| ObjectiveTo explore the relationship between different clinical subtypes of polycystic ovary syndrome and TCM constitutional types.MethodsA cross-sectional survey research method was used. And then doctors collect the demographic and social information, clinical symptoms and signs, and the related clinical examination results of patients who have clinical polycystic ovary syndrome, as well as the assessment of "TCM constitution". A database was established by using EPIDATA.3.0and the obtained data were processed by SPSS19.0statistical package for preliminary exploration on the relationship between different clinical subtypes of polycystic ovary syndrome and TCM constitutional types.Results1. Four classical subtypes divided in accordance with Rotterdam criteria included A-type (O+H+P):oligo-ovulation, hyperandrogenemia and polycystic ovary syndrome; B-type (H+O):hyperandrogenemia, oligo-ovulation and normal ovarian morphology; C-type (H+P):hyperandrogenemia, polycystic ovary syndrome and normal menstruation; D-type (O+P):oligo-ovulation, polycystic ovary syndrome, without biochemical or clinical hyperandrogenemia. PCOS D-type (i.e.,O+P subtype) had the maximum number of population accounting for about57.7%, followed by A-type (H+P+O subtype) accounting for about25%, B-type (H+O subtype) accounting for about13.5%, and only two cases of C-type (H+P subtype) accounting for3.8%.2. Sex hormones LH and T, the LH/FSH ratio and2h insulin level were significantly different in the distribution in H+P+O subtype; and the LH/FSH ratio and sex hormone T were positively correlated to the H+P+O subtype. Hirsutism and acne were significantly different in the distribution in H+0 subtype, P<0.05; and hirsutism was significantly positively correlated to H+0subtype. The average levels of BMI, sex hormone E2, hormone T, fasting insulin and2h insulin in O+P subtype were lower than H+0and H+P+O subtypes. Hormones E2and T were significantly different in the distribution in O+P subtype, P<0.01. Both hormones E2and T were significantly positively correlated to H+0subtype.3. PCOS was only divided into three subtypes including hyperandrogenemia, insulin resistance (IR), and hyperandrogenemia and IR subtypes based on with or without hyperandrogenemia and insulin resistance. Hyperandrogenemia subtype and insulin resistance subtype were mostly distributed in PCOS, accounting for about36.5%and34.6%, respectively; and hyperandrogenemia and IR subtype was less distributed in PCOS, with only nine cases (17.3%).4. Hirsutism, sex hormone T and the LH/FSH ratio were significantly different in the distribution in hyperandrogenemia subtype, P<0.05, showing positive correlations. The2h blood glucose, fasting insulin and2h insulin in OGTT trial were significantly different in the distribution in IR subtype, P<0.05, showing positive correlations. The average levels of BMI, LH/FSH>2, fasting insulin and2h insulin in hyperandrogenemia and IR subtype were all higher than hyperandrogenemia subtype and IR subtype. In addition, the LH/FSH ratio and2h insulin were significantly different in the distribution in hyperandrogenemia and IR subtype, P<0.01, showing positive correlations.5. The obese subtype and non-obese subtype were divided in accordance with obesity or not. During the analysis, acanthosis nigricans, hirsutism, high-density lipoprotein (HDL-L) and triglycerides (TG) were significantly different in the distribution in obese and non-obese patients, P<0.05; acanthosis nigricans and high-density lipoprotein (HDL-L) were significantly negatively correlated to obese subtype, and the others were all positively correlated to obese subtype; TG and hirsutism were positively correlated to obese subtype, and TG was significantly positively correlated to obese subtype.6. The TCM constitutions of polycystic ovary were distributed as follows:most of Yang-deficiency constitution in21cases (40.4%), followed by Qi-deficiency constitution in13cases (25.0%), Yin-deficiency constitution and stagnant blood constitution in8cases (15.4%), phlegm constitution and damp-heat constitution in6patients (11.5%), specific endowment constitution and Qi-stagnation constitution in4cases (7.7%), gentleness constitution and temperament constitution in3cases (5.8%). In addition, there were many cases of concurrent constitutions.7. A, C and D subtypes of PCOS were significantly different in the distribution in nine TCM constitutions; B-type (H+0) was different from damp-heat constitution in the distribution in nine TCM