多囊卵巢综合征中医证型与胰岛素抵抗的相关性研究

发布时间：2018-05-02 11:55

本文选题：多囊卵巢综合征 + 辨证分型　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：研究多囊卵巢综合征(PCOS)不同中医证型与胰岛素抵抗(IR)的相关性,探讨口服葡萄糖耐量试验(OGTT)、胰岛素释放试验(IRT)在评估多囊卵巢综合征患者胰岛素抵抗中的价值。方法：将60例多囊卵巢综合征患者按照中医辨证分为痰湿证、肝郁证、肾虚证三组,对三组进行口服75g葡萄糖行糖耐量及胰岛素释放试验,使用SPSS 20.0软件采用方差分析、秩和检验、卡方检验等统计学方法,比较不同证型患者各时相血糖、胰岛素,及曲线下面积、胰岛素抵抗指数(HOMA-IR)、糖代谢异常等情况,分析三组患者以胰岛素抵抗简易指标异常、胰岛素释放曲线异常为不同评估标准的胰岛素抵抗的发生率。结果：1.经纳入的60例PCOS患者,中医证型分布存在差异(P＜0.01),以痰湿证最多,共32例(53.33%),其次为肝郁证18例(30.00%)、。肾虚证10例(16.67%)。2.痰湿证患者BMI及WHR均比肝郁证、肾虚证偏高(P0.01),肝郁证、肾虚证之间无统计学差异。痰湿证患者BMI均值大于25kg/m2,WHR均值大于0.85,肥胖及腹型肥胖严重。肝郁证、肾虚证整体处于健康体重,WHR均值大于等于0.80。3.三组患者0GTT 0.5h、2h、3h血糖之间无统计学差异(P＞0.05),平均血糖水平均未出现糖耐量异常。痰湿证大部分时间点的平均血糖有高于另外两组的趋势。空腹血糖较肾虚证增高(P0.05),服糖1h血糖、血糖曲线下面积比肝郁证高(P＜0.05,P0.01)。4.痰湿证较肝郁证、肾虚证患者空腹胰岛素、服糖2h胰岛素、胰岛素释放曲线下面积、HOMA-IR高,差异有统计学意义。痰湿证空腹胰岛素均值大于15μIU/mL。5.共有18例(30%)患者出现糖代谢异常(IFG/IGT/糖尿病),其中1例达到糖尿病标准。三组间糖代谢异常发病率无统计学差异(P＞0.05)。6.采用简易指标进行IR的评估,痰湿证IR发生率明显高于肝郁证和肾虚证。采用胰岛素释放曲线异常指标进行IR的评估,三组IR发生率差异无统计学意义。采用胰岛素释放曲线异常指标来评估肝郁证和肾虚证患者IR发生率显著高于采用简易指标所评估的发生率。结论：痰湿证多囊卵巢综合征患者胰岛素抵抗较非痰湿证严重,OGTT、IRT更能敏感反映多囊卵巢综合征患者尤其是非痰湿证患者的胰岛素抵抗状态。
[Abstract]:Objective: to study the relationship between different TCM syndromes and insulin resistance (IRI) in polycystic ovary syndrome (PCOS), and to explore the value of oral glucose tolerance test (OGTT) and insulin release test (IRTT) in evaluating insulin resistance in patients with polycystic ovary syndrome (PCOS). Methods: sixty patients with polycystic ovary syndrome were divided into three groups according to TCM syndrome differentiation: phlegm and dampness syndrome, liver stagnation syndrome and kidney deficiency syndrome. The glucose tolerance and insulin release test were performed in three groups by oral administration of 75g glucose, and the variance analysis was used with SPSS 20.0 software. Rank sum test, chi-square test and other statistical methods were used to compare the blood glucose, insulin, area under curve, insulin resistance index (HOMA-IRN), abnormal glucose metabolism and so on in different syndromes of patients with different syndromes. The abnormal insulin release curve was the incidence of insulin resistance in different assessment criteria. The result is 1: 1. There was significant difference in the distribution of TCM syndromes in 60 PCOS patients (P < 0.01). The phlegm and dampness syndrome was the most common, 32 cases had a total of 53.33D, followed by 18 cases of liver depression syndrome. There were 10 cases of kidney deficiency syndrome. The BMI and WHR of phlegm dampness syndrome were higher than those of liver stagnation syndrome, and there was no statistical difference between kidney deficiency syndrome and liver stagnation syndrome. The mean value of BMI in patients with phlegm dampness syndrome was more than 25 kg / m ~ 2. The mean value of WHR was more than 0.85. Obesity and abdominal obesity were serious. Liver depression syndrome, kidney deficiency syndrome as a whole in a healthy body weight WHR mean greater than equal to 0.80.3. There was no significant difference in blood glucose between the three groups (P > 0.05), and no abnormal glucose tolerance was found in the mean blood glucose level. The average blood glucose at most time points of phlegm dampness syndrome was higher than that of the other two groups. The fasting blood glucose was higher than that of kidney deficiency syndrome (P < 0.05), and the area under blood glucose curve was higher than that of liver depression syndrome (P < 0.05). Phlegm and dampness syndrome was higher than that of liver stagnation syndrome, and the fasting insulin, 2 h glucose insulin and the area under the insulin release curve were significantly higher in the patients with kidney deficiency than those in the patients with kidney deficiency, and the difference was statistically significant. The mean value of fasting insulin in phlegm dampness syndrome was greater than 15 渭 IUP / mL. 5. There were 18 patients with abnormal glucose metabolism (IFG / IGT / DM), one of whom met the diabetes standard. There was no significant difference in the incidence of abnormal glucose metabolism among the three groups (P > 0.05. 6). The incidence of IR in phlegm dampness syndrome was significantly higher than that in liver stagnation syndrome and kidney deficiency syndrome. There was no significant difference in the incidence of IR among the three groups. The incidence of IR in patients with liver depression and kidney deficiency was significantly higher than that with simple index. Conclusion: insulin resistance in patients with polycystic ovary syndrome with phlegm dampness syndrome is more sensitive than that in patients without phlegm dampness syndrome, especially in patients with non-phlegm dampness syndrome.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R271.9

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