针药人工周期疗法对痰湿型多囊卵巢综合征胰岛素抵抗患者临床疗效及部分作用机制观察

发布时间：2018-07-20 12:27

【摘要】：目的:观察在西药基础上针灸联合中药人工周期疗法与单纯西药治疗痰湿型多囊卵巢综合征(PCOS)胰岛素抵抗患者的临床疗效差异,并探讨其部分作用机制。方法:将60例患者随机分为观察组和对照组,每组30例。对照组于月经第3天开始口服来曲唑和二甲双胍。观察组在对照组基础上予以针灸配合中药治疗。主穴取关元、气海及双侧子宫、卵巢、丰隆、阴陵泉、足三里、三阴交,卵泡期配合大赫穴,并于关元和气海穴行温针灸;排卵期配合中极、血海穴,并于气海和中极穴、血海和阴陵泉穴接2组电针,选择2 Hz连续波;黄体期取以上主穴,并艾灸关元和气海穴,每次30 min,隔日1次;月经期间停止治疗。中药以补肾养血、健脾化痰为主。两组均连续治疗3个月经周期。观察两组治疗前后血清中血清微小核糖核酸-29(mi R-29)表达水平、中医症状积分、内分泌激素值[促卵泡生成素(FSH)、促黄体生成素(LH)、睾酮(T)、催乳素(PRL)、LH/FSH值]、胰岛素(INS)和血糖含量及胰岛素抵抗(HOMA-IR)指数,并比较两组治疗后妊娠情况。结果:两组治疗后mi R-29基因表达及中医症状积分均低于治疗前(P0.01,P0.05),且观察组改善情况优于对照组(P0.01,P0.05)。观察组治疗后LH、LH/FSH及T值均低于治疗前(P0.01,P0.05),对照组治疗后T值低于治疗前(P0.05),观察组LH、LH/FSH改善情况优于对照组(均P0.05)。两组治疗后INS、血糖含量、HOMA-IR指数均低于治疗前(P0.05,P0.01),且观察组INS、HOMA-IR指数改善情况优于对照组(均P0.05)。观察组妊娠率为56.7%(17/30),明显高于对照组的30.0%(9/30,P0.05)。结论:针药人工周期疗法能改善痰湿型PCOS患者的内分泌和胰岛素抵抗情况,同时能显著提高患者的妊娠率,从分子生物学角度,有可能通过mi R-29表达的改变来作用于多囊卵巢综合征胰岛素抵抗。
[Abstract]:Objective: to observe the clinical effects of acupuncture and moxibustion combined with traditional Chinese medicine (TCM) on insulin resistance in patients with phlegm-wet polycystic ovary syndrome (PCOS) on the basis of western medicine and to explore its mechanism. Methods: 60 patients were randomly divided into observation group and control group with 30 cases in each group. The control group took letrozole and metformin orally on the 3rd day of menstruation. The observation group was treated with acupuncture combined with traditional Chinese medicine on the basis of control group. The main points were collected from Guan Yuan, Qi Hai and bilateral uterus, ovary, Fenglong, Yin Lingquan, Zusanli, Sanyinjiao, follicular phase and Dahe points, and were used at Guanyuan and Qihai acupoints to warm acupuncture and moxibustion; at ovulation stage combined with Zhongji, Xuehai points, and at Qihai and Zhongji points, Xuehai and Yinlingquan points were connected with two groups of electroacupuncture, 2 Hz continuous wave was selected, and the above main points were taken in luteal phase, and moxibustion at Guanyuan and Qihai points, 30 minutes each time, once every other day, and the treatment was stopped during menstruation. Traditional Chinese medicine to tonify the kidney and nourish blood, invigorating spleen and resolving phlegm. The two groups were treated continuously for 3 menstrual cycles. To observe the expression level of serum minute ribonucleic acid (miR-29) in serum of both groups before and after treatment, and to observe the score of TCM symptoms. Endocrine hormone values (FSH, LH, T, PRL), insulin (ins), blood glucose content and HOMA-IR index were compared between the two groups. Results: after treatment, the expression of miR-29 gene and the score of TCM symptom in both groups were lower than those before treatment (P 0.01 P 0.05), and the improvement of observation group was better than that of control group (P 0.01 P 0.05). After treatment, the LHH / FSH and T values in the observation group were lower than those before the treatment (P 0.05), and the T values in the control group were lower than those before the treatment (P0.05). The improvement of LHH / FSH in the observation group was better than that in the control group (P0.05). After treatment, the levels of insulin, glucose and HOMA-IR in the two groups were lower than those before treatment (P0.05, P0.01), and the improvement of INSHOMA-IR index in the observation group was better than that in the control group (P0.05). The pregnancy rate in the observation group was 56.7% (17 / 30), which was significantly higher than that in the control group (30.0%). Conclusion: acupuncture and medicine artificial cycle therapy can improve endocrine and insulin resistance in PCOS patients with phlegm dampness, and increase pregnancy rate in patients with phlegm dampness type PCOS. It is possible that the insulin resistance of polycystic ovary syndrome is affected by the change of mi R 29 expression.
【作者单位】：福建医科大学附属福建省妇幼保健院中医科;
【基金】：国家自然科学基金资助项目:81302998 福建省科学技术厅科技计划项目:2015Y0002 福建省中医药科研项目:wzfg201304 福建省卫生计生委青年科研课题:2014-1-20
【分类号】：R246.3

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