhea were follows:the most symptoms of premenstrual irritability, premenstrual breast pain, blood black-red and with clots, lassitude, soreness and weakness of waist and knees.
3The results of the present study suggest that the ESR1rs2234693and rs9340799gene are associated with hypomenorrhea. Patients with low frequencies of the p allele and x allele were more likely to impede the hypomenorrhea.The study showed that the single nucleotide polymorphism frequencies of ESR1ppxx and ESR1pp genotype and xx genotype were more susceptibility to hypomenorrhea.
4The results of the present study suggest that the ESR1rs2234693and rs9340799gene are associated with the different TCM syndromes of hypomenorrhea.Patients with high frequencies of the p allele and x allele were more likely to respond to the hypomenorrhea with the excessive and the deficiency syndrome. especially kidney deficiency and blood stasis syndrome and the kidney deficiency and liver stagnation syndrome. The single nucleotide polymorphism frequencies of ESR1ppxx were more susceptibility to the hypomenorrhea with the excessive and the deficiency syndrome.
5The results of the present study suggest that the estrogen receptor-α TA repeat ((TA)n) are associated with the hypomenorrhea.the ESR1(TA)19were more susceptibility to hypomenorrhea.
6The results of the present study suggest that the variations of the endometrial thickness and endometrial morphology and endometrial blood flow are associated with the hypomenorrhea, but no significant correlation with the different TCM syndromes of hypomenorrhea.
7The efficacy of hypomenorrhea therapy with Chinese Traditional Medicine were was achieved in72.5%, it may obviously improve the endometrial blood flow.
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