多囊卵巢综合征高雄激素血症和胰岛素抵抗的中医认识及诊疗思路

35920179CHINESEAＲCHIVESOFTＲADITIONALCHINESEMEDICINEVol．35No．9Sep．20172436DOI10．13193/j．issn．1673-7717．2017．09．066121341．2012032．2000513．2000304．100700PolycysticovarysyndromePCOShyperandrogenemiaHAinsulinresistanceIＲPCOSPCOS、。HAIＲPCOSPCOS。Ｒ285．5A1673-7717201709-2436-05TraditionalChineseMedicineCognitionandTreatmentThoughtsofPolycysticOvarySyndromewithHyperandrogenemiaandInsulinＲesistanceLIYuwei1YULiqing2SUNJie1SHIYin3LILiang41．ShanghaiUniversityofTCMShanghai201203China2．ShanghaiTianshanHospitalofTraditionalChineseMedicineShanghai200051China3．ShanghaiInstituteofAcu－MoxibustionandMeridiansShanghai200030China4．ChinaAcademyofTraditionalChineseMedicineInstituteofAcupunctureandMoxibustionBeijing100700ChinaAbstractPolycysticovarysyndromePCOSisoneofthemostcommonclinicaldiseasescausedbyneuroendocrinesystemandmetabolicabnormalities．HyperandrogenemiaHAandinsulinresistanceIＲarethemainpathologicalphysiologychangesofPCOSwhicharetheperformancecharacteristicsofPCOSendocrinedisorderandthemainfactorsofPCOSpatientswithobesityacneetc．ThisarticleattemptsfromtheperspectiveofcorrelationbetweenHAandIＲandwediscusstheChineseandwesternmedicinepathogenesisofPCOS．AtthesametimeweputforwardtheTCMtreatmentofPCOSideasonourassumptionsinordertoprovideanewdirectionforfutureclinicaltreatment．Keywordspolycysticovarysyndromehyperandrogenemiainsulinresistance2017－05－15ZYSNXD－ＲC－LJＲCZZKF080021990－。1968－。1980－。polycysticovariansyndromePCOS、、、、、。PCOSinsulinresistanceIＲhyper－androgenemiaHA。、、、、。。－－hypothalamus－pituitary－go-nadalaxisHPGA。－－－、、、。《·》“……”。HPGAgonadotropin－releasinghormoneGnＲHfolliclestimulatinghor-moneFSH、LuteinizinghormoneLH。。、。、。。35920179CHINESEAＲCHIVESOFTＲADITIONALCHINESEMEDICINEVol．35No．9Sep．20172437。。、、HPGA。PCOS、－－。HAIＲPCOSPCOS、。。PCOS。12PCOS、。3、。4PCOS———、、、。5PCOSHAP-COSIＲ。PCOS6、、、。1PCOShyperandrogenemiaHAPCOSPCOSHA。。－－、。HA。HAPCOS。。78PCOSPCOSHAPCOS。、PCOSPCOS9。10HAPCOS55%～75%GnＲHGnＲH。GnＲHGnＲHHPGA。PCOSHPGAHALHFSHLH/FSH。Leo10PCOSHALHFSH。11PCOSHALH。LH、。12PCOSLH。HPGA。HA。60%。、。13PCOS。、。14PCOSHA、。CYP17LH15－16。CYP17。LH－Iinsulin－likegrowthfactor－1IGF－IIGF－ICYP17IGF－IGnＲHHPGA。LHrenin－angiotensinsystemＲASPCOSＲASLHⅡAngiotensinⅡATⅡ。17。P-COSHPGA、/HA。2PCOSinsulinresistanceIＲβPCOS。β。18－19IＲPCOSPCOSIＲIＲPCOS。《》“”IＲP-35920179CHINESEAＲCHIVESOFTＲADITIONALCHINESEMEDICINEVol．35No．9Sep．20172438COS。820。21IＲPCOSPCOS。PCOSIＲ、、。IＲ。PCOSPCOSPCOSIＲ、HA。IＲ。IＲ22－23。。