中药治疗多囊卵巢综合征文献数据库的建立及中药疗效的数据分析
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摘要
由于治疗多囊卵巢综合征(PCOS)的许多西药多有不同程度的副作用且药价昂贵,因此相对来说经济安全的中药被较为普遍地用于PCOS的治疗,或被用来与西药结合使用以提高治疗效果。迄今为止中药在治疗PCOS中的应用规律及治疗效果尚有待于系统全面的分析。本研究从1980年到2009年间发表的临床实验和系列病历研究文献中收集数据,通过建立关联数据库,对中药治疗PCOS文献数据进行了两个方面的分析。
文献研究一是通过系统分析方法来研究中药对PCOS的治疗效果。相关文献检索使用www.ilib.cn和PUBMED。检索年代为1980年到2008年。关键词为“多囊卵巢综合征(PCOS)".“中医”、“中药”、“克罗米芬(Clomid citrate)"、“文献系统分析”和"Meta-analysis"。被收入研究一的研究为使用中药或中药结合克罗米芬并以西药克罗米芬治疗PCOS为对照的临床实验及临床系列研究,治疗周期为至少三个月或三个月经周期,治愈标准为患者怀孕或获得有证据排卵。利用Mantel-Haenszel方法对38个临床试验(病人总数为2883人)的Meta分析表明中药加克罗米芬的治愈率为60.39%(927/1535)而单用克罗米芬的治愈率为34.57%(466/1348)。结果表明中药结合西药治疗PCOS显著提高了治愈率[OR=3.01(95%CI=2.57/3.52),p=0.00]。倒漏斗图形不对称表明发表偏倚存在(α=2.05,95% CI=0.10/3.99,p=0.04)。研究发现,克罗米芬对PCOS的疗效可以通过结合中药的使用得到显著提高。考虑到发表偏倚的存在,本研究所得结论有待更多临床随机对照实验进一步检验。
文献研究二是通过文献数据库的建立和分析来研究中药在治疗PCOS时的用药规律、常用方法、以及不同中药的临床治疗效果。文献检索使用了www.cnki.net, www.ilib.cn和PUBMED。检索年代为1984年到2009。关键词为“多囊卵巢综合征(PCOS)"、“中药”、“数据挖掘(data-mining)"、和“文献数据分析(literature data analysis)。重要相关文献的参考文献使用手工检索。被收入研究二的研究为使用中药或中药结合西药治疗PCOS的临床实验及临床系列研究,治疗周期为至少三个月或三个月经周期；治疗标准为患者怀孕或获得有证据排卵。用来收集和管理数据的软件是微软SQL和微软Excel。中药的功效和类别以英文教科书《中药学》(Materia Medica)为参考,将中药治疗PCOS的相关数据包括中药的使用、治疗方法及治疗结果等输入数据库。通过数据排序和数据挖掘找出与高治愈率最相关的常用中药。
在研究二所收集的125篇相关文献中,共有8150位PCOS病人分别接受了中药、中药结合西药、或西药(作为对照)的治疗。所使用的中药分别来自30个类别,共179味。本研究发现,当中药单独使用时或当中药与克罗米芬结合使用时,有12味最常用并与高治愈率最相关的中药。这12味中药分别来自7个中药类别,即活血化瘀药中的川芎、丹参、桃仁和红花；补血药中的当归；补阳药中的巴戟天、肉苁蓉、仙茅；补阴药中的女贞子；补气药中的黄芪；辛凉解表药中的柴胡(在此应用了其疏肝解郁的功效)；及温化寒痰药中的制半夏。值得注意的是,在筛选常用有效中药的过程中发现,当单独使用中药治疗PCOS时,在使用时比不使用时治愈率显著提高的中药主要来自活血、补血、补阳、补阴和补气药。当使用中药结合克罗米芬治疗PCOS时,在使用时比不使用治愈率显著提高的中药主要来自补血、补阳、补阴和补气药。此结果表明中药结合克罗米芬治疗PCOS时,克罗米芬可能起到了相当于中药活血药的功效。
通过以上研究发现在使用中药治疗PCOS时补肾活血化瘀类药起着重要作用。中药结合克罗米芬显著提高了单用克罗米芬治疗PCOS的疗效。常用并与高治愈率相关的中药主要来自活血补血药、补阳药、补阴药和补气药。由于目前我们对不同中药间及中西药间可能存在的相互影响的复杂生理生化关系认识得尚十分有限,因此本研究的结论有待更多随机对照临床实验进一步检验。
Background:Due to the vast array of side effects associated with many western medicines typically prescribed to treat polycystic ovarian syndrome (PCOS), Chinese herbal medicine has been commonly used in China as a less invasive, yet economical approach to treat PCOS or to improve western medicine's treatment effect. To date the application status and clinical outcome of Chinese herbs in treating PCOS in China has not been systematically examined.
Objectives:(1) To study the effects of Chinese medical herbs on PCOS treatment by a systematic review and meta-analysis of the literature published between 1980 and 2008. (2) To exam the application status, treatment strategies and clinical outcomes of Chinese medical herbs in PCOS treatment by establishing and analyzing a relational database that collects information of PCOS treatment using Chinese herbs from clinical trials and case serial studies published between 1984 and 2009.
Methods:(1)Clinical trials using Chinese herbs to treat PCOS were retrieved from www. ilib.cn and MEDLINE (1980-2008) using key words of "PCOS", "Chinese herbs", "systemic review of literature", "meta-analysis", "data mining", "integral Chinese and western medicine". All case serial studies and randomized trials using Chinese herbs alone, comparing herbs combined with clomiphene citrate and clomiphene citrate alone were studied. (2)Publications were searched and retrieved from www.cnki.net,www.ilib.cn and PUBMED (1984-2009) using key words of "PCOS", "Chinese herbs", "integral Chinese and western medicine", "data-mining", and "literature data analysis". Reference lists of each primary study were hand-searched. Clinical trials and case serial studies using pregnancy rate or confirmed ovulation as primary outcome measures and with treatment durations of at least three months or three menstrual cycles were selected for the study. Microsoft SQL Server program and Microsoft Excel were used as data collection and database management tools. Functions and action sections of Chinese herbs were entered into the database according to Materia Medica, a comprehensive and recognized Chinese herbal medicine textbook in English. Herbal usage frequency, treatment strategies and associated treatment outcomes were analyzed. Most frequently used herbs that were also associated with higher cure rates were screened by data sorting and data-mining using Microsoft SQL Server program and Microsoft Excel. In both studies, the main outcome measures were pregnancy rates or obtaining regular ovulatory cycles of 4 weeks confirmed by biphasic body temperature or transvaginal sonography and midluteal phase progesterone concentration levels after 3-6 months of treatment.
Results:In research (1), Meta-analysis of the 38 trials (2883 patients) using . Mantel-Haenszel method (fixed effect model) showed the cure rate of Clomid Citrate (CC) with herbs was 60.39%(927/1535) and the cure rate of CC alone was 34.57% (466/1348). There was a significant increased probability of cured [OR=3.01 (95% CI=2.57/3.52), p=0.00] in favor of the herbal integrated treatment. The test of funnel plot asymmetry showed that the chance of publication bias existed (α=2.05, 95% CI=0.10/3.99, p=0.04. In research (2), a total of 125 relevant publications, 8150 patients were treated with Chinese herbs alone, with integral Chinese herbs and western medicine, or with western medicine alone as controls. According to traditional Chinese medicine (TCM) pattern differentiation theory, a total of 179 herbs from 30 action sections were used by different practitioners. By analyzing database and performing data mining using Microsoft Association Rules algorithm,12 of the 179 herbs were found to be the most frequently used herbs that were also associated with higher cure rates in treating PCOS. These 12 herbs include Chuan Xiong, Dan Shen, Tao Ren, Hong Hua from herbs that invigorate Blood; Xian Mao, Ba Ji Tian, Rou Cong Rong from herbs that tonify the Yang; Nu Zhen Zi from herbs that tonify the Ying; Dang Gui from herbs that tonify the blood; Huang qi from herbs that tonify the Qi; Chai Hu from Cool and acrid herbs that release the exterior (used to remove Liver qi stagnation); and Zhi Ban Xia from herbs that warm and transform phlegm
Conclusion:Research (1) found that clomiphene citrate treatment outcome of PCOS patients may be significantly improved by using Chinese herbs. Considering the risk of publication bias, double blind randomized trials are needed to further confirm the above conclusion. Research (2) found that the most frequently used herbs which were also associated with higher cure rates in treating PCOS were mostly from herbs that invigorate and tonify the Blood, herbs that tonify the Yang, the Yin and the Qi. These are preliminary findings that need futher supports by more randomized controlled clinical studies.
