气虚体质PCOS患者不同高雄激素血症表型与临床生化水平的相关性研究

目的:探讨不同高雄激素血症(HA)表型的多囊卵巢综合征(PCOS)患者中医体质分布情况。方法:回顾性分析2015年4月至2019年4月黑龙江中医药大学附属第一医院妇科科研门诊首次诊断为PCOS的826例患者,根据《中医体质分类与判定》判定中医体质类型,根据血清雄烯二酮(AND)和睾酮(T)水平分为4组。观察各组中医体质类型分布情况。结果:(1)826例PCOS患者中医体质以气虚质173例(20.94%)、痰湿质142例(17.19%)为主,其次为血瘀质124例(15.01%)、湿热质111例(13.44%)。(2)PCOS患者不同中医体质中气虚质、血瘀质、痰湿质、湿热质、气郁质、平和质在不同高雄激素血症表型分组中存在差异(P<0.05);(3)临床特征:Ⅰ组、Ⅱ组、Ⅲ组多毛发生率高于Ⅳ组,且Ⅰ组高于Ⅱ组、Ⅲ组(P<0.05);Ⅰ组黑棘皮发生率高于Ⅱ组、Ⅳ组,且Ⅲ组高于Ⅳ组(P<0.05);Ⅰ组、Ⅱ组痤疮发生率高于Ⅳ组(P<0.05);(4)生化水平:Ⅰ组、Ⅱ组、Ⅲ组的LH高于Ⅳ组,且Ⅰ组高于Ⅱ组(P<0.05);Ⅰ组、Ⅱ组的FSH低于Ⅲ组及Ⅳ组,差异均有统计学意义(P<0.05);Ⅰ组的LH/FSH、T值显著高于Ⅱ组、Ⅲ组、Ⅳ组(P<0.05),且Ⅱ组LH/FSH高于Ⅳ组,T值高于Ⅲ组、Ⅳ组(P<0.05);Ⅰ组、Ⅲ组的DHEAS、AND显著高于Ⅱ组、Ⅳ组(P<0.05);Ⅰ组TG、TC、LDL显著高于Ⅱ组及Ⅳ组(P<0.05);Ⅲ组TC、LDL显著高于Ⅱ组(P<0.05)。(5)相关性分析:气虚质PCOS患者T值与LH、E2、DHEAS、TG、LDL成正相关(P<0.05);AND值与初潮年龄、LH、LH/FSH、DHEAS、TG、TC、LDL成正相关(P≤0.05),与年龄、BMI、腰围成负相关(P≤0.05)。结论:气虚体质不同高雄激素血症表型的PCOS患者的临床特征及生化水平存在差异。

Study on the Correlation between Different Phenotypes of Hyperandrogenism and Clinical Biochemical Level in Patients of Polycystic Ovary Syndrome with Qi Deficiency Constitution

Obje ctive: To explore the TCM constitution distribution in polycystic ovary syndrome(PCO S patients with different hyperandrogenism(HA) phenotypes. Methods: Totally 826 patients with polycystic ovary syndrome(PCOS), first diagnosed in the Department of gynecology of The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from April 2015 to April 2019, were reviewed and their types of TCM constitution were diagnosed according to The TCM constitution and Judgment. According to the level of Androstenedione(AND) and Testosterone(T), the patients were divided into four groups. The distribution of TCM constitution types were observed in each group. Results: Firstly, among the 826 PCOS patients, the main constitution were Qi deficiency constitution of 173 cases(20.94%), phlegm-dampness constitution of 142 cases(17.19%),blood stasis constitution of 124 cases(15.01%) and dam-heat constitution of 111 cases(13.44%). Secondly, there were statistical difference in Qi deficiency constitution, blood stasis constitution, phlegm dampness constitution,damp heat constitution, Qi depression constitution and gentleness constitution among PCOS patients of different phenotype groups of hyperandrogenemia(P <0.05). Thirdly, according to the clinical features, the group Ⅰ, Ⅱand Ⅲ showed higher incidence of hirsutism than group Ⅳ, and group I showed higher incidence of hirsutism than group Ⅱ and Ⅲ(P<0.05). The group Ⅰshowed higher incidence of acanthosis nigricans than group Ⅱ andⅣ, and group Ⅲ showed higher incidence of acanthosis nigricans than group Ⅳ(P<0.05). The group Ⅰ andⅡ showed higher incidence of acne than group Ⅳ(P<0.05). Fourthly, The group Ⅰ, Ⅱ and Ⅲ showed higher level of LH than group Ⅳ, and group Ⅰ showed higher level of LH than group Ⅱ(P<0.05). The group Ⅰ and Ⅱ showed lower level of FSH o than group Ⅲ and Ⅳ(P<0.05). The group Ⅰ showed higher LH/FSH and T values than group Ⅱ, Ⅲ and Ⅳ(P<0.05);group Ⅱ showed higher LH/FSH than group Ⅳ, as well as higher value of T than group Ⅲ and Ⅳ(P<0.05). The group Ⅰ and Ⅲ showed higher DHEAS and AND than groupⅡ andⅣ(P<0.05). The group Ⅰ showed higher TG, TC and LDL than group Ⅱ and Ⅳ(P<0.05);the group Ⅲshowed higher TC and LDL than group Ⅱ(P<0.05). Fifthly, according to correlation analysis, T was positively correlated with LH, E2, DHEAS, TG and LDL in PCOS patients with Qi deficiency constitution(P<0.05);AND was positively correlated with menarche age, LH, LH/FSH, DHEAS, TG, TC and LDL(P≤0.05), and negatively correlated with age, BMI and waist circumference(P ≤0.05). Conclusion: There is difference on the clinical characteristics and biochemical levels among PCOS patients of Qi deficiency constitution with different hyperandrogenemia phenotype.