PCOS患者代谢特征分析及水飞蓟素对PCOS大鼠的影响观察

发布时间：2018-06-16 07:09

本文选题：多囊卵巢综合征 + 痰湿证　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：1.通过对PCOS患者临床症状调查分析将患者分为中医痰湿证组与非痰湿证组,进而对其临床基本情况及代谢指标等进行统计学分析,从而归纳总结PCOS痰湿证的临床及生化检查方面的证型特征,为临床诊治提供依据。2.研究水飞蓟素对PCOS大鼠炎性纤维化的影响,以及对胰岛素敏感性,为治疗卵巢纤维化提供一种新途径。方法：1.临床研究：选自2013年5月-2015年12月在鼓楼医院内分泌科的门诊和住院PCOS患者,共收集150例,辨证分型非痰湿组81例,痰湿组69例,记录患者的一般情况、性激素及内分泌代谢指标水平行统计学分析。2.动物实验研究：选取40只21日龄雌性SD大鼠,将其随机分为空白对照组6只和模型组34只,模型组采用皮下注射DHEA(6mg/100g)+油剂(0.2ml)的造模方法,正常组采用皮下注射油剂(0.2ml)的造模方法,模型组成模后将其随机分为模型对照组、水飞蓟素组、二甲双胍组和水飞蓟素+二甲双胍组,比较治疗后各组大鼠与模型对照组的基本情况、代谢指标和血清慢性炎症因子水平差异。结果：1.临床研究：痰湿组较非痰湿组PCOS患者基本情况：BMI有显著统计学意义(P0.01); WHR、SBP、DBP有统计学意义(P0.05),且均高于非痰湿组；代谢指标：LDL、TG水平显著高于非痰湿证组(P0.05), HDL水平比较虽无统计学意义,但也较非痰湿证组低；PBG、PINS显著高于非痰湿组(P0.01), FPG、PBG水平比较虽无统计学意义,但较非痰湿组水平高；性激素：LH、T水平显著高于非痰湿证组(P0.05), LH/FSH水平比较虽无统计学差异,但也较非痰湿证组高；2.动物实验：干预结束后OGTT实验结果：治疗组血糖水平均较模型组低,其中二甲双胍组0’、120’血糖水平与模型组有显著差异(P0.01);水飞蓟素组0’血糖水平与模型组有统计学意义(P0.05)120’血糖水平与模型组有明显统计学意义(P0.01)；水飞蓟素+二甲双胍组0’、120’血糖水平与模型组差异显著(P0.01)；水飞蓟素+二甲双胍组TG、TC、LDL水平均较模型组降低明显降低(P0.05),其中水飞蓟素组、二甲双胍组LDL水平较模型组水平显著降低(P0.05)；模型组IL-6水平均较治疗组均有所升高,且与水飞蓟素+二甲双胍组存在显著统计学差异(P0.05),模型组CTGF水平均较治疗组均有所升高,其中与水飞蓟素组、水飞蓟素+二甲双胍组水平有显著差异(P0.05)；其余组间水平无显著差异；各组间ALT、AST水平均无统计学差异。结论：1.痰湿证PCOS患者较非痰湿证PCOS患者更具有代谢紊乱的特点,且痰湿证患者中发生IR的发生较非痰湿组高,由此可以说明PCOS痰湿证与IR具有一定的正相关性；2.动物实验结果提示二甲双胍可改善PCOS大鼠血脂、胰岛素和慢性炎症因子水平,水飞蓟素可能对PCOS的经典药物治疗有着辅助治疗效果。
[Abstract]:Purpose 1. Patients with PCOS were divided into phlegm dampness syndrome group and non-phlegm dampness syndrome group. Therefore, the clinical and biochemical characteristics of PCOS phlegm dampness syndrome were summarized, which provided the basis for clinical diagnosis and treatment. To study the effect of silymarin on inflammatory fibrosis and insulin sensitivity in PCOS rats, which provides a new approach for the treatment of ovarian fibrosis. Method 1: 1. Clinical study: from May 2013 to December 2015, 150 patients with PCOS were collected from the Department of Endocrinology, Gulou Hospital. There were 81 cases of non-phlegm dampness group and 69 cases of phlegm dampness group. Sex hormone and endocrine metabolism index were analyzed statistically. Animal experimental study: forty 21-day-old female SD rats were randomly divided into control group (n = 6) and model group (n = 34). The model group was made by subcutaneous injection of DHEAA 6mg / 100g oil (0.2ml) and the normal group by subcutaneous injection of oil (0.2ml). The model was randomly divided into three groups: model control group, silymarin group, metformin group and silymarin metformin group. Metabolic indexes and serum levels of chronic inflammatory factors were different. The result is 1: 1. Clinical study: there was significant difference between phlegm-dampness group and non-phlegm-dampness group in PCOS patients' basic condition: (1) BMI was significantly higher than that in non-phlegm dampness group (P 0.01), WHRX SBP DBP was significantly higher than that in non phlegm dampness group (P 0.05). The level of TG was significantly higher than that of non-phlegm dampness syndrome group (P 0.05). The level of HDL was not statistically significant, but it was significantly higher than that of non-phlegm dampness syndrome group (P 0.01). The level of FPGN PBG was higher than that of non-phlegm damp group. The level of sex hormone 1: LHN T was significantly higher than that of non phlegm dampness syndrome group (P 0.05). Although there was no statistical difference in LH / FSH level, it was also higher than that of non phlegm dampness syndrome group (P 0.05). Animal experiment: the results of OGTT experiment after intervention: the blood glucose level of the treatment group was lower than that of the model group. There was significant difference between metformin group and model group in blood glucose level (P 0.01), silymarin group (P 0.05) and model group (P 0.01). The level of blood glucose in silymarin metformin group was significantly lower than that in model group (P 0.01), and the level of TGN TCU LDL in silymarin metformin group was significantly lower than that in model group, especially silymarin group. The level of LDL in metformin group was significantly lower than that in model group, IL-6 level in model group was higher than that in treatment group, and there was significant difference between model group and silymarin metformin group (P0.05). CTGF level in model group was higher than that in treatment group. There was significant difference between silymarin metformin group and silymarin group, but there was no significant difference in other groups. Conclusion 1. Phlegm dampness syndrome PCOS patients than non-phlegm dampness syndrome PCOS patients have more characteristics of metabolic disorder, and phlegm dampness syndrome in patients with higher incidence of IR than non-phlegm dampness group, which can show that PCOS phlegm dampness syndrome and IR have a certain positive correlation. The results suggested that metformin could improve the levels of blood lipids, insulin and chronic inflammatory factors in PCOS rats. Silymarin might have an adjuvant effect on the classical drug therapy of PCOS.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R271.9

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