文献研究一是通过系统分析方法来研究中药对PCOS的治疗效果。相关文献检索使用www.ilib.cn和PUBMED。检索年代为1980年到2008年。关键词为“多囊卵巢综合征(PCOS)".“中医”、“中药”、“克罗米芬(Clomid citrate)"、“文献系统分析”和"Meta-analysis"。被收入研究一的研究为使用中药或中药结合克罗米芬并以西药克罗米芬治疗PCOS为对照的临床实验及临床系列研究,治疗周期为至少三个月或三个月经周期,治愈标准为患者怀孕或获得有证据排卵。利用Mantel-Haenszel方法对38个临床试验(病人总数为2883人)的Meta分析表明中药加克罗米芬的治愈率为60.39%(927/1535)而单用克罗米芬的治愈率为34.57%(466/1348)。结果表明中药结合西药治疗PCOS显著提高了治愈率[OR=3.01(95%CI=2.57/3.52),p=0.00]。倒漏斗图形不对称表明发表偏倚存在(α=2.05,95% CI=0.10/3.99,p=0.04)。研究发现,克罗米芬对PCOS的疗效可以通过结合中药的使用得到显著提高。考虑到发表偏倚的存在,本研究所得结论有待更多临床随机对照实验进一步检验。
文献研究二是通过文献数据库的建立和分析来研究中药在治疗PCOS时的用药规律、常用方法、以及不同中药的临床治疗效果。文献检索使用了www.cnki.net, www.ilib.cn和PUBMED。检索年代为1984年到2009。关键词为“多囊卵巢综合征(PCOS)"、“中药”、“数据挖掘(data-mining)"、和“文献数据分析(literature data analysis)。重要相关文献的参考文献使用手工检索。被收入研究二的研究为使用中药或中药结合西药治疗PCOS的临床实验及临床系列研究,治疗周期为至少三个月或三个月经周期；治疗标准为患者怀孕或获得有证据排卵。用来收集和管理数据的软件是微软SQL和微软Excel。中药的功效和类别以英文教科书《中药学》(Materia Medica)为参考,将中药治疗PCOS的相关数据包括中药的使用、治疗方法及治疗结果等输入数据库。通过数据排序和数据挖掘找出与高治愈率最相关的常用中药。
在研究二所收集的125篇相关文献中,共有8150位PCOS病人分别接受了中药、中药结合西药、或西药(作为对照)的治疗。所使用的中药分别来自30个类别,共179味。本研究发现,当中药单独使用时或当中药与克罗米芬结合使用时,有12味最常用并与高治愈率最相关的中药。这12味中药分别来自7个中药类别,即活血化瘀药中的川芎、丹参、桃仁和红花；补血药中的当归；补阳药中的巴戟天、肉苁蓉、仙茅；补阴药中的女贞子；补气药中的黄芪；辛凉解表药中的柴胡(在此应用了其疏肝解郁的功效)；及温化寒痰药中的制半夏。值得注意的是,在筛选常用有效中药的过程中发现,当单独使用中药治疗PCOS时,在使用时比不使用时治愈率显著提高的中药主要来自活血、补血、补阳、补阴和补气药。当使用中药结合克罗米芬治疗PCOS时,在使用时比不使用治愈率显著提高的中药主要来自补血、补阳、补阴和补气药。此结果表明中药结合克罗米芬治疗PCOS时,克罗米芬可能起到了相当于中药活血药的功效。
通过以上研究发现在使用中药治疗PCOS时补肾活血化瘀类药起着重要作用。中药结合克罗米芬显著提高了单用克罗米芬治疗PCOS的疗效。常用并与高治愈率相关的中药主要来自活血补血药、补阳药、补阴药和补气药。由于目前我们对不同中药间及中西药间可能存在的相互影响的复杂生理生化关系认识得尚十分有限,因此本研究的结论有待更多随机对照临床实验进一步检验。
Background:Due to the vast array of side effects associated with many western medicines typically prescribed to treat polycystic ovarian syndrome (PCOS), Chinese herbal medicine has been commonly used in China as a less invasive, yet economical approach to treat PCOS or to improve western medicine's treatment effect. To date the application status and clinical outcome of Chinese herbs in treating PCOS in China has not been systematically examined.
Objectives:(1) To study the effects of Chinese medical herbs on PCOS treatment by a systematic review and meta-analysis of the literature published between 1980 and 2008. (2) To exam the application status, treatment strategies and clinical outcomes of Chinese medical herbs in PCOS treatment by establishing and analyzing a relational database that collects information of PCOS treatment using Chinese herbs from clinical trials and case serial studies published between 1984 and 2009.
Methods:(1)Clinical trials using Chinese herbs to treat PCOS were retrieved from www. ilib.cn and MEDLINE (1980-2008) using key words of "PCOS", "Chinese herbs", "systemic review of literature", "meta-analysis", "data mining", "integral Chinese and western medicine". All case serial studies and randomized trials using Chinese herbs alone, comparing herbs combined with clomiphene citrate and clomiphene citrate alone were studied. (2)Publications were searched and retrieved from www.cnki.net,www.ilib.cn and PUBMED (1984-2009) using key words of "PCOS", "Chinese herbs", "integral Chinese and western medicine", "data-mining", and "literature data analysis". Reference lists of each primary study were hand-searched. Clinical trials and case serial studies using pregnancy rate or confirmed ovulation as primary outcome measures and with treatment durations of at least three months or three menstrual cycles were selected for the study. Microsoft SQL Server program and Microsoft Excel were used as data collection and database management tools. Functions and action sections of Chinese herbs were entered into the database according to Materia Medica, a comprehensive and recognized Chinese herbal medicine textbook in English. Herbal usage frequency, treatment strategies and associated treatment outcomes were analyzed. Most frequently used herbs that were also associated with higher cure rates were screened by data sorting and data-mining using Microsoft SQL Server program and Microsoft Excel. In both studies, the main outcome measures were pregnancy rates or obtaining regular ovulatory cycles of 4 weeks confirmed by biphasic body temperature or transvaginal sonography and midluteal phase progesterone concentration levels after 3-6 months of treatment.
Results:In research (1), Meta-analysis of the 38 trials (2883 patients) using . Mantel-Haenszel method (fixed effect model) showed the cure rate of Clomid Citrate (CC) with herbs was 60.39%(927/1535) and the cure rate of CC alone was 34.57% (466/1348). There was a significant increased probability of cured [OR=3.01 (95% CI=2.57/3.52), p=0.00] in favor of the herbal integrated treatment. The test of funnel plot asymmetry showed that the chance of publication bias existed (α=2.05, 95% CI=0.10/3.99, p=0.04. In research (2), a total of 125 relevant publications, 8150 patients were treated with Chinese herbs alone, with integral Chinese herbs and western medicine, or with western medicine alone as controls. According to traditional Chinese medicine (TCM) pattern differentiation theory, a total of 179 herbs from 30 action sections were used by different practitioners. By analyzing database and performing data mining using Microsoft Association Rules algorithm,12 of the 179 herbs were found to be the most frequently used herbs that were also associated with higher cure rates in treating PCOS. These 12 herbs include Chuan Xiong, Dan Shen, Tao Ren, Hong Hua from herbs that invigorate Blood; Xian Mao, Ba Ji Tian, Rou Cong Rong from herbs that tonify the Yang; Nu Zhen Zi from herbs that tonify the Ying; Dang Gui from herbs that tonify the blood; Huang qi from herbs that tonify the Qi; Chai Hu from Cool and acrid herbs that release the exterior (used to remove Liver qi stagnation); and Zhi Ban Xia from herbs that warm and transform phlegm
Conclusion:Research (1) found that clomiphene citrate treatment outcome of PCOS patients may be significantly improved by using Chinese herbs. Considering the risk of publication bias, double blind randomized trials are needed to further confirm the above conclusion. Research (2) found that the most frequently used herbs which were also associated with higher cure rates in treating PCOS were mostly from herbs that invigorate and tonify the Blood, herbs that tonify the Yang, the Yin and the Qi. These are preliminary findings that need futher supports by more randomized controlled clinical studies.
