Study On The Intervention Effect Of Qi Gong Wan In Patients With Phlegm-dampness Syndrome Of Polycystic Ovary Syndrome Based On Intestinal Flora-specific Phenotype

Objective:1.The purpose of this study was to observe the intestinal microflora spectrum of patients with(PCOS)phlegm-dampness syndrome of polycystic ovary syndrome,patients with non-phlegm-dampness syndrome and normal people,to compare the species and structure of intestinal microflora,to find the dominant microflora of patients with PCOS phlegm-dampness syndrome,and to establish a diagnostic model of PCOS phlegm-dampness syndrome based on intestinal microflora.2.By observing the changes of intestinal flora and clinical efficacy of PCOS patients with phlegm-dampness syndrome treated with Qi Gong Wan Prescription,a classic prescription of dryness-dampness and resolving phlegm,the mechanism and therapeutic target of Qi Gong Wan Prescription were explored from the point of view of microbiology,so as to provide new direction and support for traditional Chinese medicine in the treatment of phlegm-dampness PCOS.Methods:20 patients with PCOS phlegm-dampness syndrome,20 patients with PCOS non-phlegm-dampness syndrome and 20 normal endocrine controls were selected as subjects.Waist circumference,hip circumference,height and weight were measured,waist-to-hip ratio(WHR)and body mass index(BMI);were calculated.The indexes of sex hormones,fasting blood glucose(FPG)and fasting insulin(FINS),were measured by chemiluminescence method,and the insulin resistance index(HOMA-IR)was evaluated by steady-state model.16s rDNA high-throughput sequencing technique was used to determine the intestinal flora of each group,and the difference of intestinal flora of the three groups was analyzed.At the same time,the PCOS phlegm-dampness syndrome group was treated with Qi Gong Wan Prescription,and the changes of TCM syndrome,sex hormone index,BMI,WHR,FPG,FINS,HOMA-IR and intestinal flora were observed before and after treatment.Results:1.Comparison of general condition and hormone level:BMI,waist circumference,hip circumference and WHR in PCOS phlegm-dampness group were significantly higher than those in non-phlegm-dampness group and control group(P<0.05),the levels of LH,LH/FSH and T in PCOS phlegm-dampness group and PCOS non-phlegm-dampness group were significantly higher than those in control group(P<0.05),and there was no significant difference in LH,LH/FSH and T between PCOS phlegm-dampness group and PCOS non-phlegm-dampness group.2.Intestinal flora analysis:(1)The alpha diversity index of intestinal flora in the PCOS phlegm-dampness syndrome group was significantly lower than that in the PCOS non-phlegm-dampness syndrome and the control group(P<0.05),and the beta diversity of the PCOS phlegm-dampness syndrome group was significantly different from the other two groups;(2)Compared with PCOS non-phlegm-dampness syndrome and control group,the patients with PCOS phlegm-dampness syndrome had more Bacteroidetes,higher values of Bacteroidetes/F irmicutes,higher contents of Prevotellaceae,Veillonellaceae and Megamonas,and lower contents of Bifidobacterium and Lactobacillus;(3)Species with significant differences between patients with PCOS phlegm-dampness syndrome and patients with PCOS non-phlegm-dampness syndrome:Megamonas is more enriched in the PCOS phlegm-dampness syndrome group,Actinobacteria,Ruminococcaceae,and Faecalibacterium are more enriched in the PCOS non-phlegm-dampness syndrome group;(4)Species with significant differences between the PCOS phlegm-dampness syndrome group and the control group:Megamonas was more abundant in the PCOS phlegm-dampness syndrome group;(5)The functional genes of carbohydrate metabolism,translation,metabolism,endocrine and metabolic diseases,signal molecules and interactions in PCOS phlegm-dampness group were higher than those in PCOS non-phlegm-dampness group.3.Correlation analysis:PCOS phlegm-dampness syndrome was closely related to obesity and insulin resistance.Insulin resistance index was positively correlated with the number of Proteobacteria and Spiochaetes,and negatively correlated with the number of Actinobacteria and Tenericutes.There was a negative correlation between body mass index and Tenericutes.4.Clinical efficacy of Qi Gong Wan Prescription in the treatment of PCOS phlegm-dampness syndrome rafter treatment,the levels of BMI,waist circumference,hip circumference,WHR,FPG,FINS,HOMA-IR and TCM syndrome scores were improved(P<0.05).5.Effect of Qi Gong Wan Prescription on intestinal flora:(1)After treatment of PCOS phlegm-dampness syndrome,the alpha diversity of the intestinal flora was higher than that before treatment,and the beta diversity was significantly different;(2)At the phylum level,the proportion of Firmicutes,Actinobacteria and Proteobacteria increased,while Bacteroidetes decreased after treatment.The species with significant difference is Actinobacteria;(3)At the family level,Ruminococcaceae increased significantly and Prevotellaceae decreased significantly after treatment;(4)At the genus level,Megamonas and unidentified_Lachnospiraceae decreased significantly,while Fusicatenibacter and unidentified_Ruminococcaceae increased significantly after treatment.After treatment,the number of probiotics such as Bifidobacterium and Lactobacillus in intestinal tract of patients with PCOS phlegm-dampness syndrome increased compared with that before treatment;(5)Qi Gong Wan Prescription improves the function of intestinal flora in patients with PCOS phlegm-dampness syndrome.After treatment,nucleotide metabolism,polysaccharide biosynthesis and metabolism,folding,sorting and degradation,enzyme family,drug resistance,endocrine and metabolic properties Diseases,signal molecules and interaction functions were reduced compared to before treatment,and amino acid metabolism and signal transduction functions were increased compared to before treatment.Conclusion:1.The patients with PCOS phlegm-dampness syndrome have obvious characteristics of obesity and insulin resistance.2.There are some differences in the structure and function of intestinal flora between the patients with PCOS phlegm-dampness syndrome and PCOS non-phlegm-dampness syndrome and the control group.The imbalance of intestinal flora may be a factor in the pathogenesis of PCOS phlegm-dampness syndrome and has a certain influence on glucose and lipid metabolism,obesity and menstrual cycle of PCOS phlegm-dampness syndrome.It is related to the decrease in the number of butyrate-producing bacteria,the increase in the number of lipopolysaccharide-producing,bacteria,and the increase of pro-inflammatory bacteria.3.Intestinal flora is related to obesity,impaired glucose tolerance and hyperandrogenemia in patients with PCOS phlegm-dampness syndrome.4.The intervention of Qi Gong Wan Prescription can increase the diversity of intestinal flora,increase the number of intestinal probiotics,improve the structure and functional genes of intestinal flora,so as to improve the state of insulin resistance,regulate endocrine metabolism and improve symptoms.Intestinal flora can interact with other organs and systems through specific neurotransmitters,hormones and metabolites to participate in the regulation of human physiological function.