Distribution Of Syndrome Factors Of Polycystic Ovary Syndrome And Its Relationship With Physical And Chemical Indicators

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder among the women of childbearing age, with the symptoms of Chronic anovulation, hyperandrogenism, hyperinsulinemia and insulin resistance. And irregular menstruation, obesity, hypertrichiasis, dysgenesia, acne and acanthosis nigricans are commonly presented in clinic. Because of the heterogenicity of its clinical manifestation, TCM syndromes were complexity. Syndrome elements were the smallest possible part of syndromes. It not only briefly reflects the characteristics of diseases like the disease location and the disease nature, but also are of small quantity thus can be easily mastered. So taking syndrome elements in syndrome differentiation in clinical diagnosis and treatment will be concise and to the point. Therefore, this study plans to analyze the distribution of PCOS’s common syndrome elements and the relevance between them and physical and chemical index and to explore the modern biological basis of PCOS’s syndrome elements, to provide basis for establishing its clinical differentiation criterion.Objective1 Summarize the distribution of PCOS’s common syndrome elements through the literature review and clinical investigation.2 Through the clinical investigation, analyze the relevance between PCOS’s common syndrome elements and physical and chemical index and explore the pathophysiological basis of PCOS syndrome elements to provide basis for establishing its clinical differentiation criterion.Methods1 Literature researchSearchd literature on CNKI, Wanfang Med Online and CQVIP, screened the documents according to both inclusion and exclusion criteria, and applied Excel to establish the data base and SPSS17.0 to have statistical analysis on frequency. 2 Clinical research2.1 Collect clinical statisticsCollect the symptoms, signs and physical and chemical index of patients, with the application of cross-sectional study method and the PCOS Information Collection Table made uniformly by the research group.2.2 Work out the Determination Criterion of PCOS’s Common SyndromeElementsRefer to the guidelines for the diagnosis and treatment, based on the previous literature review and expert argumentation, Work out the Determination Criterion of PCOS’s Common Syndrome Elements, (exclusive for this study)2.3 Process statisticsUse Epidata3.1 to build database, include data entry, data cleaning and data type conversion.2.4 Statistical methodsSPSS17.0 software package was applied. Independent samples t test or Rank-Sum test was adopted to compare the measurement data from two groups, and the measurement data from three groups was compared by One-Way ANOVA or Kmskal-Wallis H test. And Chi-square test was used to compare the enumeration data of two groups. Statistical inference was made taking 0.05 as the test standard.Results1 Literature researchIn the included 181 articles, there are 48 articles for survey literature and 133 articles for intervention literature. In survey literature, there were 64 kinds original diagnosis results, involved 29 kinds of syndromes. There were five kinds of syndromes whose frequency was more than 10%:kidney deficiency syndrome、phlegm-dampness syndrome blood stasis syndrome, stagnation of liver qi syndrome and deficiency of kidney yang syndrome. In intervention literature, there were 50 kinds original diagnosis results, involved 22 kinds of syndromes. There were three kinds of syndrome whose frequency was more than 10%:kidney deficiency syndrome、phlegm-dampness syndrome and blood stasis syndrome. In two kinds of literature, the syndrome elements were relatively uniform. The syndrome elements of disease location whose frequency was more than 10% were kidney, liver and spleen. The syndrome elements of disease nature whose frequency was more than 10% mainly were deficiency, phlegm dampness (turbidity), blood stasis, qi stagnation, deficiency of Yang, In addition, there were Yin in investigation of literature and fire (heat) in intervention literature. 2 Clinical research2.1 The distribution of PCOS’s syndrome elements2.1.1 The general distribution of common syndrome elementsAmong 375 patients,48 cases (12.8%) could not be classified as any syndrome elements,58 (15.5%) cases could not be classified as any syndrome elements of disease nature,249(66.4%) cases could not be classified as any syndrome elements of disease location and 116 cases manifest the syndrome elements of both disease nature and location.The syndrome elements of disease nature include 9 types, among which there are 135 cases (36.0%) of blood stasis,129 cases (34.4%) of phlegm and dampness,110 cases(29.3%) of qi stagnation,104 cases (27.7%) of fire(heat),103 cases(27.5%) of yin deficiency,94(25.1%) cases of cold coagulation,90 cases(24.0%) of qi deficiency,15 cases(4.0%) of blood deficiency and 2 cases(0.5%) of yang deficiency. And the syndrome elements of disease location has 3 types, including 103 cases(27.5%) relating to kidney,27 cases (7.2%) to liver and 11 cases (2.9%) to spleen.2.1.2 The distribution of PCOS’s syndrome elements based on BMI and the phenotype of menstruationThe patients were divide into obesity group with 158 cases(42.1%) and non-obesity group including 217 cases (57.9%) under the standard with BMI≧24kg/m2. In the comparison between two groups, phlegm and dampness