引文
[1]Yen SC, Jaffe RB, Barbieri RL. Polycystic ovary syndrome (Hyperandrogenic chronic anovulation). In:Reproductive Endocrinology:Physiology, Pathophysiology and Clinical Management.4th ed. London, England:Elsevier Science,1999,p436-478.
[2]Stein I, Leventhal M. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol.1935; 29:181.
[3]Stein IF. Duration of infertility following ovarian wedge resect ion. West J Surg.1964,72:237.
[4]Yen SSC. The polycystic ovary syndrome. Clin Endocrinol.1980,12:177-207.
[5]McKenna TJ. Pathogenesis and treatment of polycystic ovary syndrome. N Engl J Med 1988,318:558.
[6]Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound insulin resistance independent of obesity in polycystic ovary syndrome. Diabetes 1989,38:1165-1174.
[7]Cononer CA, Lee PD, Kanaley JA, Clarkson JT, Jensen MD. Insulin regulation of insulin-like growth factor binding protein-1 in obese and nonobese humans. J Clin Endocrinol Metab.1992,74 (6):1355-60.
[8]Ibanez L, Potau N, Zampolli M, Prat N, Virdis R, Vicens-Calvet E, Carrascosa A. Hyperinsulinemia in postpubertal girls with a history of premature pubarche and functional ovarian hyperandrogenism. J Clin Endocrinol Metab.1996,81 (3):1237-43.
[9]Ibanez L, Potau N, Zampolli M, Rique S, Saenger P, Carrascosa A. Hyperinsulinemia and decreased insulin-like growth factor-binding protein-1 are common features in prepubertal and pubertal girls with a history of premature pubarche. J Clin Endocrinol Metab. 1997,82 (7):2283-8.
[10]Ehrmann DA, Barnes RB, Rosenfield RL. Polycystic ovary syndrome as a form of functional ovarian hyperandrogenism due to dysregulation of androgen secretion. Endocr Rev.1995,16 (3):322-53.
[11]Haning RV Jr, Hackett RJ, Flood CA, Loughlin JS, Zhao QY, Longcope C. Testosterone, a follicular regulator:key to anovulation. J Clin Endocrinol Metab.1993,77 (3):710-5.
[12]Haning RV Jr, Hua JJ, Hackett RJ, Wheeler CA, Frishman GN, Seifer DB, Dahl CA, Burger HG. Dehydroepiandrosterone sulfate and anovulation increase serum inhibin and affect follicular function during administration of gonadotropins. J Clin Endocrinol Metab.1994,78 (1):145-9.
[13]Speiser PW, Serrat J, New MI, Gertner JM. Insulin insensitivity in adrenal hyperplasia due to nonclassical steroid 21-hydroxylase deficiency. J Clin Endocrinol Metab.1992,75 (6):1421-4.
[14]Legro RS, Driscoll D. Strauss 3rd JF, Fox J, Dunaif A. Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome. Proc Natl Acad Sci USA 1998,95:14956-14960.
[15]Gonzalez A, Abril E, Roca A, Arag o n MJ, Figueroa M J, Velarde P, et al. Specific CAPN10 Gene Haplotypes Influence the Clinical Profile of Polycystic Ovary Patients. J.Clin End Met 2003,88:5529-5536.
[16]Diamanti-Kandarakis E, Piperi C. Genetics of polycystic ovary syndrome:searching for the way out of the labyrinth. Hum Reprod update,2005,11:631-643.
[17]Urbaoek M. The genetics of the polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab.2007,3 (2):103-11.
[18]Diao FY, Xu M, Hu Y, Li J, Xu Z, Lin M, Wang L, Zhou Y, Zhou Z, Liu J, Sha J. The molecular characteristics of polycystic ovary syndrome (PCOS) ovary defined by human ovary cDNA microarray.J Mol Endocrinol.2004,33 (1):59-72.
[19]Meyer MF, Gerresheim F, Pfeiffer A, Epplen JT, Schatz H. Association of polycystic ovary syndrome with an interstitial deletion of the long arm of chromosome 11. Exp Clin Endocrinol Diabetes.2000,108 (8):519-23.
[20]Franks S. Polycystic ovary syndrome. N Engl J Med. 1995,333(13):853-61.
[21]Fox R, Corrigan E, Thomas PA, Hull MG. The diagnosis of polycystic ovaries in women with oligo-amenorrhoea:predictive power of endocrine tests. Clin Endocrinol (Oxf).1991,34(2):127-31.
[22]YEN, S. S. C. REVIEW ARTICLE:THE POLYCYSTIC OVARY SYNDROME. Clinical Endocrinology.1980,12:177-208.
[23]Marx TL, Mehta AE. Polycystic ovary syndrome:pathogenesis and treatment over the short and long term. Cleve Clin J Med, 2003,70(1):31-3,36-41,45.
[24]5. Taylor AE, McCourt B, Martin KA, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab.1997,82:2248 2256.
[25]Venturoli S, Porcu E, Fabri R, et al. Longitudinal evaluations of different gonadotropin pulsatile patterns in anovulatory cycles of young girls. J Clin Endocrinol Metab,1992,74:836-841.
[26]Zumoff B, Freeman R, Coupey S, et al. Chronobiologic abnormality in luteinizing hormone secretion in teenage girls with the polycystic ovary syndrome. N Engl J Med,1983,309:1206-1209.
[27]Robin G, Catteau-Jonard S, Young J, et al. Physiopathological link between polycystic ovary syndrome and hyperprolactinemia:Myth or reality? Gynecol Obstet Fertil,2011,39 (3):141-145.
[28]Azziz R. Hirsutism. In:Droegemueller W, Sicarra JJ, eds. Gynecology and obstetrics. Vol 5. Philadelphia:Lippincott,1994:1-22.
[29]Chang RJ, Katz SE. Diagnosis of polycystic ovary syndrome. Endocrinol Metab Clin North Am,1999,28(2):397-408.
[30]Faloia E, Filipponi S, Mancini V, et al. Effect of finasteride in idiopathic hirsutism. J Endocrinol Invest.,1998,21:694-698.
[31]Woodard TS, Burghen GZ, Kitabehi AE, Wilimas JA. Glucose intolerance and insulin resistance in aplastic anemia treated with oxymethalone. J Clin Endocrinol Metab.,1981,53:905-908.
[32]Givens JR, Kerber IJ, Wiser WL, et al. Remission of acanthosis nigricans associated with polycystic ovarian disease and a stromal luteoma. J Clin Endocrinol Metab.,1974,38:347-355.
[33]Nagamani M, Van Dinh T, Kelver ME. Hyperinsulinemia in hyperthecosis of the ovaries. Am J Obstet Gynecol.,1986,154:384-389.
[34]Geffner ME, Kaplan SA, Bersch N, et al. Persistence of insulin resistance in polycystic ovarian disease after inhibition of ovarian steroid secretion. Fertil Steril.,1986,45:327-333.
[35]Elkind-Hirsch KE, Valdis CT, McConnel TG, et al. Androgen responses to acutely increased endogenous insulin levels in hyperandrogenic and normally cycling women. Fertil Steril.,1991,55:486-491.
[36]Billiar RB, Richardson D, Schwartz R, et al. Effect of chronically elevated androgen or estrogen on the glucose tolerance test and insulin response in female rhesus monkeys. Am J Obstet Gynecol,1987,157:1297-1302.
