Study On Clinical Characteristics And TCM Constitution Of Obese And Non-obese PCOS Patients Based On Human Body Composition Analysis

Objective:To study the similarities and differences of body composition,clinical characteristics and TCM constitution distribution of obese and non-obese PCOS patients,and to analyze the relationship between clinical characteristics,TCM constitution and body composition of PCOS patients,so as to provide objective basis for individual lifestyle intervention and clinical treatment of two different types of PCOS patients.Methods:PCOS patients who were admitted to the Reproductive and Genetic Center of Integrated Traditional Chinese and Western Medicine in the affiliated hospital of Shandong University of Traditional Chinese Medicine from December 2020 to December 2021 were divided into obese group（BMI≥25kg/m²）and non-obese group（BMI<25kg/m²）according to BMI.On the 2nd to 4th day of menstruation or amenorrhea when ultrasound revealed that there were no dominant follicles,the elbow venous blood was collected for the endocrine and biochemical indexes,and the symptoms such as menstrual disorder,hirsutism and acne were collected.And doctors guide patients to fill in the"TCM constitution investigation scale".At the same time,the body composition of the patients was determined by South Korea ioi353 body composition analyzer.Results:1.A total of 244 patients with PCOS were included in this study,including 128 obese patients and 116 non-obese patients.There was no significant difference in age and height between the two groups of PCOS patients（P>0.05）.2.Comparison of body composition between the two groups of PCOS patients:The BMI,waist circumference,waist-hip ratio,visceral fat area,body weight,body fat weight,body fat rate,fat-free weight,muscle weight,water content,protein mass,inorganic salt content and basal metabolic rate of PCOS patients in obese group were significantly higher than those in non-obese group,while the muscle percentage,water percentage,protein percentage and inorganic salt percentage in obese group were significantly lower than those in non-obese group（P<0.05）.3.Comparison of clinical characteristics between the two groups of PCOS patients:（1）the incidence of acne,hyperandrogenemia,insulin resistance and dyslipidemia in PCOS patients in obese group was significantly higher than that in non-obese group,while the levels of HOMA-IR,TG,TC and LDL-C in obese group were significantly higher than those in non-obese group,while the levels of LH,LH/FSH,AMH and HDL-C in obese group were significantly lower than those in non-obese group（P<0.05）.（2）there was no significant difference in menstruation,incidence of hirsutism,and FSH,E₂,P,T and PRL levels between the two groups（P>0.05）.4.Correlation between endocrine,glucose and lipid metabolic parameters and body composition in patients with PCOS:the levels of HOMA-IR,TG,TC and LDL-C in patients with PCOS were positively correlated with BMI,waist circumference,waist-to-hip ratio,visceral fat area and body fat percentage,and negatively correlated with water percentage,protein percentage and inorganic salt percentage.The levels of LH,LH/FSH,AMH and HDL-C were negatively correlated with BMI,waist circumference,waist-to-hip ratio,visceral fat area and body fat rate in patients with PCOS.The levels of LH,LH/FSH and HDL-C were positively correlated with water percentage,protein percentage and inorganic salt percentage in patients with PCOS.The level of AMH was positively correlated with water percentage and protein percentage in patients with PCOS（P<0.05）,but not with inorganic salt percentage（P>0.05）.In addition,there was no correlation between the levels of FSH,E₂,P,T and PRL and body composition in patients with PCOS（P>0.05）.5.The ability of obesity index to predict insulin resistance and dyslipidemia in patients with PCOS:the AUC of body fat rate in predicting insulin resistance in patients with PCOS was the highest（0.807）,followed by waist circumference（0.804）,visceral fat area（0.802）,BMI（0.788）and waist-to-hip ratio（0.756）.The AUC of dyslipidemia in patients with PCOS predicted by body fat rate was the highest（0.777）,followed by visceral fat area（0.769）,waist circumference（0.760）,BMI（0.745）and waist-hip ratio（0.733）.6.Comparison of TCM constitution between the two groups of PCOS patients:there was a significant difference in TCM constitution between the two groups of PCOS patients（P<0.05）.The TCM constitution of PCOS patients in obese group from high to low was phlegm-dampness,yang deficiency,peace,qi depression,dampness-heat,qi deficiency,blood stasis,yin deficiency and special quality,while that of non-obese PCOS patients from high to low was qi depression,yang deficiency,peace,dampness-heat,phlegm-dampness,qi deficiency,blood stasis,yin deficiency and special quality.7.Correlation between TCM constitution and body composition in patients with PCOS:by analyzing the body composition of patients with phlegm-dampness,qi-depression,yang-deficiency,peace and dampness-heat,it was found that BMI,waist circumference,waist-hip ratio,visceral fat area and body fat rate of PCOS patients with phlegm-dampness were significantly higher than those of qi-depression,peace and dampness-heat.The BMI and waist circumference of PCOS patients with yang deficiency were significantly higher than those of qi depression and dampness-heat.The waist-to-hip ratio of PCOS patients with yang deficiency was significantly higher than that of qi depression and peace.The visceral fat area and body fat rate of PCOS patients with yang deficiency were significantly higher than those of qi depression,peace and dampness-heat（P<0.05）.On the contrary,the percentage of water and protein in PCOS patients with phlegm-dampness and yang deficiency was significantly lower than that of qi depression,peace and dampness-heat,and the percentage of inorganic salt in PCOS patients with phlegm-dampness was significantly lower than that of qi depression and dampness-heat（P<0.05）.Conclusion:1.There were significant differences in body composition and clinical characteristics between obese and non-obese PCOS patients;with the increase of body fat,the levels of LH,LH/FSH and AMH decreased and the risk of glucose and lipid metabolism disorder increased in PCOS patients;BMI,waist circumference,waist-to-hip ratio,body fat rate and visceral fat area all had certain predictive value for insulin resistance and dyslipidemia in PCOS patients,among which body fat rate had the higher predictive value.2.Obese PCOS often occurs in phlegm-dampness,yang deficiency and peace,while non-obese PCOS occurs in qi depression,yang deficiency and peace.and the higher the degree of obesity in PCOS patients,the greater the probability of phlegm-dampness constitution and yang deficiency constitution.