多囊卵巢综合征患者中西医结合精准辨证分型的初步研究

A preliminary study on the integrated traditional Chinese and Western medicine precise syndrome differentiation typing in PCOS patients

关键词:  PCOS  精准辨证分型  体脂率  代谢  激素

Key words:  PCOS  precise syndrome differentiation  body fat percentage  metabolism  hormones

摘要:

[目的] 以肥胖为切入点，以体脂量和体脂分布为基础，形成基于四诊合参、体脂率和血清生物学指标三要素的多囊卵巢综合征（PCOS）精准辨证分型标准。[方法] 收集2023年1至12月就诊于天津中医药大学第二附属医院妇产科PCOS患者的临床资料及中医四诊信息，总结PCOS的中医证型分布特征；比较不同中医证型PCOS患者的临床特征和生物学指标。[结果] 本研究共纳入PCOS患者393例，脾虚痰湿证的患者数量最多，为218例（55.22%），其次是肾阴虚证151例（38.42%）。高体脂患者中包含了大部分的高身体质量指数（BMI）型患者（92.37%），但高BMI型患者中依然存在相当多一部分的低体脂患者（20.73%），且低体脂患者中也存在相当多一部分的高BMI型患者（36.31%）；脾虚痰湿证的高BMI型、低BMI型PCOS患者中均以高体脂为主要特征；肾阴虚证的高BMI型、低BMI型PCOS患者中以低体脂为主要特征。脾虚痰湿证PCOS患者BMI、体脂率、腰臀比、多毛发生率、痤疮发生率显著高于肾阴虚证患者（P＜0.05），血清生物学指标促甲状腺激素（TSH）、空腹血糖（FPG）、胰岛素抵抗指数（FINS）、稳态模型-胰岛素抵抗指数（HOMA-IR）、内脏脂肪指数（VAI）、脂质蓄积指数（LAP）显著高于肾阴虚证患者（P＜0.05），促黄体生成素（LH）、LH/促卵泡生成素（FSH）、高密度脂蛋白胆固醇（HDL-C）显著低于肾阴虚证患者（P＜0.05）。[结论] PCOS的主要中医证型为脾虚痰湿证和肾阴虚证，而体脂率有望成为脾虚痰湿证和肾阴虚证的标志性特征，脾虚痰湿证PCOS患者显示了更严重的代谢紊乱，而肾阴虚证患者反映了典型的下丘脑-垂体轴功能亢进的特征。体脂率结合激素及代谢指标为PCOS精准辨证分型提供了客观依据。

Abstract:

[Objective] To establish a precise traditional Chinese medicine（TCM） syndrome differentiation standard for polycystic ovary syndrome（PCOS） based on the integration of four diagnostic methods（inspection，auscultation and olfaction，inquiry，and palpation），body fat percentage，and serum biomarkers，with obesity as the entry point and body fat content and distribution as the foundation. [Methods] Clinical data and traditional Chinese medicine diagnostic information were collected from PCOS patients attending the gynecology outpatient clinic at the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine between January 2023 and December 2023. The distribution characteristics of traditional Chinese medicine syndrome types in PCOS were summarized，and the clinical features and biological indicators of different traditional Chinese medicine syndrome types were compared. [Results] A total of 393 PCOS patients were included in this study. The most prevalent traditional Chinese medicine syndrome was spleen deficiency with phlegm-dampness（218 cases，55.22%），followed by kidney yin deficiency（151 cases，38.42%）. Analysis of the relationship between BMI and body fat percentage revealed that while the majority of patients with high BMI also had high body fat（92.37%），a considerable proportion of high-BMI patients（20.73%） were found to have low body fat. Conversely，a significant subset of patients with low BMI（36.31%） had high body fat. Among both obese and non-obese PCOS patients with spleen deficiency and phlegm-dampness syndrome，high body fat was the predominant feature. Conversely，in both obese and non-obese PCOS patients with kidney yin deficiency syndrome，low body fat was the primary characteristic. Patients with spleen deficiency and phlegm-dampness syndrome showed significantly higher body mass index（BMI），body fat percentage，waist-to-hip ratio，hirsutism incidence，and acne incidence compared to those with kidney yin deficiency（P＜0.05）. Serum biomarkers，including TSH，FPG，FINS，HOMA-IR，LAP，and VAI，were also significantly elevated（P＜0.05），while LH，LH/FSH ratio，and HDL-C levels were significantly lower（P＜0.05）. [Conclusion] The primary traditional Chinese medicine syndrome types of PCOS are spleen deficiency with phlegm-dampness and kidney yin deficiency. Body fat percentage may serve as a distinctive marker for these syndromes. Patients with spleen deficiency and phlegm-dampness exhibit more severe metabolic disturbances，whereas those with kidney yin deficiency demonstrate characteristic hyperactivity of the hypothalamic-pituitary axis. The combination of body fat percentage with hormonal and metabolic indicators provides an objective basis for the precise syndrome differentiation of PCOS.