| ?Objectives?Clinical observation PCOS with insulin resistance(PCOS-IR)uterus hotmetabolic characteristics and according to the height and body mass index(BMI)and warming uterus and dispelling and phlegm and dispelling removing stasismethod to determine the the methods to LGHYQY and jointly apply rosiglitazoneand metformin/asay that peptide of doctor of traditional Chinese medicine andtraditional Chinese and western medicine treatment the curative effect of.?Methods?Source of cases from January 2017 to December 2018 pcos,patients with IRwere collected chengdu university of traditional Chinese medicine of theaffiliated hospital of department of gynaecology and endocrinology clinicpatients with PCOS and IR.Research plan is divided into three parts 1)PCOS-IR thermal infraredmetabolic part is fit into the cases fill out on the basis of traditional Chinesemedicine constitution classification and decision making of physical scale,themenstrual period in patients with PCOS and IR infrared scan standard,usinginfrared thermal image system(chongqing ADT-YL-100-a module type)scan,according to infertility,menoxenia infrared measuring calorific value andprophase research foundation of the theory of measuring calorific value of theuterus,etc.10 location.2)the method of warming utherus dissoving phlegm andremoving and dispelling stasis method were blood stcosos treat PCOS-IR clinicalobservation fits into the exclusion criteria(kidney empty phlegm and bloodstasis syndrome)patients with PCOS and IR temperature using warming uteruswith phiegm-dissoving phlegm and dispelling stasis method,research methodsobsering before and after,giving an oral Chinese medicine decoction a dose,3times/day,stop taking in period.3)combined with traditional Chinese andwestern medicine treatment for PCOS-IR clinical observation fits into theexclusion criteria(kidney empty phlegm and blood stasis syndrome)patientswith PCOS-IR according to BMI(BMI < 22 kg/m2;22 kg/m2 or less BMI < 30kg/m2;BMI),30 kg/m2 or respectively using warm palace phlegm and dispellingstasis method combined rosiglitazone and metformin/asay that peptide, observing taking the methods for themselves,to give an oral Chinese medicinedecoction(a dose of daily,3 times/day,stop taking in period.)combining use ofrosiglitazone(4 mg,Po,qd;BMI < 22 kg/m2)/metformin(0.85 g,Po,qd;22kg/m2 or less BMI < 30 kg/m2)/asay that peptide(5 ug,subcutaneous injection,the bid;BMI 30 kg/m2 or higher).Observation indexes: BMI,HOMA IR,menstrual cycle,ovulation rate,pregnancy rate,miscarriage rate,FINS,hins 1 and 2 hins,3 hins indicators.Acourse of 3 months.?Results?This study included 154 cases,80 cases complete infrared hot line scan(Including PCOS-IR 60 cases group,reproductive health 20 cases group).Ages19 and 44 years old,the average age of 28.5 years,before the treatment HOMA3.67 + /-1.02-IR.1,the metabolism of PCOS-IR thermal infrared characteristics1)infrared thermal image scanning 60 cases of patients with PCOS and IR,reproductive health control group 29 cases.PCOS group-IR the age is from 19 and 44 years old,with an average age of 28.6 years.Reproductive healthy groupof 20 patients,aged 24 to 43,with an average age of 30.9 years.2)PCOS-IR people are maintly marked by menstrual symptoms mainly,with abnormal the amount and menstrual cycle disorder,purpuris dark colordark purple