影响多囊卵巢综合征不孕症患者受孕结局的中医体质、中医证候相关因素分析

目的分析影响多囊卵巢综合征(PCOS)不孕症患者受孕结局的中医体质、中医证候相关因素。方法选取医院2017年3月—2018年11月收治的268例多囊卵巢综合征不孕症患者作为研究对象。分别以PCOS的中医体质和中医证候为因变量,以人体、生殖及内分泌等相关临床指标为自变量进行Logistic回归分析。结果中医体质分析结果显示,年龄、体质量指数(BMI)、空腹血糖(FPG)和痤疮是痰湿质患者的危险因素,收缩压和空腹胰岛素(FINS)是痰湿质患者的保护因素(P<0.05);初潮年龄、空腹血糖(FPG)和痤疮是湿热质患者的危险因素(P<0.05);BMI是血瘀质患者的危险因素,腰臀比(WHR)和FINS是血瘀质患者的保护因素(P<0.05);初潮年龄和卵泡刺激素(FSH)是阴虚质患者的危险因素(P<0.05);BMI是特禀质患者的危险因素,睾酮(T)是特禀质患者的保护因素(P<0.05)。中医证候分析结果显示,黄体生成素(LH)是肾虚血瘀证患者的危险因素,FSH是肾虚血瘀证患者的保护因素(P<0.05);BMI、FINS、FPG、多毛评分、WHR和LH/FSH>3是脾虚痰湿症患者的危险因素(P<0.05);FSH和LH/FSH>3是脾肾阳虚证患者的危险因素,垂体泌乳素(PRL)、FINS和痤疮是脾肾阳虚证患者的保护因素(P<0.05);雌二醇(E2)是肾阴虚症患者的保护因素(P<0.05);PRL和E2是气滞血虚证患者的危险因素(P<0.05);BMI、FSH、孕酮(PRG)、FINS和痤疮是肝郁血热症患者的危险因素,LH和C-肽是肝郁血热症患者的保护因素(P<0.05)。结论通过对多囊卵巢综合征不孕症的相关影响因素进行分析,建立了患者身体、生殖及内分泌指标与中医体质、中医证候之间的相关性,对客观评价患者病症严重程度,选择合理治疗方案,改善受孕结局有参考意义。

Study onRelated Influencing Factors of TCM Constitutions and TCM Syndromes in Infertility Patients with Polycystic Ovary Syndrome

Objective To analyze the related factors of TCM constitutions and TCM syndromes affecting the pregnancy outcome of infertility patients with polycystic ovary syndrome(PCOS).Methods Totally 268 cases of infertility with PCOS admitted to our hospital from March 2017 to November 2018 were selected as the research objects.TCM constitutions and TCM syndromes of PCOS were taken as dependent variables,and clinical indexes such as body,reproduction and endocrine were taken as independent variables for Logistic regression analysis.Results The results of TCM constitutions showed that age,body mass index(BMI),fasting blood glucose(FPG)and acne were risk factors for phlegm-dampness patients,while systolic blood pressure and fasting serum insulin(FINS)were protective factors(P<0.05).Menarche age,fasting blood glucose(FPG)and acne were risk factors for damp-heat syndrome(P<0.05).BMI was a risk factor for patients with blood stasis,while the waist-hip ratio(WHR)and FINS were protective factors(P<0.05).Menarche age and follicle stimulating hormone(FSH)were risk factors for Yin deficiency(P<0.05).BMI was a risk factor for patients with idiosyncrasy,and testosterone(T)was a protective factor(P<0.05).The results of TCM syndromes analysis showed that luteinizing hormone(LH)was a risk factor for patients with kidney deficiency and blood stasis syndrome,and FSH was a protective factor for it(P<0.05).BMI,FINS,FPG,hirsutism score,WHR and LH/FSH>3 were risk factors for spleen deficiency and phlegm-dampness(P<0.05).FSH and LH/FSH>3 were risk factors for patients with spleen and kidney Yang deficiency syndrome,and pituitary prolactin(PRL),FINS and acne were protective factors(P<0.05).Estradiol(E2)was a protective factor in patients with kidney Yin deficiency(P<0.05).PRL and E2 were risk factors of stagnation of the circulation of vital energy and blood deficiency(P<0.05).BMI,FSH,progesterone(PRG),FINS and acne were risk factors for patients with liver-Qi stagnation and blood-heat syndrome,while LH and C-peptide were protective factors(P<0.05).Conclusions Through the analysis of the influencing factors of PCOS infertility,the correlation between the body,reproductive and endocrine indexes of patients and TCM constitutions and TCM syndromes was established,which has reference significance for objective evaluation of the severity of patients’disease,selection of reasonable treatment schemes and improvement of pregnancy outcomes.