| Objective:Through analyzing and discussing the distribution of PCOS patients’ constitution,it can improve the clinical symptoms and test indexes of patients through"differentiation and conditioning",and provide certain theoretical basis for prevention and treatment of PCOS;Through observing and discussing the clinical effect of nourishing Yin and tonifying Yang sequential on infertile patients with PCOS-IR,and provide a new method of diagnosis and treatment.Methods:The cases were from patients who were diagnosed with PCOS in the department of reproductive medicine of Jiangsu Provincial Hospital of Chinese Medicine from October 2018 to October 2019 in this study,voluntarily using "tongue pulse information acquisition system" to identify the Chinese constitution,and analyze the distribution law of constitution.Then 60 infertile patients with IR were selected from 159 PCOS patients with TCM constitution identification,and they were divided into two groups randomly,with 30 cases in each group.Patients in the control group were treated with western medicine(LE+HMG+HCG)for ovulation induction therapy combined with metformin for 78 cycles,while patients in the observation group were treated with traditional Chinese medicine for nourishing Yin and tonifying Yang sequential combined with western medicine for 71 cycles,and according to the constitution to add or subtract drugs,both groups were treated for 3 menstrual cycles and a total of 149 cycles were observed.Patient’s general information was recorded,and the two groups were compared in BMI,basal sex hormone levels,carbohydrate metabolism levels,basic condition of the ovary,TCM syndrome and menstrual symptom scores,HMG dosage and follicular development days,sex hormone levels and endometrial conditions on HCG day,Ovulation rate and pregnancy outcomes.Results:(1)In this study,a total of 159 PCOS patients were selected,and there were 135 concurrent constitution in all patients,so the proportion was 84.91%.The accumulated occurrence frequency of TCM constitution was 337 times,and the biased constitution was 332 times,accounting for 98.52%of the total.The proportion of each constitution is as follows:Qi depression constitution accounted for 21.96%,Qi deficiency constitution accounted for 19.29%,Phlegmy-damp constitution accounted for 18.69%,Damp-heat constitution accounted for 17.51%,Yang deficiency constitution accounted for 7.42%,Blood stasis constitution accounted for 5.64%,Specific endowment constitution accounted for 5.04%,Yin deficiency constitution accounted for 2.97%,Peace constitution accounted for 1.48%.(2)There were 93 patients with PCOS-IR in this study,accounting for 58.49%of the total,the cumulative occurrence frequency of TCM constitution was 196 times.The proportion of each constitution is as follows:Phlegmy-damp constitution accounted for 21.43%,Qi deficiency constitution accounted for 19.90%,Qi depression constitution accounted for 16.75%,Damp-heat constitution accounted for 14.66%,Yang deficiency constitution accounted for 8.90%,Specific endowment constitution accounted for 6.81%,Blood stasis constitution accounted for 6.81%,Yin deficiency constitution accounted for 2.62%,Peace constitution accounted for 1.05%.(3)There were 32 patients with PCOS whose age was<20 years,accounting for 20.13%of the total;There were 108 PCOS patients whose age was 21～30 years,accounting for 67.92%;There were 19 PCOS patients whose age was 31～40 years,accounting for 11.95%.(4)The cumulative frequency of TCM constitution in PCOS patients aged<20 years was 73 times,and the proportion of Qi deficiency constitution,Qi depression constitution,Phlegmy-damp constitution,Damp-heat constitution,Yang deficiency constitution,Specific endowment constitution,Blood stasis constitution,Yin deficiency constitution and Peace constitution was 27.40%,20.55%,15.07%,15.07%,10.96%,5.48%,4.11%,1.37%and 0.00%;The cumulative frequency of TCM constitution in PCOS patients aged from 21 to 40 years was 264 times,and the proportion of Qi depression constitution,Phlegmy-damp constitution,Damp-heat constitution,Qi deficiency constitution,Yang deficiency constitution,Blood stasis constitution,Specific endowment constitution,Yin deficiency constitution and Peace constitution was 22.35%,19.70%,18.18%,17.05%,6.44%,6.06%,4.92%,3.41%and 1.89%.(5)Weight and BM:both groups have shown to lower Weight and BMI after treatment,there were differences in the two groups(P<0.05),and there was no difference between the two groups(P>0.05),however,the decrease of Weight and BMI in the observation group was significantly higher than that in the control group,hence there is significant difference(P<0.05).