PCOS-IR的病因病机及中西医治疗的研究进展
Research Progress on the Etiology and Pathogenesis of PCOS-IR and Its Treatment in Chinese and Western Medicine
DOI: 10.12677/TCM.2023.129374, PDF,   
作者: 张楚楚:湖北中医药大学中医临床学院,湖北 武汉
关键词: 多囊卵巢综合征胰岛素抵抗中医药Polycystic Ovary Syndrome Insulin Resistance Traditional Chinese Medicine
摘要: 多囊卵巢综合征作为中国育龄妇女的一个重大公共健康问题,患病率逐年上升,从身体以及心理的角度都为女性带来了重大的影响,而胰岛素抵抗型多囊卵巢综合征(PCOS-IR)患者在这之中占据较大比例,探究其病理机制有助于寻找相应的治疗方法,临床上常用二甲双胍作为治疗PCOS伴随代谢症状的一线治疗药物,但这种单一的疗法有时并不能取得很好的疗效,故结合中西医治疗方法来进行汇总,现综述如下。
Abstract: As a major public health problem among Chinese women of reproductive age, the prevalence of polycystic ovary syndrome (PCOS) is increasing year by year, which brings significant impact on women from physical as well as psychological perspectives, and insulin-resistant polycystic ovary syndrome (PCOS-IR) patients occupy a large proportion of this, and exploring its pathological mechanism helps to find corresponding treatment methods. Metformin is commonly used clinically as the first-line treatment for PCOS with metabolic symptoms, but the effect of this monotherapy sometimes does not achieve good efficacy, so the combination of Chinese and Western medicine treatment methods to summarize, is reviewed as follows.
文章引用:张楚楚. PCOS-IR的病因病机及中西医治疗的研究进展[J]. 中医学, 2023, 12(9): 2497-2504. https://doi.org/10.12677/TCM.2023.129374

参考文献

[1] Yang, R., Li, Q., Zhou, Z., et al. (2022) Changes in the Prevalence of Polycystic Ovary Syndrome in China over the Past Decade. The Lancet Regional Health-Western Pacific, 25, Article ID: 100494. [Google Scholar] [CrossRef] [PubMed]
[2] 中华医学会妇产科学分会内分泌学组及指南专家组. 多囊卵巢综合征中国诊疗指南[J]. 中华妇产科杂志, 2018, 53(1): 2-6.
[3] Siddle, K. (2011) Signalling by Insulin and IGF Receptors: Supporting Acts and New Players. Journal of Molecular Endocrinology, 47, R1-R10. [Google Scholar] [CrossRef
[4] Corbould, A., Kim, Y.-B., Youngren, J.F., et al. (2005) Insulin Resistance in the Skeletal Muscle of Women with PCOS Involves Intrinsic and Acquired Defects in Insulin Signaling. American Journal of Physiology-Endocrinology and Metabolism, 288, E1047-E1054. [Google Scholar] [CrossRef] [PubMed]
[5] Dunaif, A., Xia, J., Book, C.B., Schenker, E. and Tang, Z. (1995) Excessive Insulin Receptor Serine Phosphorylation in Cultured Fibroblasts and in Skeletal Muscle. A Potential Mechanism for Insulin Resistance in the Polycystic Ovary Syndrome. Journal of Clinical Investigation, 96, 801-810. [Google Scholar] [CrossRef
[6] Ciampelli, M. and Lanzone, A. (1998) Insulin and Polycystic Ovary Syndrome: A New Look at an Old Subject. Gynecological Endocrinology, 12, 277-292. [Google Scholar] [CrossRef] [PubMed]
[7] Baillargeon, J. and Nestler, J.E. (2006) Polycystic Ovary Syndrome: A Syndrome of Ovarian Hypersensitivity to Insulin? The Journal of Clinical Endocrinology & Metabolism, 91, 22-24. [Google Scholar] [CrossRef] [PubMed]
[8] Ezeh, U., Ezeh, C., Pisarska, M.D. and Azziz, R. (2021) Menstrual Dysfunction in Polycystic Ovary Syndrome: Association with Dynamic State Insulin Resistance Rather Than Hyperandrogenism. Fertility and Sterility, 115, 1557-1568. [Google Scholar] [CrossRef] [PubMed]
[9] Geffner, M.E., Kaplan, S.A., Bersch, N., et al. (1986) Persistence of Insulin Resistance in Polycystic Ovarian Disease after Inhibition of Ovarian Steroid Secretion. Fertility and Sterility, 45, 327-333. [Google Scholar] [CrossRef
