Based On PCOS Analysis Of The Characteristics Of Endocrine And Metabolic Syndrome And Evidence-based Medicine Research On Chinese Medicine Cycle Therapy

Polycystic ovary syndrome is a kind of hyperandrogenemia,reproductive function and glucose metabolism as disorders of insulin resistance.The polymorphism of PCOS diagnostic criteria are not uniform and clinical symptoms,and the prevalence of differences in different ethnic groups,consensus diagnostic criteria until 2003 PCOS to reach the world.The rare or no ovulation of the main clinical manifestations,the biochemical or clinical hyperandrogenemia,polycystic ovary change.The main clinical symptoms were irregular menstruation,amenorrhea,irregular uterine bleeding,infertility,obesity,hirsutism and acne syndrome.This paper is divided into three parts,the first part:the polymorphism of symptoms as the starting point,according to the relevant indexes of PCOS patients with different symptom characteristics of endocrine and metabolism;the second part:the distribution of TCM syndromes in the symptom group;the third part:to improve the effectiveness of symptoms in patients with PCOS group of reproductive regulation cycle therapy of traditional Chinese medicine.This article provides a new idea for the clinical application of Chinese medicine from the aspects of clinical symptoms,endocrine and metabolic characteristics-TCM symptoms distribution-TCM cycle therapy,syndrome adjustment,evidence-based medicine research.Part One The analyzes the characteristics of endocrine metabolism based on PCOS syndromeObjective:To research the diagnostic value of four indicators of PCOS syndrome,which are sparse,amenorrhea,irregular uterine bleeding,infertility.Methods:From January 2015 to December 2016 year in Hunan province people’s Hospital of second infertility infertility treatment center is in accordance with the diagnostic standard of PCOS patients in Rotterdam 178 cases,58 cases of non PCOS patients.The area under receiver operating characteristic curve（area under curve,AUC）and 95%confidence intervals（confidence interval,CI）Objective to analyze the difference of the four syndromes of PCOS.Results:178 cases of PCOS group and 58 cases of non PCOS group in age,height,body mass index were compared,the difference was not statistically significant（P>0.05）;FSH,T,E₂,T/E₂,HOMA-IR,BMI,SHBG,DHEAS,A₂ index were compared,the difference was statistically significant（P<0.05）;LH,LH/FSH index comparison,the difference was statistically significant（P<0.01）.LH/FSH,LH,IR,T/E₂,ROC curve area of T index is greater than 0.9,LH/FSH,LH,IR,T/E₂,T index of PCOS high diagnostic value.In this research 178 cases of patients with PCOS four syndrome distribution:PCOS group of 87 patients with oligomenorrhea,amenorrhea accounted for 48.9%;25 cases,accounting for 14%;irregular uterine bleeding（dysfunctional uterine bleeding）in 23 cases,accounting for 12.9%;43 cases of infertility patients,accounting for 24.2%.and PCOS group investigation of the cases of oligomenorrhea is most common,followed by infertility.87 cases of PCOS oligomenorrhea group and 58 cases of non PCOS group in age,height,body mass index were compared,the difference was not statistically significant（P>0.05）;FSH,T,E₂,T/E₂,HOMA-IR,BMI,SHBG,DHEAS,A₂ index by comparison,the difference was statistically significant（P<0.05）;LH,LH/FSH index were compared,the difference was statistically significant（P<0.01）.LH,LH/FSH,ROC curve area of T/E₂index is greater than 0.9,The results indicated that LH,LH/FSH and T/E₂ were of high diagnostic value for PCOS.25 cases of amenorrhea PCOS group and 58 cases of non PCOS group in age,height,body mass index were compared,the difference was not statistically significant（P>0.05）;FSH,E₂,T/E₂,HOMA-IR,BMI,SHBG,DHEAS,A2 index were compared,the difference was statistically significant（P<0.05）;T,LH,LH/FSH were compared,the difference was statistically significant（.T/E2,P<0.01）ROC curve T index is greater than 0.9,T index of PCOS.23 PCOS