目的 观察辛开苦降法对多囊卵巢综合征(Polycystic ovarian syndrome,PCOS)胰岛素抵抗(Insulin resistance,IR)患者卵巢功能、子宫内膜容受性及磷脂酰肌醇3激酶/丝苏氨酸蛋白激酶(Phosphatidylinositol 3 ki-nase/serine threonine protein kinase,PI3K/AKT)通路的影响.方法 选取2018年11月-2020年1月期间四川中医药高等专科学校附属绵阳市中医医院收治的PCOS-IR患者83例,按随机数字表法分为对照组41例和治疗组42例.对照组采用炔雌醇环丙孕酮联合二甲双胍治疗,治疗组采用中医辛开苦降法(中药),均连续治疗12周.观察比较两组患者治疗前后体质量指数(Body mass index,BMI)、卵巢功能[卵泡刺激素(Follicle stimulating hor-mone,FSH)、黄体生成素(Luteinizing hormone,LH)、LH/FSH 与抗缪勒管激素(Anti-mullerian hormone,AMH)]、血糖[空腹胰岛素(Fasting insulin,FIN)、空腹血糖(Fasting blood glucose,FPG)、餐后 2 h 血糖(2 hours postprandial blood glucose,2 h PBG)与胰岛素抵抗指数(Homeostasis model assessmentinsulin resistance,HOMA-IR)]、子宫内膜容受性[收缩期峰值流速(Vmax)、搏动指数(Pulse index,PI)、阻力指数(Resistance index,RI)、血流参数血管化指数(Vascularity index,Ⅵ)、血流指数(Flow index,FI)与血管化血流指数(Vascularity flow index,VFI)]、外周血PI3K/AKT通路(PI3K、AKTmNRA),治疗期间不良反应情况.结果 治疗后两组患者BMI、FPG、FIN、2 h GLU、HOMA-IR水平均较治疗前明显降低,差异有统计学意义(P＜0.05);且治疗组BMI、FPG、FIN、2 h GLU、HOMA-IR水平均明显低于对照组,差异有统计学意义(P＜0.05).治疗后两组患者AMH、LH、LH/FSH水平均较治疗前降低,差异有统计学意义(P＜0.05);FSH较治疗前无显著变化,差异无统计意义(P＞0.05);且治疗组AMH、LH、LH/FSH明显低于对照组,差异有统计学意义(P＜0.05).治疗后两组患者子宫内膜厚度、子宫容积、Vmax、VI、FI、VFI均较治疗前明显升高,PI、RI均较治疗前降低,差异有统计学意义(P＜0.05);且治疗组子宫内膜厚度、子宫容积、Vmax、VI、FI、VFI均明显高于对照组,PI、RI均明显低于对照组,差异有统计学意义(P＜0.05).治疗后两组患者PI3K、AktmRN表达均较治疗前升高,差异有统计学意义(P＜0.05);且治疗组PI3K、AktmRN表达均明显高于对照组,差异有统计学意义(P＜0.05).治疗期间,两组患者均未发生严重不良反应.结论 中医辛开苦降法不仅能改善PCOS-IR患者胰岛素抵抗,还可改善其卵巢功能、子宫内膜容受性,激活PI3K/AKT通路,安全性高.
Influence of Xinkai Kujiang Method on Ovarian Function,Endometrial Receptivity,and Phosphatidylinositol 3 Kinase/Serine Threonine Protein Kinase Pathway in Pa-tients with Polycystic Ovarian Syndrome and Insulin Resistance
Objective To explore the influence of the Xinkai Kujiang method on ovarian function,endometrial re-ceptivity,and phosphatidylinositol 3 kinase/serine threonine protein kinase(PI3K/AKT)pathway in patients with polycystic ovarian syndrome(PCOS)and insulin resistance(IR).Methods A total of 83 patients with PCOS-IR admitted to Mian-yang Hospital of TCM affiliated to Sichuan College of Traditional Chinese Medicine from November 2018 to January 2020 were selected.The patients were randomly divided into the control group(41 cases)and the treatment group(42 cases).The control group was treated with ethinylestradiol cycloproterenone combined with metformin,and the treatment group was treated with the Xinkai Kujiang method(Chinese herb)in traditional Chinese medicine(TCM).Both groups were treated for 12 weeks.The body mass index(BMI),ovarian function[follicle stimulating hormone(FSH),luteinizing hormone(LH),LH/FSH,and anti-Mullerian hormone(AMH)],blood glucose[fasting insulin(FIN),fasting blood glucose(FPG),2 hours postprandial blood glucose(2 h PBG),and IR index(HOMA-IR)],endometrial receptivity[peak systolic flow rate(Vmax),pulse index(PI),resistance index(RI),vascularity index of blood flow parameters(VI),flow index(FI),and vascularity flow index(VFI)],and peripheral blood PI3K/AKT pathway(PI3K and AKT mNRA)of the two groups were observed and compared before and after treatment,and adverse reactions of the two groups during treatment were recorded.Results After treatment,the levels of BMI,FPG,FIN,2 h GLU,and HOMA-IR of the two groups were significantly re-duced,and the difference was statistically significant(P＜0.05),and the above indexes in the treatment group were signifi-cantly lower than the control group(P＜0.05).After treatment,the levels of AMH,LH,and LH/FSH in the two groups were significantly decreased(P＜0.05).There was no significant change in FSH after treatment,and the difference was not statistically significant(P＞0.05).In addition,the levels of AMH,LH,and LH/FSH in the treatment group were signifi-cantly lower than those in the control group(P＜0.05).After treatment,the endometrial thickness,uterine volume,Vmax,VI,FI,and VFI in the two groups were significantly increased,while PI and RI decreased(P＜0.05).Moreover,the treat-ment group had larger endometrial thickness,uterine volume,Vmax,VI,FI,and VFI compared to the control group,while PI and RI in the treatment group were lower than those in the control group(P＜0.05).After treatment,the expressions of PI3K and Akt mRNA in the two groups were increased significantly(P＜0.05),and the expressions of PI3K and Akt mR-NA in the treatment group were higher than those in the control group(P＜0.05).Both groups had no serious adverse re-actions during treatment.Conclusion The Xinkai Kujiang method in TCM can improve IR in patients with PCOS-IR,strengthen ovarian function and endometrial receptivity,and activate the PI3K/AKT pathway,with high safety.
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维普
