中药对胰岛素抵抗多囊卵巢综合征患者性激素和胰岛素水平的影响及疗效观察

中药对多囊卵巢综合征患者糖脂代谢异常和生殖内分泌的调节作用（作者:___________单位: ___________邮编: ___________）【摘要】［目的］探讨比较中药、二甲双胍及口服避孕药复方醋酸环丙孕酮（达因35）对多囊卵巢综合征（pcos）患者胰岛素抵抗、糖脂代谢异常和生殖内分泌的调节作用。

［方法］将100例PCOS 患者分成中药组40例和西药组60例，后者又随机分为二甲双胍组和达因35组各30例。

观察3组患者治疗前后排卵恢复情况；比较体重指数、血清睾酮、空腹血糖、空腹胰岛素水平、血脂指标；稳态模型法测定的胰岛素抵抗指数。

［结果］中药组、二甲双胍组和达因35组分别有36、26、25例患者完成整个治疗疗程,排卵率为33%、20%和16%。

中药组明显高于二甲双胍组和达因35组，和达因35组比差异有统计学意义（P0.01）；中药组治疗后空腹胰岛素、睾酮、低密度脂蛋白水平、稳态模型法测定的胰岛素抵抗指数、均下降，与治疗前比，差异有统计学意义（P0.05）；与达因35组比差异有统计学意义（P0.05）。

［结论］中药对PCOS患者有改善胰岛素抵抗、降低低密度脂蛋白与恢复排卵和降低雄激素的作用。

【关键词】多囊卵巢综合征胰岛素抵抗糖脂代谢内分泌Abstract：［Objective］ To compare the efficacy of Chinese traditional medicine,metformin and cyproterone on reducing insulin resistance,improve metabolic status of glucose and lipid and raise ovulation rate in women with polycysitic ovarian syndrome.［Methods］ 100 women with PCOS were divided into three groups：40 patients chosen to be treated by Chinese traditional medicine.The rest were randomly divided into two groups which both contain 30 patients.One group is treated by metformin while another one is treated by cyproterone.Total 87 patients finished the treatment of three months.Basal body temperature （BBT）,body mass index,total testosterone,fasting serum insulin and blood sugar levels as well as lipid spectrum were measured and compared among all the patients before and after treatment.［Results］ No significant difference is found in the baseline characteristics among three groups before treatment.In Chinese traditional medicine group, 90％（36／40）patients finished the treatment，and 33％（12／36）patients ovulated.In metformin group,86％（26／30）patients finished the treatment，and 19％（5／26）patients ovulated.In cyproterone group,83％（25／30）patients finished the treatment，and 16％（4/25）patients ovulated.Ovulation rate wassignificantly higher in Chinese traditional medicine group than those in metformin and cyproterone groups .There was significant difference between Chinese traditional medicine group and cyproterone group（P0.01）.Significant difference was also found in Chinese traditional medicine group：after treatment the patients’ body mass index,total testosterone，serum fasting insulin,low density lipoprotein and the homeostasis model assessment index of insulin resistance descent significantly before treatments（P0.05）.［Conclusion］The Chinese traditional medicine can raise ovulation rate,significantly reduce insulin resistance,LDL C and total testosterone of polycysitic ovarian syndromed patients.Key words：polycysitic ovarian syndrome；insulin resistance；glucose lipid metabolism;endorine多囊卵巢综合征（polycysitic ovarian syndrome,PCOS）是目前临床最为常见的妇科内分泌疾病，发病率为5%～10%，且有不断上升趋势。

