Study On Traditional Chinese Medicine Syndrome And Medication Rule Of Polycystic Ovarian Syndrome With Insulin Resistance

Objective 1.Explore the distribution pattern of syndrome types in PCOS-IR patients in Dongguan,explore the correlation between different traditional Chinese medicine syndrome types and glucose metabolism indicators,sex hormone levels,and insulin resistance index(HOMAIR),and provide more objective basis for clinical dialectics;2.Based on modern literature mining and network pharmacology methods,summarize the medication patterns of traditional Chinese medicine for treating PCOS-IR,extract core prescriptions,and further explore the potential mechanism of its treatment of PCOS-IR,providing reference for the screening and experimental research of traditional Chinese medicine for treating PCOS-IR.Methods 1.A cross-sectional study was conducted on patients who met the PCOS-IR diagnostic criteria at the Obstetrics and Gynecology Clinic of Dongguan Hospital(Dongguan Traditional Chinese Medicine Hospital)of Guangzhou University of Traditional Chinese Medicine from January 2018 to December 2022.Record the general situation,sex hormone levels,glucose metabolism indicators,traditional Chinese medicine dialectical classification of the included patients,and calculate the HOMA-IR index of the patients.Analyze the distribution pattern of traditional Chinese medicine syndrome types in PCOS-IR patients in Dongguan region.Based on the patient’s traditional Chinese medicine dialectical classification,statistical analysis is conducted on the correlation between different PCOS-IR traditional Chinese medicine syndrome types and the patient’s general situation,sex hormone levels,and glucose metabolism indicators;According to the HOMA-IR index,patients were grouped and statistically analyzed for the correlation between different levels of insulin resistance and the distribution of traditional Chinese medicine syndrome types,general situation of patients,sex hormone levels,and glucose metabolism.Using SPSS 25.0 for statistical analysis of the data,P<0.05 indicates statistical significance.2.Collect effective traditional Chinese medicine compound decoction for the treatment of PCOS-IR through databases such as CNKI,Wanfang,and VIP,and use the frequency and attributes of traditional Chinese medicine(four qi,five flavors,and meridian tropism)of ancient and modern medical record cloud platforms for statistics.Perform correlation analysis,cluster analysis,and complex network analysis on prescription medication,and extract the core prescription for the treatment of PCOS-IR for network pharmacology analysis,Collect the active ingredients and targets of the core prescription using the TCMSP database,and match and map them with the disease genes collected from the Gene Cards database to obtain common targets.Construct a protein interaction(PPI)network using the STRING database,and perform KEGG pathway enrichment analysis using the David database.Results 1.The distribution of traditional Chinese medicine syndrome types in 204 PCOS-IR patients in Dongguan area: spleen deficiency and phlegm dampness group(37.75%)>kidney deficiency and blood stasis group(22.55%)>kidney deficiency and liver stagnation group(20.10%)>phlegm stasis interaction group(16.61%);2.Comparing the four groups of traditional Chinese medicine syndrome types,the differences in PRL,Prog,fasting insulin levels,and HOMA-IR index were statistically significant(P<0.05).The HOMA-IR index of the group with phlegm and blood stasis is higher than that of the group with kidney deficiency and blood stasis(P=0.008<0.05)and the group with kidney deficiency and liver stagnation(P=0.045<0.05).There was no statistically significant difference in height,weight,BMI,LH,FSH,E2,T,SHBG,DHEAS,FAI,LH/FSH,fasting blood glucose,1-hour blood glucose,2-hour blood glucose,1-hour insulin,and 2-hour insulin(P>0.05).3.Divide the HOMA-IR index range of the included patients into four IR groups using a quartering method: IR1 group(2.69 ≤ HOMA-IR ≤ 3.28),IR2 group(3.28<HOMAIR<3.86),IR3 group(3.86 ≤ HOMA-IR ≤ 4.86),and IR4 group(4.86<HOMA-IR ≤ 13.28).The most frequent traditional Chinese medicine syndrome type among the four groups is spleen deficiency and phlegm dampness syndrome,and the phlegm stasis syndrome is most distributed in the IR4 group.The differences in SHBG,FAI,LH/FSH,fasting blood glucose,and fasting insulin among different IR groups were statistically significant(P<0.05),with HOMA-IR positively correlated with T,fasting blood glucose,1h insulin,2h insulin,FAI,and negatively correlated with SHBG.There were no statistically significant differences in age,height,LH,FSH,PRL,Prog,T,DHEAS,AMH,1-hour blood glucose,2-hour blood glucose,1-hour insulin,and 2-hour insulin among different IR groups(P>0.05).4.Data mining included a total of 106 prescriptions,involving 158 traditional Chinese medicine flavors,among which tonifying drugs,dispelling dampness drugs,and promoting qi drugs were more common,and the four qi were mainly warm and calm;The five flavors are mainly sweet,spicy,and bitter,with the liver and spleen meridians as the main meridians.21 combinations of traditional Chinese medicine were selected through correlation analysis,and high-frequency traditional Chinese medicine was roughly divided into 6 categories through cluster analysis.Complex network analysis suggests that seven drugs,including Poria cocos,Angelica sinensis,Atractylodes macrocephala,Cuscuta chinensis,Xiangfu,Atractylodes macrocephala,and Chenpi,are the core prescriptions of traditional Chinese medicine for treating PCOS-IR.5.Conduct network pharmacology analysis on core prescriptions.A total of 191 core prescription targets for the treatment of PCOS-IR were collected.Five core targets were identified through PPI network analysis,namely JUN,TP53,MAPK3,AKT1,and MAPK1.KEGG enrichment analysis suggests that the core prescription may exert therapeutic effects on PCOS-IR through the AGE-RAGE signaling pathway.Conclusion 1.Spleen deficiency and phlegm dampness syndrome is the most common traditional Chinese medicine syndrome type in PCOS-IR patients in Dongguan area.Indicators such as PRL,fasting insulin levels,and HOMA-IR index may have the potential to serve as objective indicators for traditional Chinese medicine differentiation;2.There are differences in the degree of insulin resistance among different traditional Chinese medicine syndrome types,and the syndrome of phlegm stasis accumulation may be heavily related to the degree of insulin resistance.3.The traditional Chinese medicine treatment of PCOS-IR follows the basic principle of " strengthening the spleen and tonifying the kidney,regulating liver qi,resolving phlegm and removing blood stasis",balancing deficiency and excess,harmonizing the samples,and emphasizing the use of tonifying drugs,dampness removing drugs,and qi promoting drugs.The potential mechanism of core prescription therapy for PCOS-IR may be related to the regulation of the AGE/RAGE pathway.