中医消法对多囊卵巢综合征伴非酒精性脂肪性肝病脂代谢的影响

Effects of Resolving Method of Chinese Medicine on the Lipid Metabolism in Polycystic Ovary Syndrome Accompanied with Non alcoholic Fatty Liver Disease

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DOI：10.7661/CJIM.2013.06.0751

中文关键词: 多囊卵巢综合征非酒精性脂肪性肝病瘦素瘦素抵抗胰岛素抵抗血脂紊乱中医消法

英文关键词:polycystic ovary syndrome non-alcoholic fatty liver disease leptin leptin resistance insulin resistance dyslipidemia resolving method of Chinese medicine

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作者	单位	E-mail
陈熤,金华良,靳岭
王兴娟	1.复旦大学附属华山医院中西医结合科（上海200040）；2.上海泰坤堂中医医院中西医结合妇科（上海200032）	snakewang9@yahoo.com.cn

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中文摘要:

目的观察中医消法治疗多囊卵巢综合征（polycystic ovary syndrome，PCOS）伴非酒精性脂肪性肝病（non-acoholic fatty liver disease，NAFLD）患者脂代谢的疗效，分析PCOS与NAFLD相关性，并探讨其作用机理。方法选取35例PCOS伴有NAFLD患者为脂肪肝组，同期选择35例PCOS不伴NAFLD患者为非脂肪肝组，健康女性志愿者20名为对照组。所有受试者进行问卷调查建立个人病例档案，测量身高、体重、腰围（waist circumference，WC）、臀围（hip circumference，HC）；检测血清睾酮（testosterone，T）、泌乳素（prolactin，PRL）、卵泡刺激素（follicle stimulating hormone，FSH）、黄体生成素（luteinizing hormone，LH）、雌二醇（estradiol，E2）、瘦素（leptin）、空腹血糖（fasting blood glucose，FBG）、空腹胰岛素（fasting insulin，FINS）、餐后2 h血糖（2 h postprandial blood glucose，2 h PBG）、总胆固醇（total cholesterol，TC）、三酰甘油（triglyceride，TG）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）、性激素结合球蛋白（sex hormone binding globulin，SHBG）等指标，计算体重指数（body mass index，BMI）、腰臀比（waist-to-hip ratio，WHR）、稳态模型胰岛素抵抗指数（homeostatic model assessment for insulin resistance，HOMA-IR），并对脂肪肝组采用消法方药进行3个月治疗前后观察，治疗结束后停药随访6个月。结果非脂肪肝组患者的体重、BMI、WHR、T、LH、LH/FSH、leptin、FINS、2 h PBG、HOMA-IR、LDL-C显著高于对照组（P<0.05），FSH显著低于对照组（P<0.05）；脂肪肝组患者的体重、BMI、WC、HC、WHR、leptin、FINS、2 h PBG、HOMA-IR、TG、LDL-C、ALT、AST较非脂肪肝组显著升高（P<0.05），HDL-C显著降低（P<0.05）。采用消法方药治疗PCOS伴NAFLD患者后，83.87%恢复月经周期（26/31）；32.26%脂肪肝程度减轻或消失（10/31）；总体有效率85.71%（24/28）；48.28%受孕（14/29）；体重、BMI、FBG、leptin、TG、ALT、AST水平均较治疗前显著降低（P<0.05），SHBG水平显著增高（P<0.05），HOMA-IR、FINS以及T、FSH、LH、LH/FSH治疗前后比较，差异无统计学意义。结论PCOS患者存在糖脂代谢紊乱现象，伴有NAFLD的PCOS患者表现更为严重；消法能有效恢复PCOS伴有NAFLD代谢紊乱状态，改善患者脂肪肝程度，恢复正常的月经周期，提高受孕率，其作用环节是否通过降调leptin水平，纠正脂代谢，从而缓解患者的临床症状有待进一步深入研究。

英文摘要:

ObjectiveTo observe the therapeutic effect of resolving method of Chinese medicine （CM） on the lipid metabolism in polycystic ovary syndrome （PCOS） patients accompanied with non-alcoholic fatty liver disease （NAFLD）， to analyze the correlation between PCOS and NAFLD， and to study its mechanisms. MethodsTotally 70 female PCOS patients in the reproductive age （20－40 years old） were recruited. Among them， 35 PCOS patients accompanied with NAFLD were recruited as Group A， and 35 PCOS patients without complicated NAFLD were recruited as Group B. At the same time， 20 healthy female volunteers were recruited as the control group. All subjects had their personal medical records after relevant questionnaire. Their clinical data including body height （BH）， body weight （BW）， body mass index （BMI）， waist circumference （WC）， hip circumference （HC）， testosterone （T）， prolactin （PRL）， follicle stimulating hormone （FSH）， luteinizing hormone （LH）， estradiol （E2）， leptin， fasting blood glucose （FBG）， fasting insulin （FINS）， 2 h postprandial blood glucose （2 h PBG）， homeostatic model assessment for insulin resistance （HOMA-IR）， total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， etc. were detected. Patients in Group A were treated by the resolving method for 3 months. The follow-up was continued for 6 months after ending treatment. ResultsThe levels of BW， BMI， WHR， T， LH， LH/FSH， leptin， FINS， 2 h PBG， HOMA-IR， and LDL-C were significantly higher in Group B than in the control group （P<0.05）. The level of FSH was significantly lower in Group B than in the control group （P<0.05）. The levels of BW， BMI， WC， HC， waist-hip-ratio （WHR）， leptin， FINS， 2 h PBG， HOMA-IR， TG， LDL-C， ALT， and AST were significantly higher in Group A than in Group B （P<0.05）. The HDL-C level was significantly lower in Group A than in Group B （P<0.05）. In Group A after treatment by resolving method of CM， the menstrual cycle was recovered in 83.87% patients （26/31 cases）， reduced fatty liver degree or disappearance of fatty liver degree occurred in 32.26% patients （10/31 cases）， with the total effective rate being 85.71% （24/28 cases）. 48.28% （14/29） patients were pregnant. The levels of BW， BMI， FBG， leptin， TG， ALT， and AST significantly decreased when compared with those before treatment （P<0.05）. The level of SHBG significantly increased （P<0.05）. There was no significant difference in the levels of HOMA-IR， FINS， T， FSH， LH， or LH/FSH between before and after treatment （P>0.05）. ConclusionsThe metabolic disorder of glucolipid exists in PCOS patients， and more serious in PCOS patients accompanied with NAFLD. Resolving method can effectively restore the metabolic disturbance in PCOS patients accompanied with NAFLD， recover their fatty liver degrees， recover normal menstrual cycles， and elevate their pregnancy rates. Further studies are necessary on whether its mechanisms lie on lowering leptin levels and correcting lipid metabolisms to relieve patient′s clinical symptoms.

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