| [Objective] Polycystic ovary syndrome (PCOS) , one of the most common endocrine diseases affecting women of reproductive age, plays an important role in anovulatory infertility, with a prevalence of up to 5 % ~21 %; The syndrome encompasses a broader spectrum of signs and symptoms , such as irregular menstruation (amenorrhea or infrequent menstruation or dysfunctional uterine bleeding), infertility, hirsutism, obesity and acanthosis nigricans. Elevated serum LH levels and hyperandrogenism, insulin resistance with compensatory hyperinsulinemia are its endocrinological features. Polycystic ovary (PCO) morphology is also a common feature in PCOS. With the advance researches, PCOS displays its complexity and essential trend.Not only it impairs patients' genital health and Quality of life, but also is associated with an increased risk of type 2 diabetes, endometrial carcinoma, hyperlipemia, hyperpiesia, cardiovascular and cerebrovascular events. Up to now, precise pathogenesy of PCOS is yet unknown. The modem medicine indicates the etiopathogenisis of PCOS related to hereditism, endocrinology, immunology, metabolism and so on. The cardinal features are hyperandrogenism and hyperinsulinemia, the correlation and between the above factors and how they inference PCOS are still unclear. In the view point of Traditional Chinese Medicine (TCM) ,PCOS classifies to "menopathy" ,"infertility" and "Zhengjia", its occurrence exists a close relationship with dysfunction of liver, kidney, spleen and further inducing deficiency, sputum, sluggish stagnant and fire. Many scholars insist that pathogenesis of PCOS is a renal deficiency plus phlegmatic hygrosis. However, Professor Zhang found that there was heterogeneity among different patients of PCOS through herclinical observation in many years. Prof. Zhang discovered that the occurrence of many PCOS patients were caused by stagnation of liver-QI, hepatic fire or accompanying wet. Therefore, Professor Zhang took Shugan Xiehuo as the main therapeutic principle to be the treatment, assisting Qingre Lishi in need. The research aims to explore the clinical features, evaluate the therapeutic effects and investigate the therapeutic mechanism. These studies were performed under the direction of Professor Zhang. [Methods]1 In first part of clinical study, 118 PCOS patients were divided into 5 groups according to their differentiation of symptoms and signs. The selective data included the pattern of their menstruation, simultaneous phenomenon ,signs such as acne, hairaess and so on. The information also recorded their age,weight (kg) , height(m), waistline(cm), buttock line(cm). The study assessed serum LH, FSH, PRL, E2,,T,FINS, FPG; calculated waist-hip rate (WHR),body mass index(BMI),F-G scores and insulin sensitivity index(ISI). Finally, we applied a logistic analysis to probe the correlation between difference of symptoms type of TCM and clinical index in PCOS.2 In the second part of clinical study, 29 hepatic fire PCOS were treated with Shugan Xiehuo Chinese drugs (Jiajian Longdan Xiegan Decoction). The direction was one dose a day for 3 months, before and after administration the things as follows were done respectively:(1) calculating waist-hip rate (WHR), body mass index (BMI) ,(2)assaying serum for the levels of LH, FSH, PRL, E2, FT, A, FINS, FPG. On the same time, The information, such as pattern of their menstruation, acne, hairness, BBT and so on, were collected for 6 months from pretherapy. The therapeutic effects were evaluated through comparing the difference between before and after Jiajian Longdan Xiegan Decoction treatment.3 In empirical study, ovarian tissue was obtained from 22 women who underwent laparoscopic operation including 11 PCOS, taken as experimental study group and 11 patients that were only with pelvic cavity conglutination, taken as normal group. The operations were performed at 7th to 10th day of menstrual cycle. Resected ovarian tissue was immediately placed in ice-cold serum-free culture medium, and transported to the laboratory. On superclean bench, Mechanical dispersion of theca cells were performedaccording to the description of pertinent literature .One well was given 1×105 cells/0.5ml,all the wells were divided into 3 groups, Group a(blank group), Group b(high dose Chinese drugs )and group c(low dose Chinese drugs). After all the cells were incubated in humidified air and 5% CO2 at 37℃ for up to 24 hours, the culture fluid was moved away and put new culture fluid containing influential factor into wells. After another 48 hours, the culture fluid was collected and stored at -40 ℃ for subsequent steroid assay. [Results]1 Among the 118 PCOS patients, 56 cases were classified to hepatic fire (47.46%), 36 phlegmatichygrosis (30%); 98 patients oligomenorrhea (83.05%), 13 cases amenorrhea (11.02%),35 patients infertility(29.66%).In hyperandrogenism clinical symptom, 58 patients were acne, 13 patients hirsutism.2 The serum levels of LH, T and PRL in hepatic fire group were all significantly higher than those of phlegmatic hygrosis group and renal deficiency group (both p<0.05). It indicated that onset age of hepatic fire group was lower than those of other groups (all p<0.05 ) . The serum levels of FSH in group renal deficiency were obviously lower than other groups (all P<0.05). In phlegmatic hygrosis group cases of WHR more than 0.8, BMI more than 25 and ISI lower than 0.021 were all higher than the rest of groups(P<0.05), to be followed by the higher (both p<0.001).3 The results of regression analysis showed the hepatic fire was related with serum levels of LH, T, PRL, FPG, F-G scores and onset age, it was positive correlation between serum levels of LH, T, PRL, FPG, F-G scores and hepatic fire, onset age was negative correlation.4 Therapeutic effects displayed that Jiajian Longdan Xiegan Decoction could improve menstruation, acne and BBT, after treatment irregular menstruation 6 cases, acne 5, haimess 8, monophase of BBT 5. Four cases infertility were pregnant after treatment in 8 cases infertility prior treatment. The levels of serum LH, PRL,FT,A, and LH/FSH were lower than those of pretherapy (all p<0.05) , ISI were obviously higher than those of pretherapy (P<0.05 ) ; WHR,BMI,F-G scores were lower than those of pretherapy, but it was no significant (P>0.05 ) . There were 9 IR patients in prior treatment and only 2 cases after treatment, it was remarkable (P<0.05)。... |
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