constitutions, P<0.05, showing a significantly weaker correlation. Hyperandrogenemia subtype of PCOS was different in the distribution in Yang-deficiency constitution (P<0.05), showing a negative correlation. IR subtype was different in the distribution in Yang-deficiency constitution and Yin-deficiency constitution (P=0.011, P=0.001); IR was weakly negatively correlated to Yang-deficiency constitution and positively correlated to Yin-deficiency constitution. Hyperandrogenemia and IR subtype of PCOS was different in the distribution in Yin-deficiency constitution and Qi-stagnation constitution, showing a negative correlation.8. The phlegm constitution was significantly different between the obese and non-obese patients with PCOS (P=0.015).9. The obese subtype and non-obese subtype were then subdivided in accordance with three indicators, including hyperandrogenemia, insulin resistance, and hyperandrogenemia and IR, and six subtypes were obtained. It was found that IR subtype of the non-obese patients with PCOS were significantly different in the distribution in Yin-deficiency constitution, P=0.014, showing a significant positive correlation between them.Conelusion1. Among four classical subtypes in accordance with Rotterdam criteria, PCOS A-type (H+O+P subtype with biochemical or clinical hyperandrogenemia, oligo-ovulation and polycystic ovary change) is common in obese patients who were usually accompanied by insulin resistance IR, and with a high LH/FSH ratio. PCOS B-type (H+0subtype with biochemical or clinical hyperandrogenemia, oligo-ovulation and normal ovarian morphology) is common in obese patients with prominent clinical hyperandrogenemia such as hirsutism and acne. PCOS D-type (0+P subtype with oligo-ovulation and polycystic ovary change) is common in non-obese and slim patients without manifestations of hyperandrogenemia (including clinical hyperandrogenemia and biochemical hyperandrogenemia) or IR.2. Among three classical subtypes divided into hyperandrogenemia or insulin resistance (IR) alone and the coexistence of hyperandrogenemia and IR, the hyperandrogenemia subtype is with prominent manifestations of biochemical hyperandrogenism and hirsutism. In addition, some subtypes may be accompanied by manifestations of hyperandrogenemia more obvious concomitant with higher LH/FSH ratio, but without other obvious manifestations.IR subtype is common in non-obese patients with the average pre-existing early impaired glucose tolerance.Hyperandrogenemia and IR subtype is common in obese patients who were accompanied by more prominent hyperinsulinemia and insulin resistance; for some patients, the higher LH/FSH ratio is concomitant with the prominent hyperandrogenemia and IR. In addition, screening (oh,2h) of OGTT is important for diagnosis of PCOS and determination of its subtypes and progress.3. Among two classical subtypes divided into non-obese and obese subtypes, acanthosis nigricans are more common in non-obese patients with PCOS, and hirsutism is more common in obese patients with PCOS. The obese patients with PCOS have higher blood lipid levels and high risk of cardiovascular diseases.4. Yang-deficiency constitution is most distributed in the TCM constitutions with polycystic ovary syndrome, followed by Qi-deficiency constitution, Yin-deficiency constitution and stagnant blood constitution, phlegm constitution and damp-heat constitution, specific endowment constitution and Qi-stagnation constitution. Various concurrent constitutions indicate the existence of heterogeneity of TCM constitutions in polycystic ovary syndrome.5. Among four classical subtypes of PCOS in Guangzhou region, H+0subtype is mainly manifested as damp-heat constitution and concurrent with Qi-stagnation constitution, with prominent clinical hyperandrogenemia, such as hirsutism and acne; the other three subtypes have no significant biased constitutions.6. Among hyperandrogenemia subtype, IR subtype and hyperandrogenemia and IR subtype of PCOS in Guangzhou region, non-hyperandrogenemia and non-IR subtype is mainly manifested as Yang-deficiency constitution; IR subtype of PCOS tends to Yin-deficiency constitution; hyperandrogenemia and IR subtype tends to more Qi-stagnation constitution, perhaps a small part of this type tends to Yin-deficiency constitution. On the other hand, PCOS patients in this region have early-and middle-term insulin resistances.7. The obese patients with PCOS are mainly with phlegm constitution. |
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