摘要
目的探讨焦虑状态对多囊卵巢综合征(PCOS)不同中医证候患者的影响。方法将309例伴焦虑状态的PCOS患者进行中医辨证,观察其中医证候分布情况,并比较不同证候组Zung焦虑自评量表(SAS)评分,年龄、体重指数(BMI)、腰臀比(WHR),痤疮、多毛、黑棘皮评分,性激素指标及糖脂代谢指标,分析不同证候组患者焦虑状态评分与不同因素的相关性。结果 309例伴焦虑状态的PCOS患者中,肾虚肝郁组107例(34.63%)、痰瘀互结组80例(25.89%)、脾虚痰湿组62例(20.06%)、肾虚血瘀组60例(19.42%)。各组SAS评分比较,肾虚肝郁组SAS评分高于脾虚痰湿组、痰瘀互结组、肾虚血瘀组(P<0.05)。脾虚痰湿组、痰瘀互结组BMI和WHR均高于肾虚肝郁组、肾虚血瘀组(P<0.05)。痤疮评分由高到低分别为肾虚血瘀组、肾虚肝郁组、痰瘀互结组、脾虚痰湿组,且所有两两组比较均具有统计学意义(P<0.05);多毛评分肾虚肝郁组高于脾虚痰湿组、痰瘀互结组(P<0.05);黑棘皮评分脾虚痰湿组、痰瘀互结组均高于肾虚肝郁组、肾虚血瘀组(P<0.05)。促黄体生成素(LH)肾虚肝郁组、痰瘀互结组、肾虚血瘀组均高于脾虚痰湿组(P<0.05);促卵泡生成素(FSH)肾虚肝郁组、肾虚血瘀组均高于痰瘀互结组、脾虚痰湿组,其中痰瘀互结组又高于脾虚痰湿组(P<0.05)。胆固醇(TC)痰瘀互结组高于肾虚肝郁组、肾虚血瘀组(P<0.05);甘油三酯(TG)脾虚痰湿组、痰瘀互结组均高于肾虚肝郁组、肾虚血瘀组(P<0.05);低密度脂蛋白胆固醇(LDL-C)痰瘀互结组高于肾虚肝郁组、脾虚痰湿组、肾虚血瘀组,其中脾虚痰湿组又高于肾虚血瘀组(P<0.05);空腹血糖(FPG)脾虚痰湿组、痰瘀互结组均高于肾虚肝郁组、肾虚血瘀组,其中肾虚肝郁组又高于肾虚血瘀组(P<0.05);空腹胰岛素(FINS)与稳态模型胰岛素抵抗指数(HOMA-IR)均为脾虚痰湿组、痰瘀互结组高于肾虚肝郁组、肾虚血瘀组(P<0.05)。相关分析中,焦虑评分与肾虚肝郁组PCOS患者FSH,睾酮(T),泌乳素(PRL),硫酸脱氢表雄酮(DHEAS),LDL-C呈正相关;与脾虚痰湿组PCOS患者WHR,T,TC,TG,LDL-C,FPG呈正相关,与性激素结合球蛋白(SHBG)呈负相关;与痰瘀互结组PCOS患者的年龄,雌二醇(E2),T,TC,TG,LDL-C呈正相关,与高密度脂蛋白胆固醇(HDL-C)呈负相关;与肾虚血瘀组PCOS患者的BMI,E2,T,PRL,雄烯二酮(AND),LDL-C呈正相关,与SHBG和HDL-C呈负相关。结论焦虑状态对PCOS不同证候患者有不同的影响,临床应针对不同证候采取不同的治疗和预防措施,以获取更好的临床疗效。
Objective To explore the effect of anxiety on patients with polycystic ovary syndrome(PCOS) with different TCM syndromes. Methods TCM syndrome differentiation was carried out on 309 PCOS patients with anxiety. Observing the distribution of TCM syndromes, Zung Self-rating Anxiety Scale(SAS) score, age, body mass index(BMI), waist-hip ratio(WHR), acne score, hirsutism score and acanthosis nigricans score, sex hormone index and glycolipid metabolism index among different syndromes groups, then analyzing the correlation between anxiety score and different factors in patients with different syndromes. Results In 309 PCOS anxiety patients, 107(34.63%)are in the kidney deficiency and liver constraint group, 80(25.89%) are in the binding of phlegm and stasis group, 62(20.06%)are in the spleen deficiency and phlegm-damp group, and 60(19.42%) are in the kidney deficiency and blood stasis group. SAS score of kidney deficiency and liver constraint group is higher than that of spleen deficiency and phlegm-damp group, binding of phlegm and stasis group and kidney deficiency and blood stasis group(P<0.05).BMI and WHR in spleen deficiency and phlegm-damp group and binding of phlegm and stasis group are higher than in the kidney deficiency and liver constraint group and kidney deficiency and blood stasis group(P<0.05). Acne scores ranged from high to low respectively is kidney deficiency and blood stasis group, kidney deficiency and liver constraint group, binding of phlegm and stasis group and spleen deficiency and phlegm-damp group, and the comparison between the two groups has statistical significance(P<0.05). Hirsutism score in kidney deficiency and liver constraint group is higher than spleen deficiency and phlegm-damp group and binding of phlegm and stasis group(P<0.05). Acanthosis nigricans socre in spleen deficiency and phlegm-damp group and binding of phlegm and stasis group is higher than in the kidney deficiency and liver constraint group and kidney deficiency and blood stasis group(P<0.05).Luteinizing hormone(LH) is