【摘要】  　　【目的】观察穴位埋线联合健脾祛痰中药对肥胖型多囊卵巢综合征（ＰＣＯＳ）患者胰岛素抵抗及脂肪细胞因子的影响。【方法】采用随机数字表法将４２例肥胖型ＰCOS患者随机分为2组，针药组22例予穴位埋线联合加减苍附导痰汤治疗，中药组２０例予加减苍附导痰汤治疗。连续治疗３个月为１个疗程。观察２组治疗前后月经情况，检测治疗前后患者的体质量指数（ＢＭＩ）、空腹血糖（ＦＰＧ）、空腹胰岛素（ＦＩＮＳ）以及胰岛素敏感指数（ＩＳＩ）、瘦素（Leptin)、肿瘤坏死因子α(TNFα)、抵抗素（Resistin）等的变化，记录胰岛素抵抗（ＩＲ）者的例数。【结果】月经改善总有效率针药组为８１８％，中药组为６５０％，２组比较差异有显著性意义（Ｐ＜００５）。针药组妊娠者３例，中药组妊娠者１例。治疗后２组ＢＭＩ、ＦＩＮＳ、ＩＳＩ均明显改善，与治疗前比较，差异有显著性意义（Ｐ＜００５），其中针药组改善程度更为显著（与中药组比较，Ｐ＜００５）。治疗后２组Leptin、TNFα、Resistin均明显降低（与治疗前比较，Ｐ＜００５），其中针药组的Leptin、TNFα值下降更为显著（与中药组治疗后比较，Ｐ＜００５）。【结论】穴位埋线联合健脾祛痰中药治疗肥胖型ＰＣＯＳ患者疗效确切，其效果明显优于单用中药治疗。其作用机制可能与降低ＢＭＩ及脂肪细胞因子Leptin、TNFα、Resistin水平，从而改善ＩＲ有关。
【关键词】  多囊卵巢综合征／中药疗法；多囊卵巢综合征／穴位疗法；埋线；健脾祛痰
　　Abstract： Objective To observe the effect of acupoint catgutembedding (ACE) therapy combined with spleenstrengthening and phlegmremoving herbs on insulin resistance (IR) and adipocyte factors in patients with obesetype polycystic ovary syndrome (PCOS).Methods Fortytwo obesetype PCOS patients were randomized into two groups:group A (N=22) received ACE combined with modified Cang Fu Daotan Decoction,and group B (N=20) received modified Cang Fu Daotan Decoction alone.Three months constituted one treatment course.The change of menstruation was observed,and body mass index (BMI),fasting plasma glucose (FPG),fasting insulin (FINS) and insulin sensitivity index (ISI),leptin,tumor necrosis factor α(TNFα),and resistin were detected before and after treatment.Meanwhile,the number of patients with IR was also recorded.Results The improvement rate of menstruation was 818% in group A and 650% in group B (P＜005).There were 3 patients being pregnant in group A,and there was one in group B.After treatment,BMI,FINS and ISI were much improved in the two groups (P＜005),and the improvement was obvious in group A (P＜005);serum levels of leptin,TNFα and resistin were decreased in the two groups (P＜005),and the decrease of leptin and TNFα was obvious in group A (P＜005).ConclusionAcupoint catgutembedding  therapy combined with spleenstrengthening and phlegmremoving herbs has a better effect than herbs alone for obesetype polycystic ovary syndrome,and its therapeutic mechanism may be related with the decrease of BMI and levels of leptin,TNFα and restistin.
　　Key words: POLYCYSTIC OVARY SYNDROME/TCD therapy；POLYCYSTIC OVARY SYNDROME/acupoint therapy；EMBEDDING,THREAD；STRENGTHENING SPLEEN AND REMOVING PHLEGM
　　近年来随着对多囊卵巢综合征（ＰＣＯＳ）病因病机研究的不断深入，学者们发现ＰＣＯＳ患者不仅存在脂肪量的增多，同时还存在脂肪细胞因子分泌的异常。脂肪中分泌的多种激素信号调节分子与ＰＣＯＳ导致的代谢紊乱及内分泌紊乱存在一定的关系。现代研究表明［１］痰湿体质是肥胖人群中的主要体质类型，也是ＰＣＯＳ患者胰岛素抵抗（ＩＲ）和代谢紊乱发生的重要病理基础。本研究观察了穴位埋线联合健脾祛痰中药对肥胖型ＰＣＯＳ患者ＩＲ及脂肪细胞因子瘦素（Leptin）、肿瘤坏死因子α(TNFα)及抵抗素（Resistin)的影响，现将结果报道如下。
　　1资料与方法
　　11一般资料
　　选择２００６年１月～２００７年１月于广州中医药大学第一附属医院妇科门诊及针灸减肥门诊就诊且符合纳入标准的患者４２例，年龄在１４～３２岁，病程２～１１年，均表现有月经异常（月经稀发３０例，闭经１２例），其中有１０例因不孕前来就诊。采用随机数字表法将４２例患者随机分为２组。针药组２２例，平均年龄（２３５４±４５２）岁，平均病程（４５９±２４４）年，月经稀发１７例，闭经５例，不孕者６例，痤疮３例，多毛２例。中药组２０例，平均年龄（２４５５±３６４）岁，平均病程（４８５±２１８）年，月经稀发１３例，闭经７例，不孕者４例，痤疮２例，多毛２例。２组年龄、病程、月经异常情况比较差异均无显著性意义（Ｐ＞００５），而且治疗前体质量指数（ＢＭＩ）、空腹血糖（ＦＰＧ）及空腹胰岛素（ＦＩＮＳ）、Leptin、ＴＮＦα、Resistin水平等比较，差异亦无显著性意义（Ｐ＞００５），具有可比性。(责任编辑：admin)