荷芪散联合二甲双胍治疗多囊卵巢综合征伴胰岛素抵抗的临床研究刘玲;赵恒侠;李惠林;楚淑芳;刘雪梅;刘德亮;张学文【摘要】Objective:To observe the clinical curative effect of Heqi Powder combined with Metformin in treating PCOS with insulinresistance.Methods:Ninety patients who met the criteria were included and randomly divided into group A (Chinese medicine group),group B (western medicine group) and group C (Chinese-western medicine group),with 30 cases in each group.Chinese medicine group took Heqi Powder,western medicine group took metformin,while the Chinese-western medicine group took Heqi Powder plus metformin.Clinical syndromes,glucose metabolic and insulin resistant parameters and sex hormone levels of the two groups before and after the treatment were compared.Results:After 3-month treatment,improvement in clinical syndromes of the Chinese-western medicine group was better than Chinese group and western medicine group (P ＜ 0.05).Insulin level and HOMA-IR in the western group and Chinese-western medicine group decreased effectively (P ＜ 0.01),ISI increased (P ＜ 0.01).The Chinese-western medicine group received better results,showing that the difference between the two groups was significant (P ＜0.05).LH (P ＜0.01) and T level (P ＜0.05,P ＜0.01) in the Chinese group and the Chinese-western medicine group decreased,but T level only decreased in the western medicine group (P ＜ 0.01).Conclusion:Heqi Powder combined with Metformin may improve patients' clinicalsyndromes and insulin resistance and regulate insulin and sex hormone levels for patients with PCOS with insulin resistance.%目的:研究荷芪散联合二甲双胍对多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)伴胰岛素抵抗(Insulin Resistance,IR)的临床疗效.方法:选取2015年1月至2016年1月深圳市中医院住院及门诊治疗的多囊卵巢综合征患者共90例,随机分为A组(中药组)、B 组(西药组)、C组(中西药组),每组30例.中药组予荷芪散,西药组予二甲双胍,中西药组予荷芪散加二甲双胍.观察治疗前后临床症状、糖代谢及胰岛素抵抗指标、性激素水平的变化.结果:治疗3个月后,中西药组临床症状改善优于中药组及西药组(P＜0.05);西药组、中西药组均可显著降低胰岛素(FINS、2 hINS)水平、稳态胰岛素评价指数(HOMA-IR) (P ＜0.01),提高胰岛素敏感性指数(ISI) (P ＜0.01),中西药组比西药组治疗效果更显著,差异有统计学意义(P＜0.05).中药组与中西药组能降低血清黄体生成素(Luteinizing Hormone,LH)(P＜0.01)、睾酮(Tes-tosterone,T)水平(P ＜0.05,P＜0.01),而西药组仅可降低T水平(P＜0.01).结论:荷芪散联合二甲双胍可改善多囊卵巢综合征伴胰岛素抵抗患者的临床症状和胰岛素抵抗,调节胰岛素及性激素水平.【期刊名称】《世界中医药》【年(卷),期】2017(012)008【总页数】4页(P1832-1835)【关键词】多囊卵巢综合征;荷芪散;二甲双胍;胰岛素抵抗;性激素【作者】刘玲;赵恒侠;李惠林;楚淑芳;刘雪梅;刘德亮;张学文【作者单位】深圳市中医院内分泌病科,深圳,518033;深圳市中医院内分泌病科,深圳,518033;深圳市中医院内分泌病科,深圳,518033;深圳市中医院内分泌病科,深圳,518033;深圳市中医院内分泌病科,深圳,518033;深圳市中医院内分泌病科,深圳,518033;陕西中医药大学,咸阳,712046【正文语种】中文【中图分类】R271.19多囊卵巢综合征是青春期及育龄期妇女常见病,发病率达5%～10%[1],以雄激素增多、慢性无排卵或少排卵、胰岛素抵抗为主要特征的内分泌综合征。

丹栀逍遥丸对多囊卵巢综合征患者内分泌功能的影响及机制王香格，张海梅①，梁晓兰②，黄彦林③，李金梅④，张晓芳⑤（冀中能源井陉矿业集团有限公司总医院妇产科，石家庄 050100）摘要：目的 分析丹栀逍遥丸对多囊卵巢综合征患者内分泌功能的影响及机制。