the higher in kidney deficiency and liver constraint group,binding of phlegm and stasis group and kidney deficiency and blood stasis group than in the spleen deficiency and phlegm-damp(P<0.05). And follicle-stimulating hormone(FSH) is higher in kidney deficiency and liver constraint group and kidney deficiency and blood stasis group than in the binding of phlegm and stasis and spleen deficiency and phlegm-damp, and binding of phlegm and stasis is also higher than spleen deficiency and phlegm-damp(P<0.05).Total cholesterol(TC) is higher in binding of phlegm and stasis than kidney deficiency and liver constraint and kidney deficiency and blood stasis(P<0.05). Triglyceride(TG) is higher in spleen deficiency and phlegm-damp and binding of phlegm and stasis than kidney deficiency and liver constraint group and kidney deficiency and blood stasis group(P<0.05). Low density lipoprotein cholesterol(LDL-C) is higher in binding of phlegm and stasis group than kidney deficiency and liver constraint group, spleen deficiency and phlegm-damp group and kidney deficiency and blood stasis group, and spleen deficiency and phlegm-damp is higher than kidney deficiency and blood stasis group(P<0.05). Fasting blood glucose(FPG) is higher in spleen deficiency and phlegm-damp group and binding of phlegm and stasis group than in the kidney deficiency and liver constraint group and kidney deficiency and blood stasis group, and kidney deficiency and liver constraint group was also higher than in the kidney deficiency and blood stasis group(P<0.05). Fasting insulin(FINS) and insulin resistance index in homeostasis model(HOMA-IR) in spleen deficiency and phlegm-damp and binding of phlegm and stasis are higher than in the kidney deficiency and liver constraint and kidney deficiency and blood stasis(P<0.05). In correlation study, anxiety score of pcos patients is positively related with FSH, Testosterone(T), Prolactin(PRL), Dehydroepiandrosterone Sulfate(DHEAS), LDL-C in kidney deficiency and liver constraint. And is positively correlated with WHR, T, TC, TG, LDL-C, FPG and negatively related to sex hormone binding globulin(SHBG) in spleen deficiency and phlegm-damp. And is positively correlated with age, Estradiol(E2), T, TC, TG and LDL-C and negatively correlated with high density lipoprotein cholesterol(HDL-C) in binding of phlegm and stasis. And is positively correlated with BMI, E2, T, PR, Androstendione(AND), LDL-C and negatively correlated with SHBG and HDL-C in kidney deficiency and blood stasis. Conclusion Anxiety has different effects on PCOS patients with different syndromes, different treatment and preventive measures should be taken according to different syndromes in order to obtain better clinical efficacy.
作者
张红阳
侯丽辉
Zhang Hongyang;Hou Lihui(Heilongjiang University of Chinese Medicine,Heilongjiang 150040;Departmnet of Obstrics and Gynecology,The First Affiliated Hospital of Heilongjiang University of Chinese Medicine)
出处
《现代中医临床》
2019年第3期11-17,共7页
Modern Chinese Clinical Medicine
基金
国家中医药管理局国家中医临床研究基地业务建设科研专项课题(No.JDZX2012039)
国家中医药管理局全国名老中医药专家传承工作室建设项目
2016年黑龙江省政府博士后资助项目(No.LBH-Z16199)
作者简介
张红阳,女,在读博士生;通信作者:侯丽辉,女,主任医师、教授,博士生导师,E-mail:houlihui2007@sina.com.