[37]Nagamani M, Van Dinh T, Kelver ME. Hyper insulinemia in hyperthecosis of the ovaries. Am J Obstet Gynecol 1986,154:384-389.
[38]Nestler JE, Barlascini CO, Matt DW, et al. Suppression of serum insulin by diazoxide reduces serum testosterone levels in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab.,1989,68:1027-1032.
[39]Pasquali R, Attenucci D, Casimirri F, et al. Clinical and hor-monal characteristics of obese and amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab.,1989,68:173-179.
[40]Velazquez EM, Mendoza S, Hamer T, et al. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, andsystolic blood pressure while facilitating normalmenses and pregnancy. Metabolism,1994,43:647-654.
[41]Dunaif A, Scott D, Finegood D, et al. The insulin sensitizing agent, troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. J Clin Endocrinol Metab.,1996,81:3299-3306.
[42]Barbieri RL, Makris A, Randall RW, Daniels G, Kistner RW,Ryan KJ. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 1986; 62:904-910.
[43]Burghen CA,Givens JR,Kitabchi AE.Correlation of hyperandrogenism with hyperinsulinemia in polycystic ovarian disease. J Clin Endocrinol Metab.,1980, 50:113-116.
[44]Zawadsky JK, Dunaif A. Polycystic ovary syndrome. In:Dunaif A, Givens JR, Haseltine FP, Merriam GR, editors. Polycystic Ovary Syndrome. Cambridge, MA: BlackwellScientific,1992:377.
[45]Polson DW, Adams J, Wadsworth J, et al. Polycystic ovaries—a common finding in normal women. Lancet,1988,1:870-872.
[46]Setji TL, Brown AJ. Polycystic ovary syndrome and type 2 diabetes. In:Feinglos MN, Bethel MA, eds. Type 2 Diabetes Mellitus:An Evidence-Based Approach to Practical Management. Totowa, New Jersey:Humana Press,2006, in press.
[47]Balen AH, Laven JS, Tan SL, et al. Ultrasound assessment of the polycystic ovary:International consensus definitions. Hum Reprod Update,2003,9:505-514.
[48]Gambarin-Gelwan M, Kinkhabwala SV, Schiano TD, et al. Prevalence of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Clin Gastroent Hepat.,2007,5:496-501.
[49]Ehrmann DA, Barnes RB, Rosenfield RL, et al. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabet Care, 1999,22:141-146.
[50]Janus ED, Watt NM, Lam KS, et al. The prevalence of diabetes, association with cardiovascular risk factors and implications of diagnostic criteria(ADA 1997 and WHO 1998) in a 1996 communitybased population study in Hong Kong Chinese. Diabet Med.,2000,17:741-745.
[51]Wallace TM, Matthews DR. The assessment ofinsulin resistance in man. Diabet Med.,2002,19:527-534.
[52]Kiddy DS, Hamilton-Fair ley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf),1992,36:105-111.
[53]Burkman RT Jr. The role of oral contraceptives in the treatment of hyperandrogenic disorders. Am J Med.,1995,98(suppl 1A):130S-136S.
[54]Nader S, Diamanti-Kandarakis E. Polycystic ovary syndrome, oral contraceptives and metabolic issues:New perspectives and a unifying hypothesis. Hum Reprod.,2007,22:317-322.
[55]Gokman 0, Senoz S, Gulekli B, et al. Comparison of four different regimens in hirsutism related to polycystic ovary syndrome. Gynecol Endocrinol,1996,10:249-255.
[56]Rittmaster RS. 5-alpha reductase inhibitors.J Androl.,1997,18:582-587.
[57]Wong IL, Morris RS, Chang L, et al. A prospective randomized trial comparing finasteride to spironolactone in the treatment of hirsute women. J Clin Endocrinol Metab.,1995,80:233-238.
[58]Moll E, van der Veen F, van Wely M. The role of metformin in polycystic ovary syndrome:A systematic review. Hum Reprod Update,2007,13(6):527-537.
[59]Legro RS, Barnhart HX, Schlaff WD et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med.,2007,356:551-566.
[60]Unlu C, Atabekoglu CS. Surgical treatment in polycystic ovary syndrome. Curr Opin Obstet Gynecol,2006,18:286-292.
[61]Farquhar C, Lilford RJ, Marjoribanks J, et al. Laparoscopic 'drilling' by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev.,2007, (3):CD001122.
[62]Lord JM, Flight IH, NormanRJ. Insulinsensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. Cochrane Database Syst Rev.,2003, (3):CD003053.
[63]Costello M, Shrestha B, Eden J, et al. Insulin-sensitising drugs versus the combined oral contraceptive pill for hirsutism, acne and risk of diabetes, cardiovascular disease, and endometrial cancer in polycystic ovary syndrome. Cochrane Database Syst Rev.,2007, (1):CD005552.
[1]王东梅,赵坷.多囊卵巢综合征中医证候分布规律研究.山东中医杂志,2006,25(6)：378-380.
[2]王兴娟,戴婷,贾丽娜.肾虚型多囊卵巢综合征与血清T、LH的相关性研究.上海中医药杂志,2006,40(8)：40-41.
[3]许小凤.多囊卵巢综合征基础性激索水平与中医辨证的相关性.江苏中医药,2004,(11)：14～15.
[4]肖承宗.对多囊卵巢综合征所致不孕的认识与治疗.江苏中医药,2006,27(3)： 8～9.
[5]尤昭玲补肾化瘀法治疗多囊卵巢综合征心得.江苏中医药,2006,27(3)：11.
[6]林至君.中药人工周期疗法治疗多囊卵巢综合征的临床探讨.中医杂志,1984,1(6)：28.
[7]夏阳.苍附导痰汤加减治疗肥胖型多囊卵巢综合征30例.天津中医药,2004,21(2)：169.
[8]俞瑾,孙月丽,邵公全,等.补肾化痰治疗多囊卵巢综合征对下丘脑-垂体-卵巢功能的调节.中西医结合杂志,1986,6(4)：218～221.
[9]陈玲,王丽英,王君.健脾益肾化痰汤治疗多囊卵巢综合征30例.江苏中医,1999,20(7)：31.
[10]陆眉亚.汤昆华辨治多囊卵巢综合征经验撷要.福建中医药,2003,34(6)：18～19.
[11]陶莉莉,桑霞,张玉珍,等.加减龙胆泻肝汤对肝经郁火型多囊卵巢综合征患者胰岛素抵抗的影响.河北中医,2007,29(20)：107-111.
[12]柴丽宏.疏肝清解汤治疗肝经郁热型青春期多囊卵巢综合征临床观察.北京中医,2006,25(6)：323～326.
[13]刘丽清,蔡平平.戴德英治疗多囊卵巢综合征经验.中医杂志,2002,43(4)：261.
[14]戴春秀,王海波.多囊卵巢综合征的中医辨治思路.浙江中医药大学学报,2009,33(1)：94—95.
[15]高雅.辨证论治多囊卵巢综合征60例.辽宁中医杂志,2006,33(7)：825.
[16]张君满.中西医结合治疗多囊卵巢综合征16例疗效分析.四川中医,2008,26(1)：87—88.
[17]赵洪.黄芪丹参为主治疗高雄激素血症的效果观察.现代中西医结合杂志,2005,14(4)：466.
[18]陈利生,陈守信,倪雅莲,等.自拟“导痰助孕丸”治疗多囊卵巢综合征58例分析.铁道医学,1997,25(6)：374-375.
[19]胡章如.温肾涤痰汤治疗多囊卵巢综合征64例疗效观察.浙江中医学院学报,1999,23(1)：40.
[20]宁美华,刘艳娟,宁喜光.益肾消瘕方治疗多囊卵巢综合征85例小结.湖南中医药导报,2004,10(3)：27-28.
[21]卢丽为.补肾疏肝活血汤治疗多囊卵巢综合征15例.现代中西医结杂志,2006,15(2)：218.
