A Study Of The Relativity Of TCM Syndrome Types Between The Endocrine And Metabolism Disorder Characteristics Of PCOS Patients

ObjectiveThis study is aiming to analyze the relationship between TCM syndrome and the endocrine features of PCOS patients by using the clinical manifestation sheets and the endocrines,in order to find out the evidence for judging the severity of the illness and the suitable clinical treatment.Methods93 patients diagnosed PCOS were involved in this study,all of them were out-patients in the Department of Gynecology of the Fist Affiliated Hospital of Guangzhou University of TCM.Clinical manifestations sheets were used to observe the patients abnormalities of menstruation,acnes,pilosity,the TCM syndrome;measuring the body basal temperature,weight,height,waist circumference,hip circumference for calculating BMI and WHR;ovulation supervision started at 10^thday of menstruation cycle by using the ultrasonic and the three dimensions of the ovaries were measured to calculate the ovary volume;fasting blood was taken at 3^rd-5^thdays of menstruation cycle before treatment to measure the sexual hormones such as FSH,LH,PRL,T,E2 and the metabolic endocrine of fasting insulin. Statistic software of SPSS 13.0 for windows was used for clinical data processing.Results1.Deficiency of kidney was the main syndrome type of PCOS;hepatic fire was the important syndrome type of PCOS;Phlegm-damp and sluggishness of Qi and blood stasis were minor syndrome types of PCOS.2.Acnes,pilosity and obesity were the significant symbol of PCOS.Acnes and pilosity were most severe in Hepatic fire group,P=0.000;the mean-SD values of BMI and WHR were highest in the Phlegm-damp group,P＜0.05,which proved that obesity was severe in this group when compared with other groups.Anovulation and polycystic ovaries(53.8%)were common manifestations of PCOS,polycystic ovaries changes compared among groups, has significance.It was mostly common in phlegm-damp group.84 patients finished the ultrasonic ovulation supervision,30 patients had ovulation and 54 patients had anovulation.3.Menstruation disorder occured in all groups.Delayed menstruation was the main type of menstruation disorder;irregular menses,prolonged menstruation period,hypomenorrhea,hypermenorrhea and amenorrhea were the minor types of menstruation disorder.There were 30 cases of infertility due to menstruation disorder,it occured mostly in both Deficiency of Kidney and sluggishness of Qi and blood stasis groups. There were 5 cases with the history of spontaneous abortion(SA),3 cases in Deficiency of Kidney group and 2 cases in Hepatic fire group.4.LH,FSH,LH/FSH,E2 and T mean levels were raising upwards,which were characteristics of endocrine disorder patterns of PCOS.LH/FSH ratio was closed to 2.It was greater than 2 in groups of Deficiency of Kidney, sluggishness of Qi and blood stasis and Hepatic fire,indicating that high Luteinizing Hormone level in serum is common among PCOS patients. The comparison of Prolactin(PRL)mean level among groups showed the statistic significance,P＜0.05,and it was the highest in sluggishness of Qi and blood stasis group which was higher than the normal value.The comparison of E2 mean level among groups showed no statistic significance, p＞0.05,but it showed statistic significance in the comparison between groups,p＜0.05,it was highest in sluggishness of Qi and blood stasis. The comparison of T mean level among groups had no statistic significance, p＞0.05,but it showed statistic significance in the comparison between groups of Deficiency of kidney and Hepatic fire,p=0.05.The comparison of insulin(INS)mean level among groups showed the statistic significance,P＜0.05,and it was highest in Phlegm-damp group,which indicated that the phlegm-damp group had the greater tendency of developing insulin resistance.5.The case discussions proved that the treatment according to the syndrome differentiation had good curative effect on regulating menstruation cycles and the irregularities of menses and improving ovulation and increasing the chance of fertilization.Conclusions1 Distribution of TCM syndrome in PCOS patients:in this research Deficiency of Kidney is the major type,Hepatic fire is the second major type,Phlegm-damp and sluggishness of Qi and blood stasis are the minor types.2 Clinical manifestations of PCOS patients:acnes,pilosity,obesity are the common clinical manifestations of PCOS.Acnes occur mostly common in Hepatic fire group proved the close correlativity of high T level in Hepatic fire group.Both BMI and WHR are highest in Phlegm-damp group proved the close relativity of central obesity with Phlegm-damp syndrome. Both anovulation and polycystic ovaries changes are often seen in PCOS patients.3 Menstruation characteristics of PCOS patients:Delayed menstruation is the main type of menstruation disorder,irregular menses,prolonged menstruation period,hypomenorrhea,hypermenorrhea and amenorrhea are the minor types of menstruation disorder.There were 30 cases of infertility due to menstruation disorder,it occurs mostly in both Deficiency of Kidney and sluggishness of Qi and blood stasis groups. There were 5 cases with the history of spontaneous abortion(SA)showed the tendency of easily abortion after pregnancy among PCOS patients.4 Clinical endocrine characteristics of PCOS patients:LH,FSH,LH/FSH,E2 and T mean levels were raising upwards,which were characteristics of endocrine disorder patterns of PCOS.LH/FSH ratio closed to 2 or greater than 2 indicating high Luteinizing Hormone level in serum is common among PCOS patients.PRL mean level was higher than the normal range indicated the close relation to blood stasis in meridians and perversion of Qi.T mean level was highest in the group with Hepatic fire syndrome.Insulin mean level was highest in Phlegm-damp group showed Phlegm-damp syndrome will lead to greater tendency of getting insulin resistance.5 The use of evidence-based medical principle according to the variety of clinical manifestations of PCOS and the complexity of TCM syndromes for individual treatment base on the syndrome differentiation which will result in good curative effect on regulating menstruation cycles and the irregularities of menses,as well as improving ovulation and increasing the chance of fertilization.