[10] Caldwell, A.S.L., Edwards, M.C., Desai, R., et al. (2017) Neuroendocrine Androgen Action Is a Key Extraovarian Mediator in the Development of Polycystic Ovary Syndrome. Proceedings of the National Academy of Sciences of the United States of America, 114, E3334-E3343. [Google Scholar] [CrossRef] [PubMed]
[11] Diamanti-Kandarakis, E. and Dunaif, A. (2012) Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications. Endocrine Reviews, 33, 981-1030. [Google Scholar] [CrossRef] [PubMed]
[12] Abdalla, M.A., Shah, N., Deshmukh, H., et al. (2022) Impact of Pharmacological Interventions on Insulin Resistance in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clinical Endocrinology, 96, 371-394. [Google Scholar] [CrossRef] [PubMed]
[13] Katsiki, N., Georgiadou, E. and Hatzitolios, A.I. (2009) The Role of Insulin-Sensitizing Agents in the Treatment of Polycystic Ovary Syndrome. Drugs, 69, 1417-1431. [Google Scholar] [CrossRef] [PubMed]
[14] Palomba, S., Falbo, A., Zullo, F. and Orio Jr., F. (2009) Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review. Endocrine Reviews, 30, 1-50. [Google Scholar] [CrossRef] [PubMed]
[15] Bennett, W.L., Aschmann, H.E., Puhan, M.A., et al. (2019) A Benefit-Harm Analysis of Adding Basal Insulin vs. Sulfonylurea to Metformin to Manage Type II Diabetes Mellitus in People with Multiple Chronic Conditions. Journal of Clinical Epidemiology, 113, 92-100. [Google Scholar] [CrossRef] [PubMed]
[16] Cai, M., Shao, X., Xing, F., et al. (2022) Efficacy of Canagliflozin versus Metformin in Women with Polycystic Ovary Syndrome: A Randomized, Open-Label, Noninferiority Trial. Diabetes, Obesity and Metabolism, 24, 312-320. [Google Scholar] [CrossRef] [PubMed]
[17] Zhang, J., Xing, C., Cheng, X. and He, B. (2022) Canagliflozin Combined with Metformin versus Metformin Monotherapy for Endocrine and Metabolic Profiles in Overweight and Obese Women with Polycystic Ovary Syndrome: A Single- Center, Open-Labeled Prospective Randomized Controlled Trial. Frontiers in Endocrinology, 13, Article 1003238. [Google Scholar] [CrossRef] [PubMed]
[18] Michałowska, J., Miller-Kasprzak, E. and Bogdański, P. (2021) Incretin Hormones in Obesity and Related Cardiometabolic Disorders: The Clinical Perspective. Nutrients, 13, Article No. 351. [Google Scholar] [CrossRef] [PubMed]
[19] Blonde, L. and Russell-Jones, D. (2009) The Safety and Efficacy of Liraglutide with or without Oral Antidiabetic Drug Therapy in Type 2 Diabetes: An Overview of the LEAD 1-5 Studies. Diabetes, Obesity and Metabolism, 11, 26-34. [Google Scholar] [CrossRef] [PubMed]
[20] Vilsbøll, T., Christensen, M., Junker, A.E., Knop, F.K. and Gluud, L.L. (2012) Effects of Glucagon-Like Peptide-1 Receptor Agonists on Weight Loss: Systematic Review and Meta-Analyses of Randomised Controlled Trials. BMJ, 344, Article No. d7771. [Google Scholar] [CrossRef] [PubMed]
[21] Sfairopoulos, D., Liatis, S., Tigas, S. and Liberopoulos, E. (2018) Clinical Pharmacology of Glucagon-Like Peptide-1 Receptor Agonists. Hormones, 17, 333-350. [Google Scholar] [CrossRef] [PubMed]
