目的 觀察加味逍遙丸聯(lián)合左甲狀腺素鈉片和二甲雙胍治療肝氣郁結(jié)型多囊卵巢綜合征(PCOS)合并甲狀腺機(jī)能減退的臨床療效。方法 選取2012年7月-2014年9月天津中醫(yī)藥大學(xué)第一附屬醫(yī)院內(nèi)分泌科就診的肝氣郁結(jié)型PCOS合并甲狀腺功能減退患者60例,隨機(jī)分為對照組和治療組,每組各30例。對照組口服左甲狀腺素鈉片50μg/次,1次/d;同時口服鹽酸二甲雙胍片0.5 g/次,3次/d。治療組在對照組的基礎(chǔ)上口服加味逍遙丸6 g/次,2次/d,兩組均連續(xù)治療8周。觀察兩組患者的臨床療效,同時比較治療前后兩組患者的空腹血糖(FBG)、空腹胰島素(FINS)、胰島素抵抗指數(shù)(IRI)、總膽固醇(TC)、三酰甘油(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、黃體生成素(LH)、卵泡生成激素(FSH)、LH/FSH、睪酮、雌二醇(E₂)、孕酮、催乳激素(PRL)、血清游離甲狀腺素(FT₃)、游離三碘甲狀腺原氨酸(FT₄)和促甲狀腺激素(TSH)的變化情況。結(jié)果 治療后,對照組和治療組的總有效率分別為73.33%、93.33%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組的FBG、FINS和IRI均明顯下降,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05、0.01);治療組的FBG、FINS和IRI的降低程度明顯優(yōu)于對照組(P<0.05、0.01)。治療組的TC、TG和LDL-C均明顯降低,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P<0.01),治療組的HDL-C有升高的趨勢,但與治療前比較差異沒有統(tǒng)計(jì)學(xué)意義;治療組的TC、TG和LDL-C降低程度均明顯優(yōu)于對照組(P<0.01),HDL-C與對照組比較差異沒有統(tǒng)計(jì)學(xué)意義。兩組的LH、FSH、LH/FSH、睪酮和PRL均明顯降低,E₂和孕酮明顯升高,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P<0.01);治療組LH、FSH、睪酮、E₂、孕酮和PRL的改善程度均優(yōu)于對照組(P<0.05、0.01),LH/FSH與對照組比較差異無統(tǒng)計(jì)學(xué)意義。兩組的FT₃、FT₄均明顯升高,TSH明顯降低,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。治療組FT₃、FT₄和TSH的改善程度均優(yōu)于對照組,差異具有統(tǒng)計(jì)學(xué)意義(P<0.01)。結(jié)論 加味逍遙丸聯(lián)合左甲狀腺素鈉片和二甲雙胍治療肝氣郁結(jié)型多囊卵巢綜合征合并甲狀腺機(jī)能減退療效顯著。

Objective To observe the clinical effect of Jiawei Xiaoyao Pills combined with Levothyroxine Sodium Tablets and metformin in treatment of polycystic ovary syndrome with hypothyrea with liver-QI stagnation. Methods Patients (60 cases) of polycystic ovary syndrome with hypothyrea with liver-QI stagnation in Department of Endocrinology of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from July 2012 to September 2014 were randomly divided into control and treatment groups, and each group had 30 cases. The patients in the control group were po administered with Levothyroxine Sodium Tablets, 50 μg/time, once daily, and were po administered with Metformin Hydrochloride Tablets 0.5 g/time, three times daily. The patients in the treatment group were po administered with Jiawei Xiaoyao Pills on the basis of the control group, 6 g/time, twice daily. The patients in two groups were treated for 8 weeks. After treatment, the efficacy was evaluated, and the changes of fasting blood glucose (FBG), fasting insulin fins (FINS), insulin resistance index (IRI), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterin (LDL-C), high density lipoprotein cholesterol (HDL-C), luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH, testosterone, estradiol (E₂), progesterone, prolactin (PRL), thyroid function indicators triiodothyronine (FT₃), free thyroxine (FT₄), and thyroid stimulation hormone (TSH) in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 73.33% and 93.33%, respectively, and there were differences between two groups (P < 0.05). After treatment, FBG, FINS, and IRI in two groups were obviously decreased, and the difference was statistically significant (P < 0.05, 0.01). The reducing degrees in treatment group were better than those in control group, with significant difference between two groups (P < 0.05, 0.01). TG, TC, and LDL-C in treatment group were significantly decreased, and there were significant differences between before and after treatment (P < 0.05). HDL-C in treatment group had the trend of increasing, but there was no significant difference. TC, TG, and LDL-C in treatment group were better than those in control group, with significant difference between two groups (P < 0.05). There was no significant difference in HDL-C between two groups. LH, FSH, LH/FSH, testosterone, and PRL in two groups were significantly decreased, E₂ and progesterone were obviously increased, and the difference was statistically significant (P < 0.05). And LH, FSH, testosterone, E₂, progesterone, and PRL improved better than those in the control group, with significant differences between two groups (P < 0.05, 0.01). There was no significant difference in LH/FSH between two groups. FT₃ and FT₄ in two groups were obviously increased, TSH was obviously decreased, and the difference was statistically significant (P < 0.01). These indicators in treatment group were better than those in control group, with significant difference between two groups (P < 0.01). Conclusion Jiawei Xiaoyao Pills combined with Levothyroxine Sodium Tablets and metformin has good effect in treatment of polycystic ovary syndrome with hypothyrea with liver-QI stagnation.