turns out to be more common in obesity group while blood stasis, qi stagnation and fire(heat), yin deficiency and cold coagulation manifested more in non-obesity group, among which phlegm and dampness, fire(heat) and cold coagulation is of statistical significance. And among the syndrome elements of disease location, kidney and spleen emerged more frequently in obesity group and liver was more common in obesity group, both with statistical significance.The patients could also be divided into three groups according to their phenotype of menstruation, including 208 cases(55.5%) with oligomenorrhea,93 cases(25.9%) with irregular bleeding and 70 cases(18.7%) with amenorrhea. By comparing the three groups, syndrome elements of disease location, kidney was more common in oligomenorrhea and amenorrhea groups, while kidney and liver were common in irregular uterine hemorrhage group; all syndrome elements of disease nature except blood and yang deficiency are of statistical significance. The oligomenorrhea group were mainly characterized with blood stasis, phlegm and dampness, qi stagnation, fire(heat), yin deficiency, cold coagulation and qi deficiency (all frequency>10%). And the irregular bleeding group mostly manifested phlegm and dampness, yin deficiency and fire (heat) while phlegm and dampness and blood stasis occupy a majority in amenorrhea group.2.1.3 The distribution of combination of common syndrome elementsAmong 375 patients,48 cases(12.8%) could not be classified as any syndrome elements,79 cases(21.1%) manifest 1 syndrome element and 248 cases manifest 2-8 syndrome elements in combination. Except 1 syndrome element,2-3 syndrome elements in combination occupy a majority in the cases, totally about 60.8%.As single syndrome element, Kidney manifest more frequently than 1% among the syndrome elements of disease location while blood stasis, cold coagulation, yin deficiency, qi stagnation, phlegm and dampness and fire(heat) have their manifest frequency higher than 1% among the syndrome elements of disease nature. And the syndrome elements in combination manifested more frequently than 1% include kidney plus phlegm and dampness and kidney plus yin deficiency as the syndrome elements of disease location combined with those of disease nature and phlegm and dampness plus blood stasis, blood stasis plus cold coagulation, fire(heat) plus yin deficiency, phlegm and dampness plus fire(heat), blood stasis plus qi stagnation, blood stasis plus fire(heat) and blood stasis plus both phlegm and dampness and cold coagulation.In the comparison of obesity group and non-obesity group, the distributions of phlegm and dampness plus blood stasis, phlegm and dampness plus qi stagnation, phlegm and dampness plus fire (heat), phlegm and dampness plus yin deficiency, phlegm and dampness plus qi deficiency, phlegm and dampness plus cold coagulation, cold coagulation plus qi stagnation and fire(heat) plus qi stagnation are all with statistical significance in both groups.But only yin deficiency is with statistical significance in different groups devided by phenotype of menstruation.2.2 The characteristics of changes of PCOS’s physical and chemical index2.2.1The overall distribution characteristics of PCOS abnormalities indexLH, LH/FSH and T increased in the proportion of both increase and decrease. FINS and HOMA-IR increase more than others in glycometabolism. And in lipid metaholism, CHO increases obviously and HDL decreases obviously while TG and LDL has insignifican increase and decrease. In the ultrasonic examination bilateral ovarian mainly enlarge.2.2.2 The comparison of manifestation characteristic of index between obesity group and non-obesity group.All sex hormones except LH/FSH of obesity group are lower than non-obesity group, among which FSH is with statistical significance. And obesity group has higher means of FBG, FINS and HOMA-IR in glycometabolism than non-obesity group, which are all with statistical significance. In lipid metaholism, CHO, TG and LDL in obesity group have higher means than non-obesity group, but HDL is on the contrary. Among them, TG and HDL has statistical significance. Otherwise, LP in obesity group turn out to be higher than in non-obesity group and SHBG is lower, among which LP is with statistical significance.2.2.3 the comparison of index level between different groups of phenotype of menstruationIn sex hormone, LH increased in irregular uterine bleeding group, which had obvious difference comparing the oligomenorrhea group and amenorrhea group; In sugar metabolism, HOMA-IR was higher (>2.65),. LP increased more in the oligomenorrhea group than other types; In the lipid metabolism, TG increased in the amenorrhea group, the other had a rising trend, but the difference was not statistically significant.2.3 The relevance between PCOS’s common syndrome elements and physical and chemical index2.3.1 The manifestation characteristics of physical and chemical index when PCOS’s common syndrome elements emergeDivide the PCOS patients into two groups by whether can be classified as a certain type of syndrome elements or not, and compare the differences between the two groups.There was no obvious difference between the blood stasis group and the non blood stasis group. HOMA-IR increases and FBG, FINS and LP were not beyond normal reference range in phlegm and dampness group, which all have statistical significance to other groups. Compared