The Clinicaland Serum Metabolomics Studies On Patients Of Polycystic Ovary Syndrome With The Type Of Phlegm-dampness Syndrome Treated By Bu Shen Hua Tan Fang

Objective:Based on the clinical observation of Bu Shen Hua Tan Fang in the treatment of Polycystic Ovary Syndrome(PCOS)with the type of Phlegm-dampness syndrome to investigate the material basis and possible mechanismbased on ultra-high performance liquid chromatography-mass spectrometry techniques.Methods:We Collected 36 outpatient-subjects with PCOS following with the 2003 Rotterdam diagnostic criteria and the type of Phlegm-dampness syndrome in TCM theory from October,2012 to December,2013 in the First Affiliated Hospital of Heilongjiang University of Chinese Medicine.The 36 subjects having signed consent were treated by Bu Shen Hua Tan Fang for three menstrual cycles.The serum samples and clinical data were collected on the third day of the menstrual cycle.The Bu Shen Hua Tan Fang included six kind of herbs from Jiang Yin Tian jiang Chinese medicine company After three menstrual cycles of intervention the serum samples and clinical data were collected again on the third day of the menstrual cycle or withdrawal bleeding.The serum samples were stored at-80°freezer to detect the Laboratory data including glycolipids,gonadal hormones until all the samples were collected and to detect the serum metabolomic differences based liquid chromatography mass spectrometry.Results:(1)Clinical Research Results:After the treatment with Bu Shen Hua Tan Fang for three menstrual cycles,firstly,the point of Phlegm-dampness syndrome in Chinese medicine syndreomes graded tables was decreased significantly.Secondly,the level of SHBG were significantly increased with significant differences(P<0.05),Thirdly,the levels of fasting glucose,60min glucose and HOMA-IR were decreased significantly(P<0.05).Fourthly the levels of CHOL,LDL-C,and ApoB were significantly decreased(P<0.05).Fifthly,the weight,BMI,hip circumference,waist circumference and acanthosis nigricans score were decreased significantly especially the WHR of PCOS in group A was significantly decreased(P<0.05).Sixthly,there were six pregnant cases in the treatment of Bu Shen Hua Tan Fang and the cycle ovulation rate was 12.2%.Sevenly,at the end of research the function of liver and kidney were detected and there were not any adverse side effects.that was to say the Bu Shen Hua Tan Fang play a positive role in elevating the reproductive function of PCOS.Eightly,the analysis of the baseline of subgroup followed as:the levels of SHBG in the group of IR accompanied with hyperinsulemia were lower than it in the group of IR accompanied with no hyperinsulemia.well,the levels of FPG,30min PG,the insulin in the time of Omin,30min,60min,and 120min of OGTT,AUC and HOMA-IR in group of IR accompanied with hyperinsulemia were higher than the group of IR accompanied with no hyperinsulemia.Then,the levels of HDL-C in the group of IR accompanied with hyperinsulemia were lower than it in the group of IR accompanied with no hyperinsulemia,but the levels of TG and ApoB were higher than it in the group of IR accompanied with no hyperinsulemia.Intrerestingly,WHR in the group of IR accompanied with hyperinsulemia was lower than it in the group of IR accompanied with no hyperinsulemia.(2)Metabolomics Results:According to screened different metabolites,there were 4 different metabolites identified after the treatment of Bu Shen Hua Tan Fang,which were related to lipid metabolism and amino acid metabolism pathways.The levels of FFA related to lipid metabolism pathway were decreased significantly,well the levels of phosphatidylcholine were significantly elevated after the treatment of Bu Shen Hua Tan Fang.The levels of glycine related to amino acid metabolism pathway were decreased significantly,well the levels of ornithine were significantly elevated after the treatment of Bu Shen Hua Tan Fang.The analysis of the baseline of subgroup in metabolimics followed as:There were 32 significant differences in metabolites between group of IR accompanied with hyperinsulemia and group of IR accompanied with no hyperinsulemia,mainly related to lipid metabolism,amino acid metabolism and purine metabolism pathway.the levels of FFA consisted of FFA20:0?FFA22:0?FFA24:0?FFA 24:1and FFA 24:2,phosphatidylcholine LPC22:0?(PC32:0?PC32:1?PC32:2?PC33:1?PC34:2?PC34:3?PC34:4?PC36:1?PC36:2?PC36:3?PC36:4?PC36:5?PC36:6?PC38:6?PC38:7?PC40:5)?Phosphatidylethanolamine PE40:5?Sphingomyelin consisted of SM34:0?SM34:1?SM34:2?SM36:2?SM(d18:1/14:0)and SM(d18:1/15:0)in the group of IR accompanied with hyperinsulemia were significantly higher than them in group of IR accompanied with no hyperinsulemia,well,the levels of methionine and phenylalanine were lower than group of IR accompanied with no hyperinsulemia.Interestingly,the levels of urate assosiated with purine metabolism pathway were higher than group of IR accompanied with no hyperinsulemia.Conclusion:First and formost,the point of Phlegm-dampness syndrome in Chinese medicine syndrome graded tables was decreased significantly and Bu Shen Hua Tan Fang could improve the Phlegm-dampness syndrome in PCOS.In the second place,insulin resistance in PCOS with the type of Phlegm-dampness syndrome was improved by Bu Shen Hua Tan Fang ascribed to the improvement of sexual hormone and liquid metabolites disorders,so that the,the body weight,BMI,waist and hip circumstance were decreased significantly.In the third place,when it comes to metabolimics,PCOS with the type of Phlegm-dampness syndrome,the level of free fatty acid was decreased significantly,it is possible that the improvment of lipid metabolic disorders uncoverd the mechanism that Bu Shen Hua Tan Fang improves insulin resistance in PCOS with the type of Phlegm-dampness syndrome.More over,at the end of the treatment,there were some significant differences between the PCOS with IR accompanied with hyperinsulemia or not hyperinsulemia in the clinical results,the levels of SHBG and HDL-C in the group of IR accompanied with hyperinsulemia were lower than it in the group of IR accompanied with no hyperinsulemia.while the levels of FPG,30min PG,the insulin in the time of 0min,30min,60min,and 120min of OGTT,AUC,HOMA-IR,TG,ApoB and WHR in group of IR accompanied with hyperinsulemia were higher than the group of IR accompanied with no hyperinsulemia,Last but not least,there were some significant differences between the PCOS with IR accompanied with hyperinsulemia or not hyperinsulemia in the meabolimics,the levels of FFA,phosphatidylcholine,Phosphatidylethanolamine,Sphingomyelin and urate were significantly higher than them in group of IR accompanied with no hyperinsulemia.,well,the levels of methionine and phenylalanine were lower than group of IR accompanied with no hyperinsulemia.