The Relevant Study Of The Clinical Characteristics Of Adolescent Polycystic Ovary Syndrome And TCM Syndrome Types

ObjectiveThrough grouping, discriminating TCM syndrome type, collecting the clinical data and statistical analysis for the 130 cases of adolescent polycystic ovary syndrome patients, the study revealed the endocrine and metabolic characteristics of adolescent PCOS patients, also the correlation between the clinical characteristic and TCM syndrome type of all the patients. By discriminating TCM syndrome type for patients with the combination of macro and micro, the study provided clinical evidence, diagnosis and treatment scheme for TCM standardized treatment of adolescent PCOS.MethodsThe study included 130 cases of adolescent patient with PCOS which saw the doctor at the First Affiliated Hospital of Guangzhou University of Chinese Medicine, during the period of 2013 December to 2015 March. According to the standard of obesity in Asia Pacific, and BMI equal to 23 kg/m2 for the community value, all the patients were divided into normal weight group (BMI<23 kg/ m2) that had 80 cases and overweight group (BMI≥23 kg/m2) that had 50 cases. Meanwhile, the two groups of patients were differentiated by TCM syndrome type, such as Kidney deficiency, stagnation of liver qi, phlegm damp, blood stasis type. And all the patients were detected relevant serum indicators including the level of AMH, FSH, LH, T, FPG, FINS, hs-CRP, TG, TC, HDL, LDL, ApoLl, ApoB in the 2-3 days of menstrual cycle. And then, comparing to these indicators’ difference between the two groups of A and B, and observing the correlation between these indexes and four kinds of TCM syndrome type.Results(1) In 130 cases of adolescent PCOS patients, phlegm dampness syndrome was a risk factor for obesity and hairy, P< 0.05.(2) Syndrome of liver depression was a risk factor for the clinical characteristics such as acne, hirsutism of the adolescent PCOS patients, P< 0.05.(3) LH level:the LH level in the A group patients was higher than that in B group patients (P<0.05);and there was no significant difference between four groups of TCM syndrome types (P>0.05)(4) FSH level:the FSH level of the B group patients was higher than that of A group, but the difference had no statistical significance(P>0.05);and there was no significant difference among the four groups of TCM syndrome type with the FSH level (P>0.05).(5) LH/FSH ratio:the ratio in the A group patients was higher than that in B group patients (P<0.01), and that in Kidney deficiency, blood stasis type group was significantly higher than those of phlegm dampness type group (P<0.01,P<0.05).(6) T level:the T level in the B group patients was higher than that in A group patients, but the difference had no statistical significance(P> 0.05);and that in Liver depression type group was significantly higher than those of kidney deficiency, blood stasis type group(P<0.05).(7) FPG level:the fasting blood glucose levels of all the patients that were between group A and B, and among the four kinds of TCM syndrome type were within the normal range, and there were no significant difference(P>0.05).(8) FINS level:the FINS level of patients in group B was significantly higher than that in group A(P<0.01);the FINS level with phlegm dampness group was significantly higher than that of kidney deficiency, blood stasis type group(P<0.01);and that of hepatic stagnation group was significantly higher than the kidney deficiency type group (P<0.01).(9) HOMA-IR:the HOMA-IR in the B group patients was significantly higher than that of patients in group A(P<0.01);the HOMA-IR with phlegm dampness group was significantly higher than that of kidney deficiency, blood stasis type group (P<0.01);and that of liver depression group was significantly higher than that of kidney deficiency type group (P<0.01).(10) hs-CRP level:the level of hs-CRP in the B group patients was higher than that in A group patients (P<0.01);and phlegm dampness group hs-CRP level was prominently above the average of the other three TCM syndrome type groups(P<0.01).(11) AMH level:there was no significant difference of the AMH level between the group A and B, as well as among the four kinds of TCM syndrome type (P>0.05);while there was a positive correlation between AMH and LH, LH/FSH, T, FINS, HOMA-IR, and the rank correlation coefficient respectively were 0.229,0.186,0.473,0.208,0.199, P<0.05.(12) TG level:the level of TG in the B group patients was higher than that in A group patients(P<0.01);and that of phlegm dampness group was prominently above the average of the other three TCM syndrome type groups(P<0.01).(13)TC level:the TC level of the B group patients was higher than that of A group,but the difference had no statistical significance(P>0.05);and there was no significant difference among the four groups of TCM syndrome type with the TC level(P>0.05).(14) HDL level:the HDL level in the B group patients was significantly lower than the patients in group A(P<0.01);and that of phlegm dampness group was significantly lower than those of the other three TCM syndrome type groups(P<0.01).(15) LDL level:the LDL level in the B group patients was higher than that in A group patients(P<0.01);and that of phlegm dampness group was significantly higher than the hepatic stagnation group(P<0.05).(16) ApoAl level:the ApoAl level in the B group patients was significantly lower than the patients in group A(P<0.01);and that of phlegm dampness group was significantly lower than the kidney deficiency type group(P<0.05).(17) ApoB level:the ApoB level in the B group patients was higher than that in A group patients(P<0.01);and phlegm dampness group ApoB level was prominently above the average of the other three TCM syndrome type groups(P<0.05).(18) ApoB/ApoAl ratio:the ratio of ApoB/ApoAl in the B group patients was significantly higher than that of patients in group A(P<0.01);and that of phlegm dampness group was prominently above the average of the other three TCM syndrome type groups (P<0.05).Conclusion1. There were differences among the various indicators of the adolescent PCOS patients with the normal weight and overweight or obese patients, such as endocrine, metabolic index,high sensitive C reactive protein and serum AMH. And there was relevance between one part of indicators and TCM syndromes:LH/FSH increased mainly associated with kidney deficiency, blood stasis syndrome;T level increased mainly associated with liver depression syndrome;the abnormality of metabolic index and high sensitive C reactive protein mainly associated with phlegm dampness syndrome. It could provide the foundation for the clinical individualized and standardized treatment, and make TCM syndromes objective.2. Phlegm dampness syndrome was a risk factor for the clinical features of adolescent PCOS patients, such as obesity and hairy;liver depression syndrome was a risk factor for acne and hairy.3. AMH of adolescent with PCOS was positively correlated with high LH hyperinsulinemia, hyperandrogenism and insulin resistance, it might help to diagnose adolescent PCOS and predict the severity of PCOS.4. The degree of metabolic disorders and the chronic low-grade inflammation in overweight or obese patients with adolescent PCOS, who were susceptible to get metabolic syndrome more easliy, were more severe than the normal weight patients. By the way, the study also showed that metabolic syndrome played an important role in the process of PCOS. As well as, it has an important significance to control weight positively for preventing metabolic syndrome.