with blood clots,menstrual abnormalities(86.7%);The incidence ofacne was 61.7%;Hairy incidence is 40%;the menstruation frequency wassignificantly lower than healthy people group(5.3 + /-2.8 vs.11.7 + /-1.3 times(P < 0.05);Body weight and BMI significantly higher than the healthy group(61.22 + /-11.52 kg VS 53.15 + /-5.73 kg(P < 0.05;26.31 vs.22.14 + /-3.18kg/m2 + /-2.99 kg/m2,P < 0.05).3)among PCOS-IR cases,there are heutral coustitution 14 cases(14/60,23.3%),qi depression consfitutions of 14 cases(14/60,23.3%),Yangdeficiency of 9 cases(9/60,15 th %),Yin deficiency group of 7 cases(7/60,11.7%),qi deficiency type 3 cases(3/60,5 %),heat-donpness constition 6cases(6/60,%),5 cases in blood stasis(5/60,8.3%),2 cases in phlegmy damp (2/60,3.4%).The top three constitution,respectively is: peace,qi depression,Yang deficiency.4)PCOS crowd-IR uterus calorific value is lower than in PCOS-IR group thehealthy group(29.31 + /-0.76 ? VS 31.92 + /-1.43 ?,P < 0.05),P < 0.05,that in the difference was statistically significant.5)uterine location of low calorific value accounted for 96.7% of PCOS-IRgroup.2,warm uterus and dissolving phlegm and dispelling stasis.the clinicalobservation of the method for treat of PCOS-IRthis study includes 4 cases with PCOS(kidney empty phlegm and bloodstasis syndrome)-IR,ages from 18 to 44 years old,the average age of 27.4years.With Clinical control,15 cases clinical control rate is 44%;11 cases weremarkedly effective,significant effect rate is 32%;6 cases effective,effective ratewas 18%;Invalid with 2 cases,the rate no efficiency is 6%.The total effectiverate was 94%.After treatment of LH/FSH(3.56 + /-1.07 vs.1.12 + /-0.46,P <0.05),HOMA IR(3.67 + /-1.02 vs.2.53 + /-0.97,P < 0.05),T(50.99 + /-16.60 vs.37.18 + /-9.79,P < 0.05),BMI(25.46 + /-1.20 vs.23.93 + /-1.77,P < 0.05),menstrual cycle(62.32 + /-9.91 vs.50.12 + /-4.82,P < 0.05)were lowering,P <0.05,the curative effect is obvious.TCM symptom score(16.88 + /-4.88 vs.12.97 + /-3.67,P < 0.05),acne integral(2.77 + /-1.31 vs.1.92 + /-1.02,P <0.05),P < 0.05,clinical curative effect is obvious.the ovulation raised(38.2% VS55.9%),pregnancy rate was 40%,adverse pregnancy rate was 12.5%.3,the clinical observation of combining traditional Chinese and westernmedicine treatment of PCOS-IRPart of this study were included in the cases of 90 patients,ages from 19 and44 years old,the average age of 31.5 years.1)scheme is one is to warm utreus and dissolve phlegm as well as relovingatasis in the treatment of PCOS-IR(kidney empty phlegm and blood stasissyndrome)in 30 patients with clinical observation.The average age of 31.2 + /-2.31 years old. Clinical control of 9 cases,30%;11 cases were markedly effective,significant efficiency is 36.7%;6 cases effective,effective rate was 20%;Invalid 4cases,no efficiency is 13.3%.The total effective rate 87.7%.BMI after treatment(19.78 + /-1.21 vs.19.51 + /-1.02,P > 0.05),menstrual cycle(75.53 + /-8.86 days versus 54.43 + /-5.92 days,P < 0.05),LH/FSH(2.26 + /-1.14 vs.1.24 + /-0.53,P < 0.05),HOMA IR(4.16 + /-2.73 vs.2.72 + /-1.83,P < 0.05),T(44.40 + /-15.02 vs.37.97 + /-10.8,P < 0.05),P < 0.05,the curative effect is obvious.TCMsymptom score(15.66 + 4.29 vs.11.9 + /-3.23,P < 0.05),acne integral(1.56 + /-1.27 vs.1.13 + /-1.07,P > 0.05),clinical curative effect is obvious.In theovulation rate(36.7% VS 