[22]王旭芳.自拟补肾疏肝汤治疗多囊卵巢综合征36例临床观察.中国社区医师,2008,24(1)：81—82.
[23]郝兰枝.中药人工周期疗法治疗多囊卵巢综合征中高雄激素血症的临床观察.山东中医杂志,2004,23(8)：467—468.
[24]王燕萍,顺慧芳.补肾化痰活血法治疗青春期多囊卵巢综合征33例临床观察.Chinese Journal of Information on TCM,2008,15(2):66-67.
[25]袁雄芳.中医周期疗法治疗多囊卵巢综合征38例.中医杂志,2003,34(2)：22.
[26]从兰香.调经促孕丸联合氯米芬治疗耐氯米芬多囊卵巢综合征不孕症观察.实用中医药杂志,2006,22(5)：2 90-291.
[27]袁丽萍,林芸,黄红英.中西医结合治疗多囊卵巢综合征不孕症63例分析.中国优生与遗传杂志,2006,14(5)：1 17-118.
[28]Y.Han, J. Niu, J. Wang, et al. Clomiphene citrate treatment outcome of PCOS patients may be improvedsignificantly by using Chinese herbs:a meta-analysis. Fertility and Sterility.2008,90:S131.
[29]应晓萍,朱曙明.中西医结合治疗多囊卵巢综合征30例.四川中医,2006,24(1)：85-86.
[1]邓铁涛.辨证论治是中医临床医学的灵魂.中医药学刊,2002,20(4)：394-395.
[2]Streptomycin treatment of pulmonary tuberculosis:A medical research council investigation. BMJ,1948,2:770-782.
[3]刘建平.中医药研究随机对照试验质量的现状及对策.中国中西医结合杂志,2003,23(1)：62-64.
[4]刘建平.循证医学方法与中医疗效评价.首都医科大学学报,2007,28(2)：212-215.
[5]李晓强.统计在生命科学中的实践和认识(Ⅳ).Meta分析—一种量化的信息综合方法(上).数理统计与管理,1997,16(4)：59.
[6]Flower A, Liu JP, Chen S, et al. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews,2009,8(3):CD006568.
[7]Grant SJ, Bensoussan A, Chang D. et al. Chinese herbal medicines for people with impaired slneose tolerance or impaired fasting blood glucose. Cochrane Database of Systematic Reviews,2009,7(4):CD006690.
[8]Liu JP, Yang H, Xia Y, et al. Herbal preparations for uterine fibroids. Cochrane Database of Systematic Reviews,2009,19(2):CD005292.
[9]刘建平,曹卉娟.从循证医学看国内发表的中医药临床研究现状及改进策略.中国中西医结合杂志,2010,30(1)：5-8.
[10]Y.Han, J. Niu, J. Wang, et al. Clomiphene citrate treatment outcome of PCOS' patients may be improvedsignificantly by using Chinese herbs:a meta-analysis. Fertility and Sterility,2008,90:S131.
[11]中国人民大学统计学系数据挖掘中心.统计学与数据挖掘.统计与信息论坛,2002,17(51)：4-9.
[12]姜良铎.温病诊断指标及证治方药规律的研究一古今温病医案10009例次统计分析. 中医杂志,1987,30(11)：30.
[13]王东梅.多囊卵巢综合征中医证候分布规律研究.山东中医杂志2006,25(6)：378-380.
[14]李霞,彭爱新,宋玮炜. 多囊卵巢综合征的现代中医文献研究.山东中医药大学学报,2008,32(01)：16-18.
[15]刘稼.聚类分析在中医药研究中的应用及意义.中医药学刊,2004,22(5)：927-928.
[16]蒋永光,李力,李认书,等.中医脾胃方配伍规律的数据挖掘试验.世界科学技术-中药现代化,2003,5(3)：33-37.
[17]范明译.数据挖掘导论..人民邮电出版社,2006.
[18]瞿海斌,毛利锋,王阶.基于决策树的血瘀证诊断规则自动归纳方法.中国生物医学工程学报,2005,24(6)：709-711.
[19]叶进,邢传鼎.基于人工人工神经网络的病症诊断原型系统.华东大学学报,2003,2(4)：43—47.
[20]吴芸,周昌乐.中医八纲辨证神经网络构造技术研究.计算机工程与应用,2008,44(18)：243—248.
[21]Pang-Ning Tan,Michael Stenbach,Vipin Kumar.数据挖掘导论.人民邮电出版社, 2006.
[22]郭超峰,施学丽,黄克南,等.关联规则数据挖掘技术在中医药研究中的应用概况. 广西中医学院学报,2009,12(4)：59-61.
[23]邹石,周莺,吴丽丽.古代心悸医案信息284例数理分析.江西中医学院学报,2007,19(5)：91.
[24]陈擎文.数据挖掘技术在古代名中医中风医案之应用研究.中华中医药学刊,2008,26(10)：2254-57.
[25]刘娟,蒋永光,胡波,等.白术类方的药证关联分析.成都中医药大学学报,2004,27(4)：55—56.
[26]纪荣芳,牛建昭,许树强,等.从数据挖掘角度看中医药治疗健忘与痴呆.中日友好医院学报,2006,20(6)：337—340.
[27]宿树兰,尚尔鑫,叶亮,等.治疗痛经方药的关联规则分析.南京中医药大学学报,2008,24(6)：383—385.
[28]李茵,于高路,莫绍强,等.治疗骨质疏松症遣药组方关联规则探讨.中国药房,2009,20(6)：477—479.
[29]黄小波,李宗信,陈文强,等.慢性疲劳综合征气虚与血虚病机关系的定量分析.中国中医药科技,2007,14(1)：3—5.
[30]沈亚诚,陈燕升,王小云.绝经综合征中医证候规律的数据挖掘研究.南方医科大学学报,2008,28(8)：1369—1371.
[31]陈明,杨慧芳,余蕾. 基于关联规则的肝硬变辨证数据挖掘研究. 河南中医,2009,29(3)：258-260.
[32]朱立成,林色奇,薛汉荣,等. 名中医哮喘医案445例关联规则分析.江西中医学院学报,2007,19(5)：83.
[33]李文林,赵国平,陆建峰,等.关联规则在名医临证经验分析挖掘中的应用.南京中医药大学学报,2008,24(1)：21-24.
[1]Legro RS,Barnhart HX,Schlaff WD.Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome. N Engl J Med.,2007,356 (6):551-566.
[2]林至君.中药人工周期疗法治疗多囊卵巢综合征的临床探讨.中医杂志,1984,(6)：28.
[3]孙月丽,郭焕如,俞瑾,等.补肾化痰法治疗多囊卵巢综合征133例.上海中医药杂志,1981,6：14-17.
[4]黎小斌,李丽云.导痰种子汤联合克罗米芬治疗多囊卵巢综合征.实用医学杂志,2000,16(4)：330-331.
[5]Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias:Dimensions of methodological quality associated with estimates of treatment effects. Journal of the American Medical Association,1995,273:408-412.
[6]Jadad AR, Moor RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:Is blinding necessary. Controlled Trials,1996,17:1-12.
[7]Gioacchino Leandro. Meta-analysis in Medical Research:The handbook for the understanding and practice of meta-analysis. BMJ Books,2005.
[1]Bensky D,Clavey S, Stoger E. Chinese Herbal Medicine Materia Medica,3rd edition, Eastland Press, Inc.2004.
[2]Lobo R,Carmina E.The importance of diagnosing the polycystic ovarian syndrome. Ann Intern Med.2000,132:989-993.
[3]Camina E, Lobo RA. Polycistic ovarian syndrome (PCOS):arguably the most common endocrinopathy is associated with significant morbidity in women.Clin Endocrinol Metab.1999,84:1897-1899.
[4]Sozen I,Arici, A.Hyperinsulinism and its interaction with hyperandrogenism in polycystic ovarian syndrome. Obstetrical & Gynecological Survey.2000; 55:321-328.
[5]李霞,彭爱新,宋玮炜.多囊卵巢综合征的现代中医文献研究.山东中医药大学学报,2008,32(1)：16-18.