with high value in the diagnosis of amenorrhea irregular uterine bleeding group and58 cases of non PCOS group in age,height comparison,body mass index,the difference was not statistically significant（P>0.05）;FSH,T,E2,T/E2,HOMA-IR,BMI,SHBG,DHEAS,A₂ index were compared,the difference was statistically significant（P<0.05）;LH,LH/FSH index were compared,the difference was statistically significant（P<0.01）,ROC curve T/E₂ index The area below 0.9.The results showed that T/E₂ and T were of high value in the diagnosis of dysfunctional uterine bleeding（PCOS）.43 cases of PCOS infertility group and 58 cases of non PCOS group in age,height,body mass index were compared,the difference was not statistically significant（P>0.05）;FSH,T,E₂,T/E₂,HOMA-IR,BMI,SHBG,DHEAS,A₂ index were compared,the difference was statistically significant（P<0.05）;LH,LH/FSH were compared,the difference was statistically significant（P<0.01）.T,LH,T/E₂,LH/FSH,ROC curve area of IR index is greater than 0.9,T,LH.T/E₂,LH/FSH,IR index of high infertility diagnostic value of PCOS.Conclusion:1The pathological research on PCOS T,LH,T/E₂,LH/FSH,IR in the high diagnostic value in syndrome,but the performance in different syndrome in different in oligomenorrhea in the diagnosis of LH the highest value,the highest value in T/E₂ diagnosis of amenorrhea,irregular uterine bleeding（dysfunctional uterine bleeding）the diagnostic value of T/E₂ is the highest,in the infertility of T has the highest diagnostic value.2 The results show that the diagnosis of T/E₂ syndrome in different throughout,but in the area under the ROC curve of the diagnostic value of T/E₂ was the highest in patients with amenorrhea.3 For patients with PCOS hyperandrogenemia in treatment of the starting point,from the simple attention should shift to T/E₂ increased androgen（hyperandrogenemia and low estrogen）.4PCOS common hypothalamic pituitary ovarian axis disorders of reproductive dysfunction and high T/E₂ abnormalities in IR metabolism of glucose metabolism disorder.Part Two The part is the distribution of TCM syndromes in symptom groupObjective:To explore the five physiological and pathological systems of PCOS and the pathogenesis of traditional Chinese medicine（TCM）from the local pathological changes.Methods:178 cases of PCOS were observed within the Rotterdam criteria,frequency analysis,symptom factor frequency and its overall pathology linked to"five system"as the core of PCOS in the five physiological pathology and pathogenesis research.Results:178 cases of medical records of patients,showed pulmonary symptoms:facial acne is the main performance,the frequency is 106,the frequency is 59.55%;kidney symptoms:hair loss as the main performance,the frequency is 98,the frequency is 55.06%;the spleen symptoms:obesity is the main performance,the frequency is 42,the frequency is 23.6%;liver symptoms:irritability as the main performance,the frequency is 25,the frequency is 14.04%;heart symptoms:insomnia is the main performance,the frequency is 19,the frequency is 10.67%;more than five lines of data show that the syndrome characteristics of the study of PCOS in patients with lung and kidney two dirty,followed by spleen,liver.Heart.Combined with clinical symptoms and frequency distribution of PCOS TCM syndromes from the main symptoms,secondary symptoms and tongue and pulse acquisition diagnosis standard,that PCOS may meet the pre hot under cold,Yin dampness,damp and hot,heart kidney disharmony four syndrome.On the heat under the cold In PCOS oligomenorrhea,amenorrhea in larger proportion;heart kidney disharmony in PCOS oligomenorrhea,the proportion of patients with infertility in larger;Yin dampness in PCOS irregular uterine bleeding,the proportion of patients with infertility in larger;damp heat accumulation in PCOS irregular uterine bleeding patients accounted for the largest proportion.Conclusion:Through the research of the frequency distribution of symptoms and the pathophysiology of the five viscera system in