Research On Clinical Phenotype Of Subjects In Different Sites In PCOSAct And Characteristics Of Tcm Syndrome

Objectives:1.To investigate phenotypical characteristics of PCOS women with different Chinese medicine patterns and the association between obstetric outcomes,pregnancy complications,time from treatment to first ovulation,time from treatment to conception and Chinese medicine patterns in PCOS,then provide symptomatic objective basis for clinical treatment based on syndrome differentiation of traditional Chinese medicine.2.To explore main phenotypic features and the association between these features and obstetric outcomes of PCOS women in different types of hospitals(Chinese medicine hospitals and western medicine hospitals,university affiliated hospitals and non-university affiliated hospitals)based on the unique Chinese health care system.Methods:Based on the"Effect of Acupuncture and Clomiphene Citrate on Live Birth in Anovulatory Women with PCOS”project,we select 1000 subjects as research objects in this study.This study consists of two parts including the followings:1.According to the clinical pathway in"Infertility(PCOS)Chinese medicine diagnostics and treatments" made by key discipline and specialty network of state administration of traditional Chinese medicine,we perform Chinese medicine syndrome differentiation together with the"Quantification table of traditional Chinese medicine syndrome”in the case report form.Then categorized all subjects into four different traditional Chinese medicine syndrome types:kidney deficiency and liver stagnation syndrome,spleen deficiency and phlegm turbid syndrome,phlegm turbid and blood stasis syndrome,and kidney deficiency and blood stasis syndrome.We compared biometric features,reproductive history,sex hormone levels,liver and kidney function,glycolipid metabolism,obstetrics outcomes(ovulation rate,conception rate,pregnancy rate,pregnancy loss rate,live birth rate),pregnancy complications,time from treatment to first ovulation or time from treatment to conception by using SAS software(version 9.4).2.According to different types of hospitals the subjects chosen,we categorized all subjects into Chinese medicine hospitals(n=623)and western medicine hospitals(n=375),or university hospitals(n=432)and non-university hospitals(n=566).Based on baseline data in the case report form,we compared and analyzed biometric features,medical history,life-style,sex hormone levels,glycolipid metabolism,liver and kidney function,electrolyte levels,quality of live and obstetrics outcomes(ovulation rate,conception rate,pregnancy rate,pregnancy loss rate,live birth rate)in different categories by using SAS software(version 9.4)and got the final results and conclusions.Results:1.Kidney deficiency and liver stagnation syndrome had the highest incidence(n=392,40.29%),followed by spleen deficiency and phlegm turbid syndrome(n=314,32.27%),phlegm turbid and blood stasis syndrome(n=161,16.55%)and kidney deficiency and blood stasis syndrome(n=106,10.89%).The anxiety and depression scores in kidney deficiency and liver stagnation syndrome group were higher than other groups(P<0.05),PCOSQ score and SF-36 score especially psychological dimension score were lower than other groups(P>0.05).Kidney deficiency and blood stasis syndrome group had higher LH and LH-FSH ratio than other groups(P<0.05).Spleen deficiency and phlegm turbid syndrome group had higher weight,BMI,waist circumference,hip circumference,waist-hip ratio,SBP,pulse,FAI,TG,rate of metabolic syndrome and ALT(P<0.05)but lower SHBG,HDL and ApoA than other groups(P<0.05).Phlegm turbid and blood stasis syndrome group had higher DBP,respiratory rate,free testosterone,FINS,and HOMA-IR than other groups(P<0.05),while PCOSQ score was lower than other groups(P<0.05).There were no differences of obstetrics outcomes,pregnancy complications,time from treatment to first ovulation and conception in four groups(P>0.05).2.Compared with western medicine hospitals,the height,weight,BMI,hip circumference,respiratory rate,pulse,ratio of calcium to phosphorus,score of PCOSQ,score of emotional and infertile dimensions in PCOSQ,score of SF-36,score of physical and mental dimensions in SF-36,pregnancy rate and live birth rate in Chinese medicine hospitals were significantly decreased(P<0.05).While husband’s age,score of hirsutism,time for conception,genital system tumor,received drug therapy of infertility,received acupuncture therapy,husband used to drinking,total testosterone,E2,LH,LH/FSH,cholesterol,HDL,LDL,APOA,serum creatinine,AST,total bile acid,total bilirubin,indirect bilirubin,lactic dehydrogenase,potassium,chlorine,rate of SAS score>50,total pregnancy loss rate,rate of early pregnancy loss and rate of biochemical miscarriage were significantly increased(P<0.05).Compared with non-university affiliated hospitals,the height,percentage of hirsutism≥5,pulse pressure,pulse,received clomiphene citrate therapy,urea,indirect bilirubin,creatine kinase,calcium,magnesium,sodium,ratio of calcium to phosphorus,score of emotional and infertile dimensions in PCOSQ,pregnancy rate and live birth rate in university affiliated hospitals were significantly decreased(P<0.05).While the husband’s age,the history of his fatty liver disease and his former acupuncture therapy,the proportion of former and present drinking,his total testosterone,high testosterone ratio,FAI,E2,LH,LH/FSH,cholesterol,LDL,APOA,APOB,potassium,chlorine,total pregnancy loss rate,rate of early pregnancy loss,rate of late pregnancy loss and biochemical miscarriage were significantly increased(P<0.05).Conclusions:1.Kidney deficiency and liver stagnation syndrome in PCOS infertile women is associated with psychological or mental problems,kidney deficiency and blood stasis syndrome is associated with reproductive axis abnormalities.Spleen deficiency and phlegm turbid syndrome manifests more severe lipid metabolic abnormalities,while phlegm turbid and blood stasis syndrome shows more severe glucose metabolic abnormalities.Clinical treatments protocol should be based on different symptoms and signs of traditional Chinese medicine syndromes.2.Women with more severe PCOS had phenotypic features of worse reproductive hormonal profile,severe lipid metabolic abnormalities and low quality of life,along with higher pregnancy loss rate after clomiphene citrate treatment.Regardless of severity of PCOS,the ovulation effects of Clomiphene citrate are the same.