Discussion On The Department Of Clinical Diagnosis Based On The Evolution Of The Pathophysiology Of PCOS And The Characteristics Of TCM Syndromes

Objective:According to discuss PCOS sufferer’s common clinical feature,endocrine and metabolize specialty,analyse PCOS diagnostic criteria,in the same time present a new conception for PCOS traditional chinese medical sience discriminate,this Research provide a impersonality preuve for PCOS clinical diagnosis and syndrome differentiation and treatment,to improve the clinical effects.Methods:Part1:Selects in May,2010to June,2011in the Hunan second people’s Hospital gynecology and obstetrics department outpatient service seeing a doctor409example ovary multi-pouch type performance (PCO) suspicious patient,defers to the present different diagnosis standard to carry on the distinction separately,compared with each kind of standard diagnosis PCOS and during each target between non-PCOS patient’s difference,and the curve following several analyzes LH, LH/FSH,T,T/E2through (ROC) in the PCOS diagnosis significance,moreover chooses the normal person who189example menstrual cycle normal, non-endocrine disease and the ultrasound inspect non-PCO to take the control group. And unifies the hormone six levels which the case and the patient determine, the IRT-OGTT result, carries on the comparison, the induction, to analyze the PCOS patient clinical diagnosis standard the characteristic.Part2:Observes the Rotterdam standard diagnosis according to the survey result371example PCOS patient’s clinical symptoms performance,Carries on the dialectical minute to it,divides into clamps the wet group,the heart kidney not to hand over the group,the hot and damp group Yin deficient,on under the heat the cold group.Through the statistics,the analysis,summarize the PCOS patient Chinese medicine card period of five days performance characteristic,Proposes to PCOS in the Chinese medicine dialectical minute on new understanding.Results:Part one:In PCOS in suspicious patient,the menstrual cycle situation sends thinly take the menstruation as the main performance, clinical Gaoxiong take the acne as the main performance.body weight index BMI and the control group compare,non-statistics difference. Metabolism aspect take the high insulin blood sickness as the main performance.Compared with five kind of diagnosis standards,we discovered that NIH, AES the diagnosis standard basic threshold is high, possibly will present excessively many false negative. But the Rotterdam standard and the Chinese standard’s PCOS basic threshold is low, it will present excessively many false positive results. Simultaneously compares under each diagnosis standard PCOS patient, Its LH,LH/FSH,T/E2,T level compares the non-PCOS specificity to be high, through calculates under the ROC curve the area, we find T>T/E2> LH> LH/FSH. Studies the discovery through the typical case, LH> FSH is not diagnoses PCOS the essential condition,so the Japanese standard integrates it the diagnosis standard possibly not to suit our country.Part two:Carduonephric cisharmony is the most in the TCM syndromes of Clinical collection about PCOS, Follow then is yin deficiency with wet> syndrome of upper heat and lower cold>damp-heat syndrome,Acne,burning sensation of five centres, exhaust,insomnia and dreaminess,chest distress,erosion of mucous membrane in oral cavity,debilitation,anorexia,chilly,hectic fever and diaphoresis are the mostly with frequency analysis of symptoms.In this study,we discovery the spleen,kidney,liver are closely related to PCOS through he symptoms of distribution table,and The clinical manifestations of kidney system more than clinical manifestations of the spleen system.The clinical manifestations of the spleen system more than clinical manifestations of liver.Study found that the majority of patients with PCOS have the performance of the wet.If the wet in the skin and depression and stagnation of QI,will appearance debilitation,pain,eczema or itching.the main manifestation of endogenous wetness-evil is abdominal distention,poor appetite,nausea and anorexia.In this study,Patients with wet accounted for66.58%.Conclusions:1. Rotterdam and Chinese diagnostic criteria is too broad in the five diagnostic criteria of PCOS.But the diagnostic criteria of the NIH and AES are too narrow relatively.At the same time,we can find the LH/FSH is not the primary diagnostic indicators for PCOS.the pathophysiology of PCOS is not iust of hyperandrogenism and hypoestrogenemia,also include hyperinsulinemia,insulin resistance,metabolic syndrome etc.Diagnostic criteria for PCOS,must have ovulation failure,PCO,hyperandrogenism or/and hyperandrogenism and hypoestrogenemia,the three point exist for the main diagnostic criteria.the diagnosis of PCOS can be divided into three stages that PCOS before,PCOS,ultra-PCOS.Showing the chromatography belt diagnostics standards. 2. TCM syndrome type of PCOS as the carduonephric cisharmony,yin deficiency with wet,syndrome of upper heat and lower cold,damp-heat syndrome as the main performance.And damp syndrome in the majority of PCOS, but no sputum display,and blood stasis is also in a minority.