PCOS patients.Found above PCOS syndrome type heat under the cold to see more,followed by heart kidney disharmony,Yin dampness,damp and hot.The characteristics of syndrome in patients with PCOS syndrome in this study in lung,kidney line followed by spleen,liver,heart,and lung and kidney essence of TCM pathogenesis and pre treatment of PCOS with.PCOS is:in the kidney Tiangui Chongren uterus axis disorders as cold,heat,deficiency,real mixed type of pathogenesis.Part Three Effectiveness of traditional Chinese medicine cycle therapy in improving PCOS reproductive regulation:Meta-analysis of clinical randomized controlled trials Objective:To investigate the effectiveness of traditional Chinese medicine in the treatment of PCOS patients with reproductive regulation.Methods:To search the 2003-2016 Chinese published in the scientific journal database（VIP）,China knowledge resources database（CNKI）,Wanfang and VIP online literature,the key words of polycystic ovary syndrome or PCOS,traditional Chinese medicine or traditional Chinese medicine traditional Chinese medicine sequential cycle,block therapy,randomized controlled trials were searched for advanced retrieval 167 articles according to the inclusion and exclusion criteria for the two screening of the literature,finally 23 references were included for analysis.The analysis methods:statistical analysis was done using the Cochrane collaboration’s RevMan5.3 software,count data using the odds ratio（odds,ratio,OR）as the analysis index and 95%confidence interval（confidence,interval,CI）,the study of heterogeneity test,if P>0.05 is no heterogeneity,using fixed effect model,if P<0.05 is heterogeneity,the random effects model analysis.Comprehensive analysis:Chinese medicine cycle Comparison of ovulation rate and pregnancy rate in patients treated with therapy.Results:the TCM cycle therapy combined with Diane-35 and Diane-35 on PCOS alone with the ovulation rate of 7 articles results show that TCM cycle therapy combined with Diane-35 can improve the ovulation rate,there was statistically Significant difference between the two groups（p<0.00001,OR:0.22,95%CI:0.14-0.35）;of which 2 articles were compared on pregnancy rate,results suggest that the difference was statistically significant（P<0.0001）（OR:0.17,95%CI:0.07-0.41）.The TCM periodic therapy combined with clomiphene alone and using clomiphene citrate on PCOS ovulation rate of 7 literatures results show that TCM cycle therapy combined with clomiphene can improve the ovulation rate,there was statistically significant difference between the two groups（P<0.0001）（OR:0.38,95%CI:0.24-0.59）;of which 2 articles were comparison of the pregnancy rate,results indicated that the difference was statistically significant（P=0.03<0.05）（OR:0.49,95%CI:0.25-0.93）.Cycle therapy with Chinese traditional medicine combined with letrozole and letrozole alone on PCOS ovulation rate 3 literature research results show that TCM cycle therapy combined with letrozole can improve the ovulation rate,there was significantdifferencebetweenthetwogroups（P=0.0002<0.01）（OR:0.34,95%CI:0.19-0.60）;of which 2 articles were compared to the pregnancy rate.That difference was statistically significant（P<0.0001）（OR:0.26,95%CI:0.14-0.50）.The TCM periodic therapy and separate use of PCOS with-35 on the rate of ovulation with 4 references the research results show that:the cycle of Chinese medicine therapy can improve the ovulation rate,there was significant difference between the two groups（P<0.0001）（OR:0.27,95%CI:0.15-0.49）.The TCM periodic therapy and clomiphene citrate on PCOS the ovulation rate of 2 references the results of the study show that:there was no significant difference between the two groups（P=1.00>0.05）（OR:1.00,95%CI:0.43-2.31）;However,there was significant difference in the pregnancy rate between the 2 articles（P=0.0007<0.01）（OR:0.25,95%CI:0.11-0.55）.Conclusion:Traditional Chinese medicine cycle therapy can promote ovulation rate and pregnancy rate in PCOS patients.