[6]Han Y,Niu J,Wang J,et al. Clomiphene citrate treatment outcome of PCOS patients may be improved significantly by using Chinese herbs:a meta-analysis. Fertility and Sterility,2008,90(null):S131-S131.
[7]黎小武,李丽芸.导痰种子方联合克罗米芬治疗多囊卵巢综合征.实用医学杂志,2000,16(4)：412.
[8]申霞,补肾活血方治疗多囊卵巢综合征105例.<世界中西医结合杂志>,2006,1(2)：123-124.
[2]Stein I, Leventhal M. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol.1935; 29:181.
[3]Stein IF. Duration of infertility following ovarian wedge resect ion. West J Surg.1964,72:237.
[4]Yen SSC. The polycystic ovary syndrome. Clin Endocrinol.1980,12:177-207.
[5]McKenna TJ. Pathogenesis and treatment of polycystic ovary syndrome. N Engl J Med 1988,318:558.
[6]Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound insulin resistance independent of obesity in polycystic ovary syndrome. Diabetes 1989,38:1165-1174.
[7]Cononer CA, Lee PD, Kanaley JA, Clarkson JT, Jensen MD. Insulin regulation of insulin-like growth factor binding protein-1 in obese and nonobese humans. J Clin Endocrinol Metab.1992,74 (6):1355-60.
[8]Ibanez L, Potau N, Zampolli M, Prat N, Virdis R, Vicens-Calvet E, Carrascosa A. Hyperinsulinemia in postpubertal girls with a history of premature pubarche and functional ovarian hyperandrogenism. J Clin Endocrinol Metab.1996,81 (3):1237-43.
[9]Ibanez L, Potau N, Zampolli M, Rique S, Saenger P, Carrascosa A. Hyperinsulinemia and decreased insulin-like growth factor-binding protein-1 are common features in prepubertal and pubertal girls with a history of premature pubarche. J Clin Endocrinol Metab. 1997,82 (7):2283-8.
[10]Ehrmann DA, Barnes RB, Rosenfield RL. Polycystic ovary syndrome as a form of functional ovarian hyperandrogenism due to dysregulation of androgen secretion. Endocr Rev.1995,16 (3):322-53.
[11]Haning RV Jr, Hackett RJ, Flood CA, Loughlin JS, Zhao QY, Longcope C. Testosterone, a follicular regulator:key to anovulation. J Clin Endocrinol Metab.1993,77 (3):710-5.
[12]Haning RV Jr, Hua JJ, Hackett RJ, Wheeler CA, Frishman GN, Seifer DB, Dahl CA, Burger HG. Dehydroepiandrosterone sulfate and anovulation increase serum inhibin and affect follicular function during administration of gonadotropins. J Clin Endocrinol Metab.1994,78 (1):145-9.
[13]Speiser PW, Serrat J, New MI, Gertner JM. Insulin insensitivity in adrenal hyperplasia due to nonclassical steroid 21-hydroxylase deficiency. J Clin Endocrinol Metab.1992,75 (6):1421-4.
[14]Legro RS, Driscoll D. Strauss 3rd JF, Fox J, Dunaif A. Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome. Proc Natl Acad Sci USA 1998,95:14956-14960.
[15]Gonzalez A, Abril E, Roca A, Arag o n MJ, Figueroa M J, Velarde P, et al. Specific CAPN10 Gene Haplotypes Influence the Clinical Profile of Polycystic Ovary Patients. J.Clin End Met 2003,88:5529-5536.
[16]Diamanti-Kandarakis E, Piperi C. Genetics of polycystic ovary syndrome:searching for the way out of the labyrinth. Hum Reprod update,2005,11:631-643.
[17]Urbaoek M. The genetics of the polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab.2007,3 (2):103-11.
[18]Diao FY, Xu M, Hu Y, Li J, Xu Z, Lin M, Wang L, Zhou Y, Zhou Z, Liu J, Sha J. The molecular characteristics of polycystic ovary syndrome (PCOS) ovary defined by human ovary cDNA microarray.J Mol Endocrinol.2004,33 (1):59-72.
[19]Meyer MF, Gerresheim F, Pfeiffer A, Epplen JT, Schatz H. Association of polycystic ovary syndrome with an interstitial deletion of the long arm of chromosome 11. Exp Clin Endocrinol Diabetes.2000,108 (8):519-23.
[20]Franks S. Polycystic ovary syndrome. N Engl J Med. 1995,333(13):853-61.
[21]Fox R, Corrigan E, Thomas PA, Hull MG. The diagnosis of polycystic ovaries in women with oligo-amenorrhoea:predictive power of endocrine tests. Clin Endocrinol (Oxf).1991,34(2):127-31.
[22]YEN, S. S. C. REVIEW ARTICLE:THE POLYCYSTIC OVARY SYNDROME. Clinical Endocrinology.1980,12:177-208.
[23]Marx TL, Mehta AE. Polycystic ovary syndrome:pathogenesis and treatment over the short and long term. Cleve Clin J Med, 2003,70(1):31-3,36-41,45.
[24]5. Taylor AE, McCourt B, Martin KA, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab.1997,82:2248 2256.
[25]Venturoli S, Porcu E, Fabri R, et al. Longitudinal evaluations of different gonadotropin pulsatile patterns in anovulatory cycles of young girls. J Clin Endocrinol Metab,1992,74:836-841.
[26]Zumoff B, Freeman R, Coupey S, et al. Chronobiologic abnormality in luteinizing hormone secretion in teenage girls with the polycystic ovary syndrome. N Engl J Med,1983,309:1206-1209.
[27]Robin G, Catteau-Jonard S, Young J, et al. Physiopathological link between polycystic ovary syndrome and hyperprolactinemia:Myth or reality? Gynecol Obstet Fertil,2011,39 (3):141-145.
[28]Azziz R. Hirsutism. In:Droegemueller W, Sicarra JJ, eds. Gynecology and obstetrics. Vol 5. Philadelphia:Lippincott,1994:1-22.
[29]Chang RJ, Katz SE. Diagnosis of polycystic ovary syndrome. Endocrinol Metab Clin North Am,1999,28(2):397-408.
[30]Faloia E, Filipponi S, Mancini V, et al. Effect of finasteride in idiopathic hirsutism. J Endocrinol Invest.,1998,21:694-698.
[31]Woodard TS, Burghen GZ, Kitabehi AE, Wilimas JA. Glucose intolerance and insulin resistance in aplastic anemia treated with oxymethalone. J Clin Endocrinol Metab.,1981,53:905-908.
[32]Givens JR, Kerber IJ, Wiser WL, et al. Remission of acanthosis nigricans associated with polycystic ovarian disease and a stromal luteoma. J Clin Endocrinol Metab.,1974,38:347-355.
[33]Nagamani M, Van Dinh T, Kelver ME. Hyperinsulinemia in hyperthecosis of the ovaries. Am J Obstet Gynecol.,1986,154:384-389.
[34]Geffner ME, Kaplan SA, Bersch N, et al. Persistence of insulin resistance in polycystic ovarian disease after inhibition of ovarian steroid secretion. Fertil Steril.,1986,45:327-333.
[35]Elkind-Hirsch KE, Valdis CT, McConnel TG, et al. Androgen responses to acutely increased endogenous insulin levels in hyperandrogenic and normally cycling women. Fertil Steril.,1991,55:486-491.
[36]Billiar RB, Richardson D, Schwartz R, et al. Effect of chronically elevated androgen or estrogen on the glucose tolerance test and insulin response in female rhesus monkeys. Am J Obstet Gynecol,1987,157:1297-1302.
[37]Nagamani M, Van Dinh T, Kelver ME. Hyper insulinemia in hyperthecosis of the ovaries. Am J Obstet Gynecol 1986,154:384-389.
[38]Nestler JE, Barlascini CO, Matt DW, et al. Suppression of serum insulin by diazoxide reduces serum testosterone levels in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab.,1989,68:1027-1032.
[39]Pasquali R, Attenucci D, Casimirri F, et al. Clinical and hor-monal characteristics of obese and amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab.,1989,68:173-179.