with that in other groups, CHO increases in qi stagnation group. The volume of right ovary gets enlarged and SHBG decreases in fire(heat) group, and HOMA-IR becomes lower than non-fire(heat) groups. And LP decreases in cold coagulation group. It makes no significant difference whether become yin deficiency or not, neither to Qi deficiency or not.2.3.2 The comparison of manifestation frequency of syndrome elements as physical and chemical index goes abnormalDivide the PCOS patients into abnormal group and normal group according to its pathological and physiological mechanism combined with the clinical reference range of all index, and compare the distribution differences of all syndrome elements in the two groups.Blood stasis mainly emerges relatively frequently in P decreasing group and FBG decreasing group, but all without statistical significance.Phlegm and dampness emerges relatively frequently in FINS increasing group, HOMA-IR increasing group and non LP decreasing group.Qi stagnation has relatively higher frequency mainly in PRL increasing group, E2 decreaseing group, FBG increasing group, non HOMA-IR increasing group, CHO increasing group, TG increasing group, non LP decreasing group, non left ovary enlarging group and non right ovary enlarging group.Fire(heat) gets manifested more often in LH/FSH increasing group, PRL increasing group, T increasing group, FBG increasing group, non HOMA-IR increasing group, CHO increasing group, non LP decreasing group, SHBG increasing group, left ovary enlarging group and right ovary enlarging groupYin deficiency emerges relatively frequently in LH/FSH increasing group, PRL increasing group, FBG increasing group, non HOMA-IR increasing group, non LP decreasing group, SHBG increasing group, non left ovary enlarging group and non right ovary enlarging group.Cold coagulation gets manifested more often in LH increasing group, PRL increasing group, non HOMA-IR increasing group, non LDL increasing group, SHBG increasing group, non left ovary enlarging group and non right ovary enlarging group.Qi deficiency has relatively higher frequency mainly in LH increasing group, PRL increasing group, FBG increasing group, non HOMA-IR increasing group, non LP decreasing group, non left ovary enlarging group and non right ovary enlarging group.2.3.3 The correlation of polycystic ovary syndrome common syndrome factors and the physical and chemical indicatorsIn sex hormones, Qi deficiency and androgen were positively correlated, but all the other had no significant linear correlation with sex hormones; In indicators of glucose metabolism, phlegm positively correlated with fasting glucose, fasting insulin and HOMA-IR. In lipid metabolism, blood stasis negatively correlated with HDL, qi stagnation and fire (heat) positively correlated with CHO. Phlegm positively correlated with leptin, fire (heat) and cold coagulation negatively correlated with leptin. PCOS common syndrome factors had no significant linear correlation with sex hormone binding globuland ovarian volume.Conclusion1 Based on the analysis of literature and clinical research, PCOS’s syndrome elements of disease location were kidney, liver and spleen; The syndrome elements of disease nature of PCOS were mainly blood stasis, qi stagnation, phlegm, fire (heat), yin deficiency, cold coagulation, Qi deficiency. Comparing PCOS’s clinical complex syndrome, the number of syndrome elements was small, and it was easy to master.There was correlation between syndrome elements and obesity:In the syndrome elements of disease nature, phlegm dampness was more in obese group, while fire (heat) and cold coagulation were more in non obese group. Obesity and phlegm dampness are closely related; in the syndrome elements of disease location, the emergence frequency of kidney and spleen were high in the obesity group while the frequency of the liver was high in the non obesity group.The syndrome elements and the menstrual phenotype had a certain correlation:syndrome elements of disease location was kidney in oigomenorrhea and amenorrhea group, while kidney and liver in irregular bleeding group; syndrome elements of disease nature:blood stasis, phlegm, qi stagnation, yin deficiency, fire (heat), cold coagulation, Qi deficiency were commom in the ol igomenorrhea group; phlegm dampness, deficiency of Yin and the fire (heat) were common in blood group; phlegm and blood stasis common in amenorrhea group.2 PCOS’s common syndrome elements correlate with the relevant physical and chemical index.Blood stasis group mainly reveals the increasing trend on their glucose and lipid metabolism index and the negative correlation with HDL. Phlegm and dampness group mostly has the increasing glycometabolism index and the positive correlation with FBG, FINS, HOMA-IR and LP. Qi stagnation group mainly reveals the increasing trend on their glucose and lipid metabolism index and the negative correlation with CHO. Fire(heat) group largely manifests the increasing sex hormone and glucose metabolism index, the enlargement of ovarian and the negative correlation with LP. The increase of sex hormone and glucose metabolism index occupies the majority in yin deficiency group. Cold coagulation group mainly shows the increase of sex hormone and the decrease of LP, and is negative correlated with LP. The majority of qi deficiency group increases on sex hormone and glucose metabolism and has positive correlation with T.