| [Objective]PCOS is a syndrome characterized by anovulation irregular or absent menstruation], infertility, obesity, excess hair growth, and acne. The causes of PCOS are compLicated, there are various theories about etiology, none of which can elucidate the abnormal manifestations of PCOS. Insulin resistance accompanied by compensatory hyperinsulinemia as well as hyperandrogenism are believed to be the main characteristics of PCOS.PCOS can cause symptoms of irregular menstrual cycle, infertility, hirsutism, and obesity ect. Causing obstetrical disorders such as natural abortion, gestational diabetes mellitus, raising the risk of cardiovascular disease, noninsulin-dependent diabetes mellitus and endometrial carcinoma. Morbid insulin and hyperandrogenism are associated with some potential complications. The vasoactive action of insulin has been extensively focused on . The damage of endothelial cell in the vessels will lead to disorders of endocrine function, thus resulting in such pathological conditions as disturbed blood circulation and thrombosis, ect.TCM, which has been studied a lot in the clinical treatment of pcos, is still lack of study on direct observation of endothelial damage and vasoactive function. Professor zhang yu-zhen has been addressing herself to the treatment of PCOS with Chinese herbs for many years, and has summarized that treatment based on syndrome differentiation accompanied by using Chinese herbs for activating blood stasis could improve the clinical efficiency. This study aims to seek the microscopic evidence of blood stasis in PCOS, discuss the mechanism of blood stasis causing PCOS and stimulate circulation to end stasis, observe the effect of Chinese herbs on endothelial cells, so as to detect the significance of TCM treating PCOS and preventing its complications, as well as reflecting a theory in TCM of preventive treatment disease.[method]1.58 cases with PCOS were selected, 18 of whom were overweight, 40 nonoverweight. According to syndrome differentiation, 18 cased are of kidney asthenia, 18 cases of phlegm and dampness, 16 of dampness heat accumulating the liver, 6 stagnation of qi and blood. 15 healthy female adults with regular menstruation were grouped into the control group. The kidney asthenia group were treated with modified yougui bolus with taohong siwu decoction, which is composed of tusizi duzhong shudi gouqizi danggui fuling shanyao shanyurou chuanxiong taoren. The therapeutic method of invigorating the kidney and spleen, reducing phlegm and activate blood was used in treating phlegm and dampness group, with modified cangfu daotan Bolus composed of cangzhu xiangfu banxia fuling chenpi huangqi danggui xianlingpi chuanxiong.The group of damp heat accumulating the liver were treated with modified danzhixiaoyao powder functioning to clear liver fire and remove damp, which is composed of danpi zhizi danggui shengdi baishao fuling zaojiaoci chaihu taoren etc. The group of qi stagnation and blood stasis were treated with modified gexiazhuyu decoction functioning to regulating qi and blood , which is composed of danggui chaunxiong chishao taoren zhiqiao xiangfu wuyao gancao etc. Observe the changes before and after the treatment of the patients;measure the serum level of FSH, LH, E2, T with electro-chemiluminescence and assay the concentration of insulin and plasma ET before and after treatment with radioimmunoassay.2.rat models of PCOS have been established according Poretsky, with the purpose of observing the effect of Guishen Bolus and Taohongsiwu Decoction on the shape and function of the endothelial cells in rat aorta. Cemitidine and Taohongsiwu Decoction was used in the control group. Measure the serum level of FSH, LH, T, INS and plasma ET PAI-1, and observe the endothelial cell morph.[results]1.clinical results(1)20 cases regain their normal menstruation, 14 of whose menstrual period is within 40days, 9 within 3months, 15 cases without any changes, the total efficiency rate is 74.1%;the rate of regaining normal BBT is 46. 9%. The results show that Chinese herbs can efficiently correct the menstrual irregularity, stimulate the ovulation, thus raising the pregnancy rate and lowering theincidence of natural abortion after conception.(2)After treatment based on syndrome differentiation, the level of LH, T, LH/ T, INS, ET in each group decreased obviously and the level of E2 increased obviously, both of which showed the significant difference (KO. 05)2. experimental results(l)In the control group, group of Guishen bolus and Taohongsiwu Decoction, the endothelial cells appear flat, arranging along the long axis of the blood vessels, normal endothelial cell integrity with scanty cytoplasm and the microscopic appearance shows highly developed golgiosome rough endoplasmic reticulum and smooth endoplasmic reticulum. In the model group, Cemitidine group and Taohongsiwu Decoction group, the endothelia cells of the rat aorta were contracted, with discontinuous basement membrane, inflated chondriosome, the middle layer smooth muscles tending to move inside and out of the normal shape of intraendothelial junction.(2)The groups which were respectively treated with Taohongsiwu Decoction and Cemitidine have a significantly lower serum level of L^ T> INS> PAI-I ET than those of the model group(KO. 05). There were no significant difference between the healthy group and the group of Taohongsiwu Decoction(/>0.05);and were significant difference between the model group and the group of Taohongsiwu Decoction(/<0. 05). Compared to the model group, the decreased level of INS in Cemitidine treatment group showed the significant difference (K0. 05), compared to the high-dosage group of Taohongsiwu Decoction , it showed no significant difference (/M). 05). Respectively compared to the model group and the group of Taohongsiwu Decoction with Guishen Bolus, the decreased level of PAI-I> ET in Cemitidine treatment group showed the significant difference (K0.05).^conclusion!1. Treatment based on syndrome differentiation combined with Chinese herbs for activating blood stasis can effectively correct irregular menstruation and stimulate ovulation, thus raising the possibility of pregnancy.2. Treatment based on syndrome differentiation combined with Chinese herbs for activating blood stasis can improve the endocrine function of patients with PCOS and lower the serum level of LH, T, LH, FSH., which indicate thatChinese herbs can regulate the endocrine function of the ovaries and be helpful in promoting pregnancy.3. Treatment based on syndrome differentiation combined with Chinese herbs for activating blood stasis can regulate the serum level of INS ET, which indicates that Chinese herbs has the function of correcting insulin resistance and preventing the endothelial cells from injury.4. The morphologic changes of the endothelial cells and increase of ET INS are found in the PCOS model rat, indicating blood stasis is one pathogenesis of PCOS.5. Guishen Bolus and Taohongsiwu Decoction , which morphologically repair damaged endothelial cells, regulate their functions, and correct insulin resistance , are of great importance for complication prevention.This study mainly discusses blood stasis involved in pcos in the light of endothelium and detect the effect of Chinese herbs on endothelial cells in pcos for the first time, results show that Chinese herbs have the function of regulating the menstruation to raise the possibility of pregnacncy, repairing the damaged endothelial cells as well as preventing the potential compications of pcos. |
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