[22] Htike, Z.Z., Zaccardi, F., Papamargaritis, D., et al. (2017) Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes: A Systematic Review and Mixed-Treatment Comparison Analysis. Diabetes, Obesity and Metabolism, 19, 524-536. [Google Scholar] [CrossRef] [PubMed]
[23] Ma, R.-L., Deng, Y., Wang, Y.-F., et al. (2021) Short-Term Combined Treatment with Exenatide and Metformin for Overweight/obese Women with Polycystic Ovary Syndrome. Chinese Medical Journal, 134, 2882-2889. [Google Scholar] [CrossRef
[24] Guo, C., Huang, T., Chen, A., et al. (2016) Glucagon-Like Peptide 1 Improves Insulin Resistance in Vitro through Anti-Inflammation of Macrophages. Brazilian Journal of Medical and Biological Research, 49, e5826. [Google Scholar] [CrossRef] [PubMed]
[25] Tao, T., Zhang, Y., Zhu, Y.-C., et al. (2021) Exenatide, Metformin, or Both for Prediabetes in PCOS: A Randomized, Open-Label, Parallel-Group Controlled Study. The Journal of Clinical Endocrinology & Metabolism, 106, e1420- e1432. [Google Scholar] [CrossRef] [PubMed]
[26] Rondanelli, M., Riva, A., Petrangolini, G., et al. (2021) Berberine Phospholipid Is an Effective Insulin Sensitizer and Improves Metabolic and Hormonal Disorders in Women with Polycystic Ovary Syndrome: A One-Group Pretest-Post- Test Explanatory Study. Nutrients, 13, Article No. 3665. [Google Scholar] [CrossRef] [PubMed]
[27] Sangouni, A.A., Pakravanfar, F., Ghadiri-Anari, A., et al. (2022) The Effect of L-Carnitine Supplementation on Insulin Resistance, Sex Hormone-Binding Globulin and Lipid Profile in Overweight/Obese Women with Polycystic Ovary Syndrome: A Randomized Clinical Trial. European Journal of Nutrition, 61, 1199-1207. [Google Scholar] [CrossRef] [PubMed]
[28] He, C., Lin, Z., Robb, S.W. and Ezeamama, A.E. (2015) Serum Vitamin D Levels and Polycystic Ovary syndrome: A Systematic Review and Meta-Analysis. Nutrients, 7, 4555-4577. [Google Scholar] [CrossRef] [PubMed]
[29] Javed, Z., Papageorgiou, M., Deshmukh, H., et al. (2019) A Randomized, Controlled Trial of Vitamin D Supplementation on Cardiovascular Risk Factors, Hormones, and Liver Markers in Women with Polycystic Ovary Syndrome. Nutrients, 11, Article No. 188. [Google Scholar] [CrossRef] [PubMed]
[30] Dastorani, M., Aghadavod, E., Mirhosseini, N., et al. (2018) The Effects of Vitamin D Supplementation on Metabolic Profiles and Gene Expression of Insulin and Lipid Metabolism in Infertile Polycystic Ovary Syndrome Candidates for in Vitro Fertilization. Reproductive Biology and Endocrinology, 16, Article No. 94. [Google Scholar] [CrossRef] [PubMed]
[31] Łagowska, K., Bajerska, J. and Jamka, M. (2018) The Role of Vitamin D Oral Supplementation in Insulin Resistance in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 10, Article No. 1637. [Google Scholar] [CrossRef] [PubMed]
[32] Shang, Y., Zhou, H., Hu, M. and Feng, H. (2020) Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism, 105, 3346-3360. [Google Scholar] [CrossRef] [PubMed]
[33] Gower, B.A., Chandler-Laney, P.C., Ovalle, F., et al. (2013) Favourable Metabolic Effects of a Eucaloric Lower- Carbohydrate Diet in Women with PCOS. Clinical Endocrinology, 79, 550-557. [Google Scholar] [CrossRef] [PubMed]
[34] Frary, J.M.C., Bjerre, K.P., Glintborg, D. and Ravn, P. (2016) The Effect of Dietary Carbohydrates in Women with Polycystic Ovary Syndrome: A Systematic Review. Minerva Endocrinology, 41, 57-69.
