| Objective: In this study,through the clinical observation of metformin and spleen dispelling formula combined with weight management of the treatment of overweight polycystic ovary syndrome,we investigated the efficacy of spleen dispelling formula combined with weight management in the treatment of obese polycystic ovary syndrome compared with conventional drug treatment,and provided new ideas for the clinical treatment of obese polycystic ovary syndrome patients.Methods: Seventy-five patients who met the above case criteria in the gynecology outpatient clinic of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine Renai Branch from February2022 to December 2022 were selected,and all patients were numbered according to the order of consultation and randomly divided into three groups using the random number method,in which group A of Western medicine(33cases,4 cases of shedding)received oral metformin and group B of combined Western and Chinese medicine(33 cases,shedding 4 cases)received strengthening the spleen and expectorant method and Western medicine,and weight management group C(33 cases,shedding 1 cases)was treated with strengthening the spleen and expectorant method and Western medicine orally,and regular weight management was performed.The menstrual score,BMI,waist circumference,waist-to-hip ratio,acne,Chinese medical evidence,sex hormone six,fasting glucose,fasting insulin,and clinical pregnancy rate and comprehensive efficacy after treatment were observed before and after treatment in the three groups,and the observed indexes were compared and analyzed.Results:(1)Pre-treatment basic data: There were no statistical differences in menstrual score,acne score,age,BMI,waist circumference,waist-hip ratio,total TCM syndrome score,fasting glucose,fasting insulin,and sex hormone six in the three groups before treatment(P>0.05),and the data were valid.(2)BMI and waist-to-hip ratio efficacy: the differences in BMI and waist-to-hip ratio between the three groups before and after treatment were significant(P<0.01).The effect of weight management group C was significant and better than the other two groups(t=7.021,P<0.05).(3)Acne grade: The difference between acne before and after treatment in the three groups was significant(P<0.05)Before and after treatment in the weight management group and the combination of Chinese and Western medicine group acne comparison,significant difference(P<0.05).Western medicine group before and after treatment,no significant difference(P>0.05).(4)Comparison of menstrual conditions:(i)All three groups showed improvement in menstrual cycles after treatment(P<0.05),with the best effect in the weight management group,followed by the combined Chinese and Western medicine group,both of which were superior to the Western medicine group.(ii)The comparison of the distribution of menstrual days after treatment in the three groups showed a significant difference(P<0.05),and the number of days of menstruation improved in all three groups after treatment.The weight management group had the best effect of returning to normal after treatment,followed by the combined Chinese and Western medicine group,both of which were better than the Western medicine group.(iii)The pre-and post-treatment differences in the menstrual PBAC scores were not significant(P>0.05),and the blood loss was in the normal range.(5)Comparison of sex hormone six items: the differences of FSH,LH,LH/FSH before and after treatment in the three groups were statistically significant(P<0.05),among which FSH,LH,LH/FSH and T decreased significantly better in the weight management group than in the combined Chinese and Western medicine group and the Western medicine group after treatment(P<0.05).There was a difference in PRL before and after treatment between the Chinese and western medicine combination group and the weight management group(P<0.05),and there was no difference before and after treatment in the western medicine group(P>0.05).The difference between the three groups before and after treatment of E2,P value was not statistically significant(P>0.05).(6)Comparison of AMH: After the treatment of patients in groups A,B and C,the AMH indexes were improved(P<0.05).And the weight management group had the most significant effect(P<0.05),followed by the combined Chinese and Western medicine group(P<0.05),and both groups were superior to the Western medicine group(P<0.05).(7)Fasting blood glucose and insulin: After treatment,there was a significant difference in fasting blood glucose between the three groups(P<0.05),and the difference before and after treatment was significant(P<0.05).fasting blood glucose decreased most significantly in group C,followed by group B.There was a significant difference between the three groups of patients before and after fasting insulin treatment P<0.05),and the difference between the three groups after treatment was significant(P<0.05),with the most significant decrease in fasting insulin in group C,followed by group B.There was a significant differ ence(P<0.05)in the comparison of insulin resistance among the three groups after treatment,and the degree of decrease in HOMA-IR was the most significant in group C of weight management,followed by group B.