50%),pregnancy rate 35.7%,adverse pregnancy ratewas 20%.2)the second scheme(warm utuers and dissolving removing phlegm anddifficioncy with stasis method combined metformin)in the treatment of PCOS-IR(kidney empty phlegm accurnulating and blood stasis syndrome)clinicalobservation in 30 cases of patients,average age 29.7 + /-3.02 years old.Clinical control is 33.3%;13 cases were markedly effective,significantefficiency is 43.3%;Effective in 5 cases,effective rate was 16.7%;Invalid in 2cases,no efficiency is 6.7%.The total effective rate was 93.3%.After treatmentthe index of BMI(27.12 + /-2.02 vs.23.93 + /-1.91,P < 0.05),HOMA IR(4.98 +/-2.57 vs.4.02 + /-2.17,P < 0.05),T(48.93 + /-17.13 vs.40.09 + /-12.75,P <0.05),LH/FSH(1.76 + /-1.14 VS1.04 plus or minus 0.53,P > 0.05),menstrualcycle(50.83 + /-4.46 days versus 48.27 + /-4.24 days,P < 0.05)weredecreased,P < 0.05,the curative effect is obvious.The score of TCM symptomsscore(16.66 + /-4.88 vs.12.63 + /-3.03,P < 0.05),acne integral(1.13 + /-1.27 vs.0.73 + /-1.12,P < 0.05),P < 0.05,decreased that showed clinical curativeeffect is obvious.THE score of ovulation rate(40% VS 53.3%),rasied pregnancyrate was 46.1%,and without adverse pregnancy rate.3)Three scheme is the mothwod of using warming utuerus,dissolvingphlegm and removing stasis combined asay the peptide)in the treatment ofPCOS-IR(kidney diffciency phlegm accumulated and blood stasis pattern)inclinical observation in 30 cases of patients,their average age 33.6 + /-2.05 yearsold. Clinical control 7 cases,cure rate is 23.4%;13 cases were markedly effective,significant efficiency is 43.3%;6 cases effective,effective rate was 20%;Invalid 4cases,no efficiency is 13.3%.The total effective rate was 86.7%.After treatmentof BMI(33.08 + /-3.87 vs.27.75 + /-2.95,P < 0.05),HOMA IR(5.06 + /-3.62 vs.3.06 + /-3.62,P < 0.05),T(52.83 + /-14.89 vs.47.58 + /-11.55,P < 0.05),LH/FSH(1.69 + /-1.47 vs.1.34 + /-0.78,P < 0.05),menstrual cycle(57.10 + /-3.91 days versus 54.50 + /-4.20 days,P > 0.05)decreased,P < 0.05,the curativeeffect is obvious.TCM symptom score(18.36 + /-5.12 vs.12.86 + /-3.12,P <0.05),and acne integral(1.26 + /-1.38 vs.0.76 + /-1.34,decreased,P < 0.05),P < 0.05,it indicates clinical curative effect is obvious.The obsevation alsoshoued.the ovulation rate(30% VS 43.3%),pregnancy rate 30.7%,and noadverse pregnancy rate.?Conclusion?1,the PCOS-IR,we found that the first three tppes of coustitutionthe to getPCOS-IR constitution,qi depression,Yang deficiency type.2,PCOS-IR mainly marifeste the "cold ness in the uterss",is characterizedby vnavkedly low heat metabolic rate of uterus.The PCOS-IR after treatmentwith ovulation is heat metabolic value of uters the rising3,Setting up treatment plan based on BMI embodies the precisive thevapyby combination of Chinese and western medicine treatment,The method of:warming uterus phlegm and removing stasis method plus rosiglitazone issuitable for BMI < 22 kg/m2 of patients with PCOS and IR;the method of warmpalace phlegm and dispelling stasis method + metformin is suitable for 22kg/m2 or less BMI < 30 kg/m2 of patients with PCOS and IR;the method warm palacephlegm and dispelling stasis method + asay the peptide is suitable for a BMI of 30kg/m2 or more patients with PCOS and IR;And three schemes are effective. |
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