[40]Velazquez EM, Mendoza S, Hamer T, et al. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, andsystolic blood pressure while facilitating normalmenses and pregnancy. Metabolism,1994,43:647-654.
[41]Dunaif A, Scott D, Finegood D, et al. The insulin sensitizing agent, troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. J Clin Endocrinol Metab.,1996,81:3299-3306.
[42]Barbieri RL, Makris A, Randall RW, Daniels G, Kistner RW,Ryan KJ. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 1986; 62:904-910.
[43]Burghen CA,Givens JR,Kitabchi AE.Correlation of hyperandrogenism with hyperinsulinemia in polycystic ovarian disease. J Clin Endocrinol Metab.,1980, 50:113-116.
[44]Zawadsky JK, Dunaif A. Polycystic ovary syndrome. In:Dunaif A, Givens JR, Haseltine FP, Merriam GR, editors. Polycystic Ovary Syndrome. Cambridge, MA: BlackwellScientific,1992:377.
[45]Polson DW, Adams J, Wadsworth J, et al. Polycystic ovaries—a common finding in normal women. Lancet,1988,1:870-872.
[46]Setji TL, Brown AJ. Polycystic ovary syndrome and type 2 diabetes. In:Feinglos MN, Bethel MA, eds. Type 2 Diabetes Mellitus:An Evidence-Based Approach to Practical Management. Totowa, New Jersey:Humana Press,2006, in press.
[47]Balen AH, Laven JS, Tan SL, et al. Ultrasound assessment of the polycystic ovary:International consensus definitions. Hum Reprod Update,2003,9:505-514.
[48]Gambarin-Gelwan M, Kinkhabwala SV, Schiano TD, et al. Prevalence of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Clin Gastroent Hepat.,2007,5:496-501.
[49]Ehrmann DA, Barnes RB, Rosenfield RL, et al. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabet Care, 1999,22:141-146.
[50]Janus ED, Watt NM, Lam KS, et al. The prevalence of diabetes, association with cardiovascular risk factors and implications of diagnostic criteria(ADA 1997 and WHO 1998) in a 1996 communitybased population study in Hong Kong Chinese. Diabet Med.,2000,17:741-745.
[51]Wallace TM, Matthews DR. The assessment ofinsulin resistance in man. Diabet Med.,2002,19:527-534.
[52]Kiddy DS, Hamilton-Fair ley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf),1992,36:105-111.
[53]Burkman RT Jr. The role of oral contraceptives in the treatment of hyperandrogenic disorders. Am J Med.,1995,98(suppl 1A):130S-136S.
[54]Nader S, Diamanti-Kandarakis E. Polycystic ovary syndrome, oral contraceptives and metabolic issues:New perspectives and a unifying hypothesis. Hum Reprod.,2007,22:317-322.
[55]Gokman 0, Senoz S, Gulekli B, et al. Comparison of four different regimens in hirsutism related to polycystic ovary syndrome. Gynecol Endocrinol,1996,10:249-255.
[56]Rittmaster RS. 5-alpha reductase inhibitors.J Androl.,1997,18:582-587.
[57]Wong IL, Morris RS, Chang L, et al. A prospective randomized trial comparing finasteride to spironolactone in the treatment of hirsute women. J Clin Endocrinol Metab.,1995,80:233-238.
[58]Moll E, van der Veen F, van Wely M. The role of metformin in polycystic ovary syndrome:A systematic review. Hum Reprod Update,2007,13(6):527-537.
[59]Legro RS, Barnhart HX, Schlaff WD et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med.,2007,356:551-566.
[60]Unlu C, Atabekoglu CS. Surgical treatment in polycystic ovary syndrome. Curr Opin Obstet Gynecol,2006,18:286-292.
[61]Farquhar C, Lilford RJ, Marjoribanks J, et al. Laparoscopic 'drilling' by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev.,2007, (3):CD001122.
[62]Lord JM, Flight IH, NormanRJ. Insulinsensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. Cochrane Database Syst Rev.,2003, (3):CD003053.
[63]Costello M, Shrestha B, Eden J, et al. Insulin-sensitising drugs versus the combined oral contraceptive pill for hirsutism, acne and risk of diabetes, cardiovascular disease, and endometrial cancer in polycystic ovary syndrome. Cochrane Database Syst Rev.,2007, (1):CD005552.
[1]王东梅,赵坷.多囊卵巢综合征中医证候分布规律研究.山东中医杂志,2006,25(6)：378-380.
[2]王兴娟,戴婷,贾丽娜.肾虚型多囊卵巢综合征与血清T、LH的相关性研究.上海中医药杂志,2006,40(8)：40-41.
[3]许小凤.多囊卵巢综合征基础性激索水平与中医辨证的相关性.江苏中医药,2004,(11)：14～15.
[4]肖承宗.对多囊卵巢综合征所致不孕的认识与治疗.江苏中医药,2006,27(3)： 8～9.
[5]尤昭玲补肾化瘀法治疗多囊卵巢综合征心得.江苏中医药,2006,27(3)：11.
[6]林至君.中药人工周期疗法治疗多囊卵巢综合征的临床探讨.中医杂志,1984,1(6)：28.
[7]夏阳.苍附导痰汤加减治疗肥胖型多囊卵巢综合征30例.天津中医药,2004,21(2)：169.
[8]俞瑾,孙月丽,邵公全,等.补肾化痰治疗多囊卵巢综合征对下丘脑-垂体-卵巢功能的调节.中西医结合杂志,1986,6(4)：218～221.
[9]陈玲,王丽英,王君.健脾益肾化痰汤治疗多囊卵巢综合征30例.江苏中医,1999,20(7)：31.
[10]陆眉亚.汤昆华辨治多囊卵巢综合征经验撷要.福建中医药,2003,34(6)：18～19.
[11]陶莉莉,桑霞,张玉珍,等.加减龙胆泻肝汤对肝经郁火型多囊卵巢综合征患者胰岛素抵抗的影响.河北中医,2007,29(20)：107-111.
[12]柴丽宏.疏肝清解汤治疗肝经郁热型青春期多囊卵巢综合征临床观察.北京中医,2006,25(6)：323～326.
[13]刘丽清,蔡平平.戴德英治疗多囊卵巢综合征经验.中医杂志,2002,43(4)：261.
[14]戴春秀,王海波.多囊卵巢综合征的中医辨治思路.浙江中医药大学学报,2009,33(1)：94—95.
[15]高雅.辨证论治多囊卵巢综合征60例.辽宁中医杂志,2006,33(7)：825.
[16]张君满.中西医结合治疗多囊卵巢综合征16例疗效分析.四川中医,2008,26(1)：87—88.
[17]赵洪.黄芪丹参为主治疗高雄激素血症的效果观察.现代中西医结合杂志,2005,14(4)：466.
[18]陈利生,陈守信,倪雅莲,等.自拟“导痰助孕丸”治疗多囊卵巢综合征58例分析.铁道医学,1997,25(6)：374-375.
[19]胡章如.温肾涤痰汤治疗多囊卵巢综合征64例疗效观察.浙江中医学院学报,1999,23(1)：40.
[20]宁美华,刘艳娟,宁喜光.益肾消瘕方治疗多囊卵巢综合征85例小结.湖南中医药导报,2004,10(3)：27-28.
[21]卢丽为.补肾疏肝活血汤治疗多囊卵巢综合征15例.现代中西医结杂志,2006,15(2)：218.
[22]王旭芳.自拟补肾疏肝汤治疗多囊卵巢综合征36例临床观察.中国社区医师,2008,24(1)：81—82.
[23]郝兰枝.中药人工周期疗法治疗多囊卵巢综合征中高雄激素血症的临床观察.山东中医杂志,2004,23(8)：467—468.
[24]王燕萍,顺慧芳.补肾化痰活血法治疗青春期多囊卵巢综合征33例临床观察.Chinese Journal of Information on TCM,2008,15(2):66-67.
