Study On The Clinicai Diagnosis Of PCOS And The Understanding Of The Pathophysiology Of Its In TCM

Objective:Analysis of the LH/FSH, SHGB, thyroid function, insulin release test on the PCOS diagnostic significance, through the research of polycystic ovary syndrome (PCOS) patients characteristics of clinical manifestations, endocrine and metabolism of glucose and lipid, and proposedto the division of three stages and twelve gray scale. In addition, understanding of the physiological and pathological characteristics of PCOS from the Chinese perspective, to explore the correlation between TCM syndrome type of the PCOS with its endocrine, metabolism of glucose and lipid, and provide objective basis for clinical diagnosis and treatment of the disease.Methods:Part1:Selects418patients with PCOS in May,2012to December,2013visit to the Hunan second people’s Hospital polycystic ovary syndrom (PCOS) and infertility treatment center, comprehensively analysis of the characteristics of the PCOS in clinical manifestations, endocrine, metabolism of glucose and lipid, thus, to explore the relationship among the major pathophysiological mechanisms, analysis of LH/FSH, SHGB, thyroid function, insulin release test on the PCOS diagnostic significance; at the same time, through multiple linear correlation analysis, proposed three stage and twelve grayscale of the PCOS.At the same time, based on the characteristic which PCOS pathophysiological state is gradually evolving, we are going to PCOS to PCOS divided into three stages and twelve gray-scale.Part2:The investigation of TCM syndromes in418patients with PCOS diagnosed by Rotterdam, divided into four syndrome type yin deficiency with wet, carduonephric cisharmony, syndrome of upper heat and lower cold, damp-heat syndrome, and analyzed the characteristics of each syndrome type symptoms, endocrine, metabolism of glucose and lipid,to deepen the understanding of PCOS pathophysiology in TCM, to explore the correlation between TCM syndrome type of the PCOS with its endocrine, metabolism of glucose and lipid.Results:Part one:418cases of PCOS patients mainly manifested as oligomenorrhea, acne in clinical symptoms; Hyperinsulinemia, mixed hyperlipidemia is mainly manifested in the metabolism. Biochemical Kaohsiung more mainly for Kaohsiung low female, the essence of PCOS is Kaohsiung low female or Kaohsiung; the obese group, IR group, HA group SHBG levels were lower than the non obese group, non IR group, non HA group, the difference was statistically significant (P<0.01orP<0.05).The LH levels, LH/FSH ratio in obese PCOS patients did not rise or close to normal value, and the non obese PCOS patients the level of LH, LH/FSHB ratio was significantly higher than the normal level.This not only suggests that LH level, LH/FSH ratio is not the diagnosis condition of the PCOS. The incidence of IR,obese group was significantly higher than that in the non obese group, the difference was statistically significant (P<0.01).In418PCOS patients, the mean value of TSH is in the normal range but at high limit state, the dyslipidemia rate as high as64.83%. IR was evaluated in418PCOS patients, HOMA-IR method was used to evaluate the the incidence was36.84%, but the use of insulin release curve method was44.26%, and there was significant difference between them (P<005). At the same time, insulin release curve method were used to assess the risk of IR in non obese and normal glucose tolerance PCOS patients, the occurrence rate of IR is respectively37.92%,44.14%, the detection rate was significantly higher than that of HOMA-IR was28.62%,27.83%, there was significant difference between the two groups (P<0.01). The diagnosis of Rotterdam is too broad, in the early stage of the PCOS patients with125cases, accounted for29.90%; There are26cases of super PCOS patients, accounting for9.42%.Part two:TCM syndrome type with the largest proportion of carduonephric cisharmony in418PCOS patients, followed by yin deficiency with wet> syndrome of upper heat and lower cold> damp-heat syndrome; damp-heat syndrome group, the serum level of T was higher than that of yin deficiency with wet, syndrome of upper heat and lower cold and carduonephric cisharmony, while the SHBG level lower than in other three groups, the difference was statistically significant (P<0.05or P<0.01); carduonephric cisharmony group and yin deficiency with wet group the levels of serum LH, LH/FSH ratio was higher than that of damp-heat syndrome, syndrome of upper heat and lower cold, the serum E2level lower than in other two groups, the difference was statistically significant (P<0.05); Fasting blood glucose and oral glucose after0.5h,1H,2h,3h blood glucose had no significant difference in four groups(P>0.05); damp-heat syndrome group TG, LDL-C, HOMA-IR, fasting insulin and post oral glucose0.5h,1h,2h,3h insulin levels were higher than those of carduonephric cisharmony group? yin deficiency with wet group and syndrome of upper heat and lower cold, the difference was statistically significant (P<0.05or P<0.01).Conclusions:The essence of PCOS is a complex endocrine and metabolic problems, under the complex pathophysiological changes, eventually progress to DM. For the PCOS,we cannot take the threshold diagnostic,its diagnosis should highlight the pathophysiological process of PCOS evolution, should be conducive to the treatment and prevention of long-term complications of the PCOS. SHBG should be used as a new indicator which predictive of polycystic ovary syndrome, diabetes, metabolic syndrome and other diseases, early detection; High LH, LH/FSH ratio is not PCOS diagnosis conditions;For PCOS patients, especially those patients with obesity, we should be performed as early as possible glucose tolerance test and insulin release test (OGTT+IRT), simultaneously screening of thyroid function, serum lipids,a comprehensive understanding of the endocrine, metabolism of PCOS patients. PCOS diagnostic criteria should be more precise, refinement, the diagnosis should be able to reflect the gradually evolving pathological physiology state, PCOS is divided three stages and twelve gray-scale, can better dynamic understand and prevent complicated evolution of PCOSpathophysiology, to break the clinical theory of "incurable".TCM syndrome type of the PCOS is mainly of carduonephric cisharmony,yin deficiency with wet, syndrome of upper heat and lower cold, damp-heat syndrome, Carduonephric cisharmonyis accounted for the majority; damp-heat syndrome and obesity, Kaohsiung hormones, insulin resistance, lipid metabolism disorder are closely related;Carduonephric cisharmony and yin deficiency with wet is mainly manifested in the high serum LH, LH/FSH ratio increased, low estrogen endocrine disorders.