苍附导痰汤加减治疗多囊卵巢综合征合并胰岛素抵抗临床研究OA

Objective:To observe the clinical efficacy of modified Cangfu Daotan Decoction on patients with polycystic ovary syndrome(PCOS)of phlegm blended with blood stasis type complicated by insulin resistance(IR),and to explore its effect on intestinal flora abundance.Methods:Retrospective analysis was given to the clinical data of 30 patients diagnosed with PCOS of phlegm blended with blood stasis type complicated by IR in the gynecological clinic of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from November 2021 to November 2022.They were assigned to the PCOS-IR group and treated with modified Cangfu Daotan Decoction for three courses of treatment,with one menstrual cycle as one course.Before and after treatment,the traditional Chinese medicine syndrome scores and menstrual cycle scores were evaluated,the body mass,waist circumference,and hip circumference were measured,the body mass index and waist-to-hip ratio were calculated,and the sex hormone indexes[testosterone(T),follicle stimulating hormone(FSH),luteinizing hormone(LH),LH/FSH ratio]and glucose metabolism indexes[fasting plasma glucose(FBG),fasting insulin(FINS),Homeostasis Model Assessment of Insulin Resistance(HOMA-IR)]were detected.A total of 30 healthy women who underwent physical examination in the First Affiliated Hospital of Guangzhou University of Chinese Medicine at the same period were selected as the healthy control group.The 16S rDNA sequencing technology was used to analyze the intestinal microbial composition of the PCOS-IR group before treatment,after three menstrual cycles of treatment and of the healthy control group,as well as the relative abundance of each strain at the level of phylum,class,order,family and genus.Results:After treatment,the total effective rate was 93.33%(28/30)in the PCOS-IR group;the traditional Chinese medicine syndrome scores,menstrual cycle scores,LH,T,FBG,FINS,HOMA-IR,and LH/FSH ratio decreased compared with those before treatment,differences being significant(P＜0.05);there were no significant differences being found in the comparisons of body mass index,waist-to-hip ratio,and FSH level before and after treatment(P＞0.05).A total of 443 core gut microbiota are shared among the healthy control group,the PCOS-IR group before treatment,and the PCOS-IR group after treatment.At the phylum level,the relative abundance of Firmicutes,Bacteroidetes,Proteobacteria,and Verrucomicrobia in the PCOS-IR group before treatment was higher than that in the healthy control group,and the relative abundance of Actinobacteria was lower than that in the healthy control group,differences being significant(P＜0.05).The relative abundance of Actinobacteria in the PCOS-IR group after treatment was increased when compared with that before treatment,and the relative abundance of Firmicutes,Bacteroidetes,and Proteobacteria decreased compared with that before treatment,differences being significant(P＜0.05).At the class level,the relative abundance of Clostridia,Bacteroidia,and Negativicutes in the PCOS-IR group before treatment was higher than that in the healthy control group,and the relative abundance of Actinobacteria was lower than that in the healthy control group,differences being significant(P＜0.05).The relative abundance of Bacteroidia and Actinobacyeria in the PCOS-IR group after treatment increased compared with that before treatment,and the relative abundance of Clostridia,Negativicutes,and Gammaproteobacteria decreased compared with that before treatment,differences being significant(P＜0.05).At the order level,the relative abundance of Clostridiales and Bifidobacteriales in the PCOS-IR group before treatment was lower than that in the healthy control group,and the relative abundance of Bacteroidales,Enterobacteriales,and Selenomonadales was higher than that in the healthy control group,differences being significant(P＜0.05).The relative abundance of Clostridiales and Bifidobacteriales in the PCOS-IR group after treatment elevated compared with that before treatment,and the relative abundance of Bacteroidales and Selenomonadales reduced compared with that before treatment,differences being significant(P＜0.05).At the family level,the relative abundance of Ruminococcaceae and Bifidobacteriaceae in the PCOS-IR group before treatment was lower than that in the healthy control group,and the relative abundance of Prevotellaceae and Bacteroidaceae was higher than that in the healthy control group,differences being significant(P＜0.05).The relative abundance of Ruminococcaceae and Bifidobacteriaceae in the PCOS-IR group after treatment was up-regulated compared with that before treatment,and the relative abundance of Prevotellaceae and Bacteroidaceae was down-regulated compared with that before treatment,differences being significant(P＜0.05).At the genus level,the relative abundance of Bifidobacterium,Faecalibacterium,and Ruminococcus in the PCOS-IR group before treatment was lower than that in the healthy control group,and the relative abundance of Prevotella and Escherichia-Shigella was higher than that in the healthy control group,differences being significant(P＜0.05).The relative abundance of Bifidobacterium and Ruminococcus in the PCOS-IR group after treatment elevated compared with that before treatment,and the relative abundance of Escherichia-Shigella and Faecallibacterium reduced compared with that before treatment,differences being significant(P＜0.05).The Shannon index in the PCOS-IR group before treatment was lower than that in the healthy control group(P＜0.05).Conclusion:The application of modified Cangfu Daotan Decoction in the treatment of PCOS of phlegm blended with blood stasis type complicated by IR can effectively alleviate the related syndromes,regulate the level of sex hormones,improve ovulation and IR,and then regulate the menstrual rhythm.It may positively regulate the intestinal microbial community structure,such as increasing the abundance of beneficial bacteria such as Bifidobacterium,and regulating the composition of flora related to PCOS-IR such as Firmicutes,Bacteroidetes,and Escherichia-Shigella,thereby improving the intestinal microecological balance.