方法 选取2015年8月-2016年8月在某院诊断为肥胖型多囊卵巢综合征的患者120例，按入院先后，以信封法随机分为观察组与对照组，各60例。

对照组患者给予二甲双胍+克罗米芬联合治疗，观察组在对照组治疗基础上给予加用丹栀逍遥丸治疗，治疗时间为3个月。

分别于治疗前后采用免疫化学发光法检测血清促卵泡刺激素(follicle-stimulating hormone ，FSH)、促黄体生成素(luteinising hormone ，LH)、雌二醇(estradiol ，E 2)，测定患者空腹胰岛素(fasting insulin secretion ，FINS)、空腹血糖(fasting plasma glucose ，FPG)，计算胰岛素抵抗指数(homeostasis model-insulin resistance ，HOMA-IR)、胰岛素分泌指数(homeostasis model assessment β，HOMA-β)指标，采用酶联免疫吸附法检测患者血清白介素-6(interleukin-6，IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)水平。

结果 治疗前，2组患者年龄、体重指数、病程等基线资料的差异均无统计学意义(P >0.05)。

治疗后，2组患者血清FSH 、LH 水平升高，E 2水平下降，治疗前后比较差异有统计学意义(P <0.05)。

其中，观察组改善幅度优于对照组，差异有统计学意义(P <0.05)。

治疗后，2组患者血FINS 、FPG 、HOMA-IR 、HOMA-β下降，观察组下降幅度大于对照组，组内治疗前后比较与治疗后组间比较差异均有统计学意义(P <0.05)。

中医药干预胰岛素抵抗机制研究进展白颖1暴雪丽2赵丹丹1莫芳芳1张东伟1姜广建1高思华1(1北京中医药大学中医学院，北京,170029；2北京中医药大学第三附属医院，北京,170027)摘要胰岛素抵抗(Insuliu RePsUnce,IR)是0型糖尿病的重要病理特征，其发病机制复杂，包括肥胖、遗传等因素引起的多种激素水平紊乱，慢性轻度炎症反应，氧化应激和能量代谢障碍导致线粒体功能受损等，基本可分为受体前、受体和受体后3个环节。

中药复方、中成药、单味中药或其有效成分、针灸等疗法都能在一定程度上改善IR,从细胞、分子水平展开的相关研究也越来越细致、深入。

关键词中医;胰岛素抵抗;2型糖尿病;发病机制；中药;中药复方;中成药;机制研究Research Progress on Mechanism of Traditional Chinese Medicine Intervention in Insulin ResistanceBAI Ying1,BAO Xaell0,ZHAO DanCan1,MO Fangfang1, ZHANG DoagweP,JIANG Gaangjian1,GAO SiUna1(1School of'Traditional Chinese Med込z ie，及沪昭University of Chinese Medicine,4eying100429,C加z m；0Beijing University of Chinese Medicinr ThirS Affiliated Hospitdl,Beijinn140429,ChOd)Abstraci Insuliu resistance(IR)is an imporianU戸801010101feature of type0diabetes mellitas(T2MD).Ns complicatee patho-aenesis incluaes Uisorrier of verioas kings of hormoaes causeS bp factors sach as obesita and mherimnee,chroaic low inCammatorri reaction,anU impaireS mitochoahriai funchoa caasee bp oxiUabve stress,eeerap metabolic disturbance,which can be basicaby UP viUee inta three staaes：pre-receptor,receptor and post-receptor staae.N has bees provee that herriai compoxnU prescriptioas,pateet meeicine, smale types of herri or its active(3011^0X6(1-and other therapies such as acapuncture can to some extest alleviate IR.Re­lateS research from cellular and molecalar levels has alse become more Uetailed and Ueeper.Starting with the pathovenesis of IR Ue-scriPeP iu trabiUoxai Chinese medicine(TCM)and Western medicine,this paper reviews the mechanism research of TCM interven-tiox of IR iu recent years,anU offers a reference for relative research iu future.KeyworCt Trabitioxai Chinese medicine;Insuliu resistance;Type0Diabetes；Pathovenesis；Chinese medicine;CompoxnU ChP nese Medicine；Chinese patent medicine；Mechanism research中图分类号:R240；R537.1文献标识码：A dot：3969/j.Pen1577-7720.747(.77.220胰岛素作为人体内最重要的血糖调节激素，能够使葡萄糖进入肌肉、脂肪等组织细胞3促进葡萄糖在组织细胞的摄取和利用，促进脂肪、蛋白质、糖原等的合成。