[35] Benham, J.L., Yamamoto, J.M., Friedenreich, C.M., Rabi, D.M. and Sigal, R.J. (2018) Role of Exercise Training in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Clinical Obesity, 8, 275-284. [Google Scholar] [CrossRef] [PubMed]
[36] Breyley-Smith, A., Mousa, A., Teede, H.J., Johnson, N.A. and Sabag, A. (2022) The Effect of Exercise on Cardiometabolic Risk Factors in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 19, Article No. 1386. [Google Scholar] [CrossRef] [PubMed]
[37] Yue, W., Huang, X., Zhang, W., et al. (2022) Metabolic Surgery on Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology, 13, Article 848947. [Google Scholar] [CrossRef] [PubMed]
[38] Hu, L., Ma, L., Xia, X., et al. (2022) Efficacy of Bariatric Surgery in the Treatment of Women with Obesity and Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism, 107, e3217-e3229. [Google Scholar] [CrossRef] [PubMed]
[39] 曾倩, 王玉娜, 张红霞. 补肾化痰活血法对肾阳虚型多囊卵巢综合征排卵障碍性不孕患者子宫内膜容受性及促排卵的干预研究[J]. 陕西中医, 2018, 39(3): 334-337.
[40] 岑怡, 周建华, 徐竺婷. 补肾化痰清解法对胰岛素抵抗型多囊卵巢综合征氧化应激影响的临床观察[J]. 上海中医药杂志, 2018, 52(2): 62-66.
[41] 范海英, 刘根霞, 黄兆政. 补肾助孕方治疗肾虚型多囊卵巢综合征的临床研究[J]. 中国中医药科技, 2023, 30(1): 14-18.
[42] 寇丽辉, 侯丽辉, 王颖, 郝松莉. 侯丽辉治疗痰瘀互结型多囊卵巢综合征的经验总结[J]. 辽宁中医杂志, 2019, 46(1): 35-37.
[43] 罗小妹, 牛向馨, 王小蔓, 等. 四物汤合五子衍宗加减治疗痰湿阻滞型多囊卵巢综合征不孕患者的临床疗效观察[J]. 中华中医药学刊, 2023, 41(5): 59-62.
[44] 付晨, 王昕. 王昕教授分消走泄法治疗多囊卵巢综合征的临床经验[J/OL]. 中医临床研究, 2023: 1-5. https://kns.cnki.net/kcms/detail/11.5895.R.20230316.1311.006.html, 2023-08-29.
[45] 沈凌宇, 梁翠梅, 杨文津, 等. 通调带脉法针刺治疗腹部肥胖型多囊卵巢综合征的随机对照研究[J]. 针刺研究, 2018, 43(4): 255-259.
[46] 虞莉青, 曹莲瑛, 谢菁, 等. 电针治疗胰岛素抵抗型多囊卵巢综合征疗效与作用机制研究[J]. 中国针灸, 2020, 40(4): 379-383.
[47] 姜晓琳, 刘静, 张阳, 等. 苍附导痰汤加二甲双胍联合穴位埋线对肥胖型多囊卵巢综合征不孕症患者免疫功能及肠道菌群的影响[J]. 临床误诊误治, 2020, 33(8): 51-56.
[48] 卫爱武, 肖惠冬子, 宋艳丽. 定坤丹联合氯米芬治疗多囊卵巢综合征伴不孕疗效观察[J]. 中国实用妇科与产科杂志, 2018, 34(4): 444-447.
[49] 杨宁, 徐芳, 刘颖华, 张阳. 补肾化痰活血中药联合二甲双胍治疗多囊卵巢综合征的Meta分析[J]. 中医临床研究, 2023, 15(8): 129-136.