| Objective Polycystic ovary syndrome (PCOS) is a common gynecologicaldisease which can cause endocrinologic disorder and infertility in women ofreproductive age. It has the feature of endocrinology such as Hyperinsulinism,insulin resistance and hyperandrogenism. Its clinical symptoms are varied anddifferent. The typical manifestations are adventitious ovulation and(or)anovulation, menstrual disorder, infertility, hirsutism, acne, obesity,polycystic ovaries, and so on. In the view point of Traditional ChineseMedicine(TCM),the etiology and pathogenesis of Obese PCOS are due to "Sputum".About 50％of PCOS patients are over weight or the obesity. And obesity wouldlead to further development of PCOS. It's probably related to HI, HAand abnormalmetabolism of adipocytokines. Adiponectin is newly found as a kind ofadipo-specificity proteinum. It enhances the sensitivity of the insulin andhas close relationship with the occurrence and development of many kinds ofmetabolism diseases. Multi-researches proved that the level of adiponectinin blood serum of the obesity decreased. But to the Obese PCOS patients, the internal effect of adiponect and the relationship between the level ofadiponectin and IR are uncertain. To lose weight is helpful to the PCOS patientsand could enhance the sensitivity of insulin and increase the level ofadiponectin. At last, the metabolism syndrome is improved.Nowadays, dimethylbiguanide is widely used for the treatment of Obese PCOS.And it has certain effect. During these years, my advisor achieved a good effecton the treatment of Obese PCOS by using chinese medicine "Jia jian chang fudao tan decoction" to invigorate spleen and remove phlem. But it's dissatisfiedfor patients to lose weight or to improve ovulation failure through the twoabove mentioned methods. Modern researches declare that to acupuncture pointson the body could inhibit appetite, promote the excitation of sympathetic nervethus increase heat production, and inhibit the synthesis of fat. Thus theweight loses. The combination of Acupuncture and chinese medicine may probablypromote the therapeutic effect of Obese PCOS. The research aims to evaluatethe therapeutic effects and explore the therapeutic mechanism. These studieswere performed under the direction of Professor Lili Yao.Methods All the cases which were dated from January, 2006 to January, 2007came from the out-patient clinic of gynecological department in the FirstAffliciated Hospital of Guangzhou University of Chinese Medicine.42 patients which were consistent with our study standard randomly weredivided into two groups:Group A, treated with jiajian CFDT decoction combinedAcupuncture and group B, treated with simple jiajian CFDT decoction. Theimformation of patients' five items of endocrine secretion, fasting bloodglucose, empty stomach insulin, and the level of adiponectin in serum weretested pretherapy and 3 months after treatment. At the same time, insulin resistance index and BMI(body mass index) were calculated while theimprovement of clinical symptoms such as menstruation, BBT and so on wereobserved.Results.1 After treatment, the cases of irregular menstruation and BBT one-wayall improved significantly in Acupuncture combined with Chinese medicine groupand simple Chinese medicine group(P＜0.05), while they were all improvedsignificantly between the two groups (P＜0.05): Three cases in fertility werepregnant in Acupuncture combined with Chinese medicine group, as one waspregnant in simple Chinese medicine group. Acne, hirsute score had notsignificant difference in the two groups respectively as compared before andafter treatment (P＞0.05), and they also had not significant difference betweenthe two groups (P＞0.05).2 After treatment, the levels of serum LH, LH/FSH in Acupuncture combinedwith Chinese medicine group and simple Chinese medicine group were allobviously lower than those of pretherapy(P＜0.05),but there was no significantdifference between the two groups(P＞0.05). The levels of serum FSH were notobviously lower than those of pretherapy (P＞0.05) while there was nosignificant difference between the two groups after treatment(P＞0.05); Thelevels of serum T in Acupuncture combined with Chinese medicine group wasobviously lower than pretherapy(P＜0.05); while it was not obviously lowerthan pretherapy(P＞0.05); There was significant difference between the twogroups(P＜0.05) 3 After treatment, the levels of BMI in Acupuncture combined withChinese medicine group and simple Chinese medicine group were all obviouslylower than those of pretherapy(P＜0.05), and there was significant differencebetween the two groups(P＜0.05). The levels of serum FINS were all obviouslylower than those of pretherapy(P＜0.05), and there was significant differencebetween the two groups after treatment(P＜0.05). There was no significantdifference between the levels of FPG as compared Acupuncture combined withChinese medicine group with simple Chinese medicine group before and aftertreatment while there was no significant difference between the two groupsafter treatment(P＞0.05). After treatment, the levels of ISI and APN, inAcupuncture combined with Chinese medicine group and simple Chinese medicinegroup were all obviously higher than those of pretherapy(P＜0.05),and therewas significant difference between the two groups(P＜0.05).Aftertreatment, the number of insulin resistance patients in Acupuncture combinedwith Chinese medicine group and simple Chinese medicine group were allobviously lower than those of pretherapy(P＜0.05), and there was significantdifference between the two groups(P＜0.05).Conclusions1 Phlegm and damp is the main pathogenesis of Obese PCOS.2 The important clinical and biochemical indicator features of phlegmand damp in Obese PCOS were hyperandrogenism, Hyperinsulinism, insulinresistance. And among these, Hyperinsulinism and insulin resistance were themain features. At the same time, the serum adiponectin levels of most paitientsdecreased. 3 Acupuncture combined with invigorating spleen to remove phlem was asignificant therapeutic principle for weak spleen with phlegm and damp in ObesePCOS patients. Acupuncture combined with the herb(jia jian CFDT decoction) ofinvigorating spleen to remove phlem could obviously increase the serumadiponectin level while decrease BMI; and it could decrease the level of Tto improve hyperandrogenism; and it also could decrease the level of FINS whileincrease the level of ISI to reduce insulin resistance; besides, it coulddecrease the levels of LH T and LH/FSH to regulate menstruation, recover OV,and impregnate a few infertility patients. The therapeutic effect was betterthan the effect of using simple jiajian CFDT decoction.
|
PDF Full Text Request