(8)Comparison of blood lipid levels before and after treatment: There was a significant difference(P<0.05)in total cholesterol between the three groups after treatment,and a significant difference(P<0.05)before and after treatment.Fasting blood glucose decreased most significantly in the weight management group,followed by the combined Chinese and Western medicine group.There was a significant difference(P<0.05)in triglycerides before and after treatment among the three groups,and the difference was significant(P<0.05)after treatment among the three groups.Fasting insulin decreased most significantly in the weight management group,followed by the combination of Chinese and Western medicine group.There was a significant difference(P<0.05)in the comparison of low-density lipoprotein among the three groups after treatment,and the degree of decrease in HOMA-IR was the most significant in the weight management group,followed by the combination of Chinese and Western medicine group.(9)Pregnancy outcome:(1)Clinical pregnancy rate: after 3 months of treatment,the clinical pregnancy rate in the weight management group was59.4%;the clinical pregnancy rate in the combined Chinese and Western medicine group was 17.2%;and the clinical pregnancy rate in the Western medicine group was 6.9%.By multiple rank sum test,the total clinical efficacy of the three groups was statistically different(P<0.05),and the best pregnancy outcome was achieved in the weight management group,followed by the combination of Chinese and Western medicine group.The early miscarriage rate: 21%,20%,and 100% in the weight management group,the combination of Chinese and Western medicine group,and the Western medicine group alone.There were only 2 pregnancies after treatment in the Western medicine only group,both of which were miscarried.(10)Comparison of TCM symptoms:(1)Total TCM symptom scores:After treatment,the total TCM symptom scores decreased in all three groups(P<0.05),and the weight management group was better than the combined Chinese and Western medicine group(P<0.05),and both were better than the Western medicine therapy alone(P<0.05).(2)Chinese medicine single symptom score: the symptoms of menstrual cycle,menstrual period,menstrual volume,phlegm in the throat,loose stools,fatigue,fullness in the abdomen and stomach,and excessive amount of hypochondrium improved in all three groups after treatment,and the difference was significant(P<0.05).The weight management group had the most significant effect on the improvement of the TCM single symptom score,followed by the combined Chinese and Western medicine group,both of which were better than the Western medicine group alone.(11)Comparison of the efficacy of TCM symptoms: after 3 months of treatment,the total effective rate of the weight management group was 93.7%;the total effective rate of the combined Chinese and Western medicine group was 89.6%;and the total effective rate of the Western medicine group was79.3%.After the rank sum test,the total clinical efficacy of the three groups was statistically different(P<0.05),suggesting that all three groups were effective,and the weight management group had the best effect,followed by the combination of Chinese and Western medicine group.(12)Comparison of clinical efficacy: After 3 months of treatment,the total effective rate of the weight management group was 93.7%;the total effective rate of the combined Chinese and Western medicine group was86.2%;and the total effective rate of the Western medicine group was 72.4%.By rank sum test,the total clinical efficacy of the three groups was statistically different(P<0.05),suggesting that all three groups were effective,and the weight management group is best,followed by the combination of Chinese and Western medicines group.Conclusion: 1.Weight management combined with strengthening the spleen and expectorant method significantly reduced patients’ BMI and waist circumference,and the effect was better than that of strengthening the spleen and expectorant method combined with Western medicine and Western medicine alone.2.Weight management combined with strengthening the spleen and expectorant method significantly improved patients’ menstrual scores and acne symptoms,and have the superior efficacy to the combining of Western and Chinese medicine.3.Weight management combined with strengthening the spleen and expectorant method remarkably reduced patients’ FSH,LH,LH/FSH,T,PRL levels and improve endocrine imbalance in patients,and its effect was the best among the three groups,and the effect of Western medicine group A was the weakest.4.Weight management combined with strengthening the spleen and expectorant method could significantly improve patients’ blood glucose and insulin levels and improve insulin resistance,and on the basis of strengthening the spleen and expectorant method combined with Western medicine,weight management could more effectively improve abnormal glucolipid metabolism.The study shows that the combination of Spleen and Phlegm formula with weight management has more obvious advantages in treating the clinical symptoms of obese PCOS patients,and can remarkably improve BMI,endocrine and metabolic indicators of obese patients,thus improving the reproductive function and metabolic disorder status of the body,restoring ovulation,improving menstruation and achieving pregnancy,which is worth promoting. |
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