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宋兴瑰, 富宏怡, 杜海胜, 王旭初, 马建新.脐周八穴埋线治疗肥胖型多囊卵巢综合征及对雄激素水平、糖脂代谢的影响[J].湖南中医药大学学报,2024,44(5):838-845[点击复制] |
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| 脐周八穴埋线治疗肥胖型多囊卵巢综合征及对雄激素水平、糖脂代谢的影响 |
| 宋兴瑰,富宏怡,杜海胜,王旭初,马建新 |
| (河北省沧州中西医结合医院生殖医学科, 河北 沧州 061000;河北省中西医结合生殖疾病协同创新中心, 河北 沧州 061000) |
| 摘要: |
| 目的 观察脐周八穴埋线治疗肥胖型多囊卵巢综合征（polycystic ovary syndrome, PCOS）的临床效果，探究脐周八穴埋线治疗对肥胖型PCOS患者体内雄激素水平和糖脂代谢的影响。方法 回顾性分析河北省沧州中西医结合医院于2019年6月至2023年3月收治的肥胖型PCOS并行体外受精-胚胎移植（invitro fertilization-embryotransfer, IVF-ET）的患者180例，根据是否进行脐周八穴埋线治疗将患者分为对照组（n=48）、观察组（n=132）。将具有显著差异的单因素纳入非条件多因素Logistic回归分析模型中，分析脐周八穴埋线有效治疗肥胖型PCOS的独立影响因素，采用多元线性回归分析总胆固醇（total cholesterol, TC）、空腹胰岛素（fasting insulin, FINS）、胰岛素抵抗指数（homeostasis model assessment for insulin resistance, HOMA-IR）、糖化血红蛋白（glycated hemoglobin, HbA1c）与游离雄激素指数（free androgen index, FAI）、睾酮（testosterone, T）、性激素结合球蛋白（sex hormone-binding globulin, SHBG）之间的相关关系。结果 与治疗前相比，两组患者空腹血糖（fasting plasma glucose, FPG）、FINS、HOMA-IR、HbA1c、2 h血浆葡萄糖浓度（2-hour plasma glucose concentration, 2hPBG）、TC、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）、甘油三酯（triglycerides, TG）、腰臀比（waist-to-hip ratio, WHR）、体质量指数（boss mass index, BMI）、黄体生成素（luteinizing hormone, LH）、LH/卵泡雌激素（follicle-stimulating hormone, FSH）、FAI、T、C反应蛋白（C-reactive protein, CRP）、肿瘤坏死因子-α（tumor necrosis factor-α, TNF-α）、白细胞介素-6（interleukin-6, IL-6）明显降低（P<0.05），SHBG、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol, HDL-C）、FSH明显升高（P<0.05）；治疗后，与对照组相比，观察组患者FINS、HOMA-IR、HbA1c、TC、TG、BMI、LH、LH/FSH、T、FAI、CRP、TNF-α、IL-6明显降低（P<0.05），SHBG明显升高（P<0.05）。治疗后，观察组临床妊娠率、活产率、周期排卵率均高于对照组（P<0.05）。治疗后，两组患者总分、主症积分、次症积分均较治疗前明显下降（P<0.05）；与对照组相比，观察组患者经治疗后总分、主症积分、次症积分更低（P<0.05）。脐周八穴埋线治疗有效率为92.42%，明显优于对照组的83.33%（P<0.05）。FAI与FINS、HOMA-IR、HbA1c呈显著正相关关系，SHBG与FINS、HOMA-IR、HbA1c呈显著负相关关系（P<0.05）；T与TC、HOMA-IR呈显著正相关关系（P<0.05）。4组FAI亚组患者TC、FINS、HOMA-IR、HbA1c指标差异有统计学意义（P<0.05）；与F1、F2组相比，F3、F4组TC、FINS、HOMA-IR、HbA1c指标水平明显升高（P<0.05）；与F3组相比，F4组TC、HbA1c指标水平明显升高（P<0.05）。结论 采用脐周八穴埋线治疗肥胖型PCOS患者可以获得更好的临床疗效，其主要通过降低FINS、FAI、HOMA-IR、T、中医证候积分、TC、IL-6、TNF-α、HbA1c和提高SHBG来实现，其中：FAI、SHBG是FINS、HOMA-IR、HbA1c的影响因素；T是TC、HOMA-IR的影响因素；FAI水平越高，糖脂代谢水平越低。 |
| 关键词: 穴位埋线 多囊卵巢综合征 雄激素水平 糖脂代谢 脐周八穴 肥胖 |
| DOI：10.3969/j.issn.1674－070X.2024.05.017 |
| 投稿时间：2023-12-28 |
| 基金项目:河北省中医药管理局科研计划项目（2021330）。 |
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| The treatment of embedding eight acupoints around the umbilicus on obese polycystic ovary syndrome and its effects on androgen level and glucose-lipid metabolism |
| SONG Xinggui, FU Hongyi, DU Haisheng, WANG Xuchu, MA Jianxin |
| (Department of Reproductive Medicine, Cangzhou Hospital of Integrative Chinese and Western Medicine, Cangzhou, Hebei 061000, China;Hebei Collaborative Innovation Center of Integrative Chinese and Western Medicine for Reproductive Diseases, Cangzhou, Hebei 061000, China) |
| Abstract: |
| Objective To investigate the clinical effects of embedding eight acupoints around the umbilicus in the treatment of obese polycystic ovary syndrome (PCOS), and to explore the effects of embedding eight acupoints on androgen level and glucose-lipid metabolism in obese PCOS patients. Methods A total of 180 patients with obese PCOS and invitro fertilisation-embryotransfer (IVF-ET) treated in Cangzhou Hospital of Integrative Chinese and Western Medicine in Hebei Province from June 2019 to March 2023 were retrospectively analyzed. The patients were assigned into control group (n=48) and observation group (n=132) based on whether they received the treatment of embedding eight acupoints around the umbilicus. The single factor with significant differences were incorporated into the unconditional multivariate Logistic regression analysis model to analyze the independent influencing factors of effective treatment of obese PCOS with embedding eight acupoints around the umbilicus. Multivariate linear regression analysis was performed to explore the correlation between total cholesterol (TC), fasting insulin (FINS), homeostasis model assessment for insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), free androgen index (FAI), testosterone (T), and sex hormone-binding globulin (SHBG). Results Compared with those before treatment, fasting plasma glucose (FPG), FINS, HOMA-IR, HbAlc, 2-hour plasma glucose concentration (2hPBG), TC, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), waist-to-hip ratio (WHR), body mass index (BMI), luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), FAI, T, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were significantly reduced in both groups (P<0.05), while SHBG, high-density lipoprotein cholesterol (HDL-C), and FSH were significantly elevated (P<0.05). After treatment, compared with the control group, patients in the observation group had significantly lower levels of FINS, HOMA-IR, HbAlc, TC, TG, BMI, LH, LH/FSH, T, FAI, CRP, TNF-α, and IL-6 (P<0.05), while SHBG was significantly higher (P<0.05). After treatment, the clinical pregnancy rate, live birth rate, and ovulation rate in the observation group were higher than those in the control group (P<0.05). The comparison of Chinese medicine pattern scores between the two groups revealed that the total scores, main pattern scores, and secondary pattern scores in both groups decreased significantly after treatment (P<0.05). Compared with the control group, the total scores, main pattern scores and secondary pattern scores in the observation group were lower after treatment (P<0.05). The effective rate of embedding eight acupoints around the umbilicus treatment was 92.42%, which was significantly higher than 83.33% of the control group (P<0.05). FAI exhibited a significant positive association with FINS, HOMA-IR, and HbA1c, whereas SHBG displayed a significant negative association with FINS, HOMA-IR, and HbA1c (P<0.05). T exhibited a significant positive association with TC and HOMA-IR (P<0.05). There were statistically significant differences in TC, FINS, HOMA-IR, and HbA1c levels among the four subgroups of FAI patients (P<0.05). The F3 and F4 groups exhibited significantly higher levels of TC, FINS, HOMA-IR, and HbA1c compared to the F1 and F2 groups (P<0.05). The F4 group exhibited significantly higher levels of TC and HbA1c compared to the F3 group (P<0.05). Conclusion The treatment of embedding eight acupoints around the umbilicus in obese PCOS patients can achieve better clinical efficacy, mainly through reducing FINS, FAI, HOMA-IR, T, TCM pattern scores, TC, IL-6, TNF-α, and HbA1c, as well as increasing SHBG levels. FAI and SHBG are influential factors of FINS, HOMA-IR, and HbA1c levels, while T is an influential factor in TC and HOMA-IR levels. The higher the level of FAI, the lower the level of glucose-lipid metabolism. |
| Key words: acupoint embedding polycystic ovary syndrome androgen level glucose-lipid metabolism eight acupoints around the umbilicus obesity |
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