| [Objective] Polycystic ovary syndrome (PCOS) , one of the most common endocrine diseases affecting women of reproductive age, plays an important role in anovulatory infertility, with a prevalence of up to 5%~21%; The main clinical manifestations include irregular menstruation (amenorrhea or infrequent menstruation or dysfunctional uterine bleeding), infertility, hirsutism, obesity and acanthosis nigricans. Elevated serum LH levels and hyperandrogenism, insulin resistance with compensatory hyperinsulinemia are its endocrinological features. Polycystic ovary (PCO) morphology is also a common feature in PCOS. With the advance researches, PCOS displays its complexity and essential trend.Not only it impairs patients' genital health and Quality of life, but also is associated with an increased risk of type 2 diabetes, endometrial carcinoma, hyperlipemia, hyperpiesia, cardiovascular and cerebrovascular events. Up to now, precise pathogenesy of PCOS is yet unknown. The modern medicine indicates the etiopathogenisis of PCOS related to hereditism, endocrinology, immunology, metabolism and so on. The main features are hyperandrogenism and hyperinsulinemia, the correlation and between the above factors and how they inference PCOS are still unclear. In the view point of Traditional Chinese Medicine (TCM) ,PCOS classifies to "menopathy" , "infertility" and "Zhengjia" , its occurrence exists a close relationship with dysfunction of liver, kidney, spleen and further inducing deficiency, sputum, sluggish stagnant and fire. Many scholars insist that pathogenesis of PCOS is a renal deficiency plus phlegmatic hygrosis. However, after many years clinical observation. Prof. Situ discovered that the occurrence of many PCOS patients were caused by stagnation of liver-QI, hepatic fire or accompanying wet.Therefore, Professor Situ took Shugan Xiehuo as the main therapeutic principle to be the treatment, assisting Qingre Lishi in need. The research aims to evaluate the therapeutic effects and explore the therapeutic mechanism. These studies were performed under the direction of Professor Situ.[ Methods I In clinical research , according to their ages and pathogenetic condition, 48 patients which were consistent with our study standard randomly were divided into two groups :group TCM(25 cases), treated with Shugan Xiehuo Chinese drugs(Jiajian Longdan Xiegan Tang), one dose every day, for 3 months and group Diane~35(23 cases), one tablet of every day, for 21 days, with the treatment beginning from first day of the menstruation, following stopping for 7 days , then a new cycle, repeating for 3 months. The information, such as pattern of their menstruation acne% hairness> BBT and so on, was collected for 6 months from pretherapy. On the same time, the levels in serum of LH> FSH, PRU FT> A^ FINSn FPGwere assayed. The therapeutic effects were evaluated through comparing the difference between before and after treatment, between group TCM and group Diane-35.In empirical study, ovarian tissue was obtained from 22 women who underwent laparoscopic operation , including 11 PCOS and 11 patients that were only with pelvic cavity conglutination and taken as normal group. The operation was performed at 7th to 10th day of menstrual cycle. Resected ovarian tissue was immediately placed in ice-cold serum-free culture medium, and transported to the laboratory. On super clean bench, Mechanical dispersion of theca cells were performed according to the description of pertinent literature .One well was given 1X105 cells/0. 5ml, all the wells were divided into 4 groups, Group A (blank group), Group B(high dose Chinese drugs ) , group C(low dose Chinese drugs) and group D( insulin group). After all the cells were incubated in humidified air and 5% C02 at 37°Cfor up to 24 hours , The culture fluid was moved away , put new culture fluid containing influential factor 0. 5ml every well. After another 48 hours , the culture fluid was collected and stored at -40°C for subsequent steroid assay. [Results] 1 The results in the clinical study.(l)After treatment, Four cases infertility were pregnant after treatment in groupTCM, as five were pregnant in the group Diane-35; Irregular menstruation, acne, BBT were all improved significantly in group TCM and group Diane-35(FKO. 05) ; F-G scoring didn' t decrease significantly (P>0. 05); irregular menstruation, acne, hirsute score and BBT had not significant difference between group TCM and group Diane-35 (P>0. 05).(2)After treatment, The levels of LH, LH/FSH, FT, A in group TCM and group Diane-35 were all obviously lower than those of pretherapy (all K0. 05);The level of PRL were significantly decrease in group TCM (R0. 05), but not in group Diane-35(P>0.05). LH, FSH, LH/FSH, FT, A had not significant difference between group TCM and group Diane-35 (P>0. 05); The level of PRL in group TCM was lower than that in group Diane-35 significantly (P<0.05).(3)After treatment, the level of FINS were significantly lower than that of pretherapy in group TCM (P<0.05) but not in group Diane-35(P>0. 05), FPG weren't significantly decrease in two groups(P>0. 05); The levels of FINS and FPG didn't have significant difference between group TCM and group Diane-35 (P>0. 05). Insulin resistance was improved significantly in group TCM(P>0. 05) ; and was not changed in group Diane-35(P>0.05); There is no significant difference between the two groups (P>0.05).2 In empirical study, the results showed for normal theca cells, high dose Chinese drugs , low dose Chinese drugs , insulin all didn't make obvious difference for the secretion of A and 17-OHP comparing with normal blank group (both P>0. 05). Levels of A, 17-OHP in group PCOS blank were significantly higher than those in group normal blank(/K0. 05). As to PCOS theca cells, Insulin remarkably increased the PCOS theca cells to secrete A and 17-OHP (K0.05), While both high dose Chinese drugs and low dose Chinese drugs inhibited the secretion of A and 17-OHP comparing with PCOS blank group, the former is obvious (K0. 05), but there was not found in the latter (P>0. 05) ;Levels of A, 17-OHP in PCOS high dose Chinese drugs group were higher than the normal blank group but it was unremarkable (P>0. 05). [Conclusion!1 Stagnant fire of the liver meridian was one of the most important pathogenesis in PCOS, especially for youthful PCOS patients.2 The important clinical and biochemical indicator features of hepatic fire... |
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