(6)Basal sex hormone levels:both groups have increased E2 and SHBG levels and decreased AMH,LH,LH/FSH,T and DHEAS levels after treatment,there were differences in the two groups(P<0.05),compared with the control group,the observation group had more significant efficacy in reducing AMH,LH/FSH and T,and increased E2 by a greater margin(P<0.05),but there was no difference in other sex hormone indexes(P>0.05).(7)Carbohydrate metabolism:both groups have shown to lower FINS and HOMA-IR after treatment,and the observation group also improved FPG,there were differences in the both groups(P<0.05).compared to the control group,the observation group showed more significant improvement in FINS and HOMA-IR(P<0.05).(8)Basic condition of the ovary:both groups could improve the ovarian volume and antral follicle count after treatment,there were differences in the two groups(P<0.05),compared with the control group,the observation group significantly improved the ovarian antral follicle count(P<0.05),but there was no difference in ovarian volume(P>0.05).(9)TCM syndrome and Menstrual symptom scores:both groups could improve TCM syndrome and Menstrual symptom scores after treatment,there were differences in the two groups(P<0.05),but compared with the control group,the improvement was more pronounced in the observation group(P<0.05).(10)HMG dosage and Follicular development days:compared with the control group,the observation group could significantly reduce the HMG dosage and shorten the follicular development days in ovulation cycle,hence there were differences among the two groups(P<0.05).(11)Sex hormone levels and Endometrial conditions on HCG day:compared with the control group,the observation group could significantly improve the level of E2,LH and P on HCG day and increase the endometrial thickness(P<0.05),but there was no difference in endometrial morphology between the two groups(P>0.05).(12)Ovulation:after treatment,the cycle ovulation rate and uninitiated cycle rate of the observation group and the control group were 83.10%(59/71),9.86%(7/71)and 58.97%(46/78),24.36%(19/78),the difference was statistically significant between the two groups(P<0.05);the incidence of LUFS and OHSS of the observation group and the control group were 5.63%(4/71),1.41%(1/71)and 11.54%(9/78),5.13%(4/78),there was no difference between the both groups(P>0.05).(13)Pregnancy outcomes:after treatment,the clinical pregnancy rates of the observation group and the control group were 48.15%(13/27)and 21.43%(6/28),the difference was statistically significant between the both groups(P<0.05);the cycle pregnancy rate and adverse pregnancy rate of the observation group and the control group were 18.31%(13/71),11.11%(3/27)and 7.69%(6/78),and 14.29%(4/28),hence comparison between the two groups was not significant(P>0.05).(14)Overall clinical effect:the cure rate of observation group was 18.31%,and overall clinical effect rate was 83.10%,the cure rate of control group was 7.69%,and overall clinical effect rate was 58.97%,hence there were significant differences among the two groups(P<0.05).Conclusions:(1)The TCM constitutions of PCOS patients are mainly composed of concurrent constitutions and biased constitutions,among which Qi depression,Qi deficiency,Phlegmy-damp and Damp-heat constitution are the top four;(2)Phlegmy-damp and Qi deficiency constitution are the most common in PCOS-IR patients;(3)The age of PCOS patients is mainly from 21 to 30 years old,and those younger than 20 years old are mainly characterized by Qi deficiency,while those aged between 21 and 40 years old are mainly characterized by Qi stagnation;(4)Nourishing Yin and tonifying Yang sequential combined with "differentiation and conditioning"can significantly reduce the BMI of infertile patients with PCOS-IR,improve endocrine and metabolic levels and antral follicle count,and obviously improve the clinical symptoms and overall clinical efficacy of patients;In terms of ovulation induction,nourishing Yin and tonifying Yang sequential combined with "differentiation and conditioning" can significantly reduce the HMG dosage and shorten the follicular development days,then reduce the economic burden of patients,but also improve the quality of follicles,increase endometrial thickness,improve the cycle ovulation rate and clinical pregnancy rate.It provides a more safe and effective treatment of combining traditional Chinese and Western medicine for infertility patients with PCOS-IR. |
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