[25]袁雄芳.中医周期疗法治疗多囊卵巢综合征38例.中医杂志,2003,34(2)：22.
[26]从兰香.调经促孕丸联合氯米芬治疗耐氯米芬多囊卵巢综合征不孕症观察.实用中医药杂志,2006,22(5)：2 90-291.
[27]袁丽萍,林芸,黄红英.中西医结合治疗多囊卵巢综合征不孕症63例分析.中国优生与遗传杂志,2006,14(5)：1 17-118.
[28]Y.Han, J. Niu, J. Wang, et al. Clomiphene citrate treatment outcome of PCOS patients may be improvedsignificantly by using Chinese herbs:a meta-analysis. Fertility and Sterility.2008,90:S131.
[29]应晓萍,朱曙明.中西医结合治疗多囊卵巢综合征30例.四川中医,2006,24(1)：85-86.
[1]邓铁涛.辨证论治是中医临床医学的灵魂.中医药学刊,2002,20(4)：394-395.
[2]Streptomycin treatment of pulmonary tuberculosis:A medical research council investigation. BMJ,1948,2:770-782.
[3]刘建平.中医药研究随机对照试验质量的现状及对策.中国中西医结合杂志,2003,23(1)：62-64.
[4]刘建平.循证医学方法与中医疗效评价.首都医科大学学报,2007,28(2)：212-215.
[5]李晓强.统计在生命科学中的实践和认识(Ⅳ).Meta分析—一种量化的信息综合方法(上).数理统计与管理,1997,16(4)：59.
[6]Flower A, Liu JP, Chen S, et al. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews,2009,8(3):CD006568.
[7]Grant SJ, Bensoussan A, Chang D. et al. Chinese herbal medicines for people with impaired slneose tolerance or impaired fasting blood glucose. Cochrane Database of Systematic Reviews,2009,7(4):CD006690.
[8]Liu JP, Yang H, Xia Y, et al. Herbal preparations for uterine fibroids. Cochrane Database of Systematic Reviews,2009,19(2):CD005292.
[9]刘建平,曹卉娟.从循证医学看国内发表的中医药临床研究现状及改进策略.中国中西医结合杂志,2010,30(1)：5-8.
[10]Y.Han, J. Niu, J. Wang, et al. Clomiphene citrate treatment outcome of PCOS' patients may be improvedsignificantly by using Chinese herbs:a meta-analysis. Fertility and Sterility,2008,90:S131.
[11]中国人民大学统计学系数据挖掘中心.统计学与数据挖掘.统计与信息论坛,2002,17(51)：4-9.
[12]姜良铎.温病诊断指标及证治方药规律的研究一古今温病医案10009例次统计分析. 中医杂志,1987,30(11)：30.
[13]王东梅.多囊卵巢综合征中医证候分布规律研究.山东中医杂志2006,25(6)：378-380.
[14]李霞,彭爱新,宋玮炜. 多囊卵巢综合征的现代中医文献研究.山东中医药大学学报,2008,32(01)：16-18.
[15]刘稼.聚类分析在中医药研究中的应用及意义.中医药学刊,2004,22(5)：927-928.
[16]蒋永光,李力,李认书,等.中医脾胃方配伍规律的数据挖掘试验.世界科学技术-中药现代化,2003,5(3)：33-37.
[17]范明译.数据挖掘导论..人民邮电出版社,2006.
[18]瞿海斌,毛利锋,王阶.基于决策树的血瘀证诊断规则自动归纳方法.中国生物医学工程学报,2005,24(6)：709-711.
[19]叶进,邢传鼎.基于人工人工神经网络的病症诊断原型系统.华东大学学报,2003,2(4)：43—47.
[20]吴芸,周昌乐.中医八纲辨证神经网络构造技术研究.计算机工程与应用,2008,44(18)：243—248.
[21]Pang-Ning Tan,Michael Stenbach,Vipin Kumar.数据挖掘导论.人民邮电出版社, 2006.
[22]郭超峰,施学丽,黄克南,等.关联规则数据挖掘技术在中医药研究中的应用概况. 广西中医学院学报,2009,12(4)：59-61.
[23]邹石,周莺,吴丽丽.古代心悸医案信息284例数理分析.江西中医学院学报,2007,19(5)：91.
[24]陈擎文.数据挖掘技术在古代名中医中风医案之应用研究.中华中医药学刊,2008,26(10)：2254-57.
[25]刘娟,蒋永光,胡波,等.白术类方的药证关联分析.成都中医药大学学报,2004,27(4)：55—56.
[26]纪荣芳,牛建昭,许树强,等.从数据挖掘角度看中医药治疗健忘与痴呆.中日友好医院学报,2006,20(6)：337—340.
[27]宿树兰,尚尔鑫,叶亮,等.治疗痛经方药的关联规则分析.南京中医药大学学报,2008,24(6)：383—385.
[28]李茵,于高路,莫绍强,等.治疗骨质疏松症遣药组方关联规则探讨.中国药房,2009,20(6)：477—479.
[29]黄小波,李宗信,陈文强,等.慢性疲劳综合征气虚与血虚病机关系的定量分析.中国中医药科技,2007,14(1)：3—5.
[30]沈亚诚,陈燕升,王小云.绝经综合征中医证候规律的数据挖掘研究.南方医科大学学报,2008,28(8)：1369—1371.
[31]陈明,杨慧芳,余蕾. 基于关联规则的肝硬变辨证数据挖掘研究. 河南中医,2009,29(3)：258-260.
[32]朱立成,林色奇,薛汉荣,等. 名中医哮喘医案445例关联规则分析.江西中医学院学报,2007,19(5)：83.
[33]李文林,赵国平,陆建峰,等.关联规则在名医临证经验分析挖掘中的应用.南京中医药大学学报,2008,24(1)：21-24.
[1]Legro RS,Barnhart HX,Schlaff WD.Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome. N Engl J Med.,2007,356 (6):551-566.
[2]林至君.中药人工周期疗法治疗多囊卵巢综合征的临床探讨.中医杂志,1984,(6)：28.
[3]孙月丽,郭焕如,俞瑾,等.补肾化痰法治疗多囊卵巢综合征133例.上海中医药杂志,1981,6：14-17.
[4]黎小斌,李丽云.导痰种子汤联合克罗米芬治疗多囊卵巢综合征.实用医学杂志,2000,16(4)：330-331.
[5]Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias:Dimensions of methodological quality associated with estimates of treatment effects. Journal of the American Medical Association,1995,273:408-412.
[6]Jadad AR, Moor RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:Is blinding necessary. Controlled Trials,1996,17:1-12.
[7]Gioacchino Leandro. Meta-analysis in Medical Research:The handbook for the understanding and practice of meta-analysis. BMJ Books,2005.
[1]Bensky D,Clavey S, Stoger E. Chinese Herbal Medicine Materia Medica,3rd edition, Eastland Press, Inc.2004.
[2]Lobo R,Carmina E.The importance of diagnosing the polycystic ovarian syndrome. Ann Intern Med.2000,132:989-993.
[3]Camina E, Lobo RA. Polycistic ovarian syndrome (PCOS):arguably the most common endocrinopathy is associated with significant morbidity in women.Clin Endocrinol Metab.1999,84:1897-1899.
[4]Sozen I,Arici, A.Hyperinsulinism and its interaction with hyperandrogenism in polycystic ovarian syndrome. Obstetrical & Gynecological Survey.2000; 55:321-328.
[5]李霞,彭爱新,宋玮炜.多囊卵巢综合征的现代中医文献研究.山东中医药大学学报,2008,32(1)：16-18.
[6]Han Y,Niu J,Wang J,et al. Clomiphene citrate treatment outcome of PCOS patients may be improved significantly by using Chinese herbs:a meta-analysis. Fertility and Sterility,2008,90(null):S131-S131.
[7]黎小武,李丽芸.导痰种子方联合克罗米芬治疗多囊卵巢综合征.实用医学杂志,2000,16(4)：412.
[8]申霞,补肾活血方治疗多囊卵巢综合征105例.<世界中西医结合杂志>,2006,1(2)：123-124.