24－αtumornecrosisfactor－αTNF－α。IＲ。IＲ－3phosphateesterinositol－3kinasePI3Kmitogenactiva-tedproteinkinaseMAPK。。αβATP。PCOS19p13．2D19S884。PCOSIＲ。IＲ、。PCOS40%25。βIＲ、26。PCOS—27。IＲ。InsulinＲeceptorSubstrate－1IＲS－1IＲS－2PCOSIＲS－1IＲS－228。Kulkarni29IＲS－1。30IＲS－1IＲPCOS。MAPK、PI3K。IＲS－1、IＲS－2MAPK、PI3KIＲS－1MAPKIＲS－2PI3Kβ31－32。、β、。33PCOSIＲPCOS。34PCOSPCOSIＲPCOS。IＲ35。BMIWHＲIＲPCOSP-COS、IＲ36。37、、、、IＲ。3－－PCOS38。LH39。IＲHAHA。IＲPCOSHA。HAHA40。P-COSIＲ41。Martens42PCOSPCOSHAHA。PCOS43。44dehydroepiandrosteroneDHEAPCOSIＲHAIＲS－2、－2Glucosetransporter－2GLUT－2。IＲHA。HPGA35920179CHINESEAＲCHIVESOFTＲADITIONALCHINESEMEDICINEVol．35No．9Sep．20172439CYP17。45。LHIGF－IIGF－Iinsulin－likegrowthfactorIGF、IGFinsulin－likegrowthfactorbindingproteinIGFBPIGF。insulinINSIGFBPIGFIGFBP－1IGF－1CYP1746－48。49T、IGF－1。IGF－1INSsexhormonebindingglobulinSHBG。5051INSHPGAHA。52－－adrenalcorticalhormoneACTH。IＲHA。IＲPCOSHA。。IＲHA。HickeyM53IＲHAPCOSHPGA。4PCOS。IＲHAPCOSPCOS、。PCOSP-COS2、、54－55。HAPCOSPCOSHA。。PCOSHP-GA/HA。IＲP-COS。IＲ。PCOS、PCOSIＲ。IＲHAPCOSPCOSIＲHAIＲHA。IＲHAPCOS。IＲPCOS。PCOS。、。1．J．2013283476－480．2．J．201648729－30．3．J．20114610710．4．J．201033190－193．5．J．2016433486－490．6．5J．2016287955－958．7．J．1996169515－518．8．J．20072711996－998．9．J．20154261379－1381．10LeoVDEMarcaALAPetiagliaF．Insulin－loweringagentsinthemanagementofpolycysticovarysyndromeJ．Endo-crineＲEV2003245633－667．11．FSH、LH、TSTOJ．2011171893－94．12．J．199820287－89．13．J．200464449－450．14．J．201549853－55．15LiXShenHGeX．Changesofplasmareninactivityandan-giotensinIIlevelsinwomenwithpolycysticovarysyndromeJ．ZhonghuaFuChanKeZaZhi20003510586－587．16．J．2006273271－373．17DiPietroMScottiLIrustaGetal．Localadministrationofplatelet－derivedgrowthfactorBPDGFBimprovesfolliculardevelopmentandovarianangiogenesisinaratmodelofPolycys-ticOvarySyndromeJ．MolCellEndocrinol2016433947－55．18DelcayreCSwynghedauwB．Molecularmechanismsofmyo-cardialremodeling．TheroleofaldosteroneJ．JMolCellCardiol200234121577－1584．35920179CHINESEAＲCHIVESOFTＲADITIONALCHINESEMEDICINEVol．35No．9Sep．2017244019．J．200393193－195．20．J．20082991571－1573．21．J．20081410725－726．22GiustiVVerdumoCSuterM．Expressionofperoxisomepro-liferatoractivatedreceptor．－1andperoxisomeproliferatoracti-vatedreceptor．－2invisceralandsubcutaneousadiposetissueofobesewomenJ．Diabetes20035271673－1676．23MhligMSprangerJOsterhoffMetal．Thepolycysticova-rysyndromeperseisnotassociatedwithincreasedchronicin-flammationJ．EurJEndocrinol20041504525－532．24．－αJ．200310232－33．25ChenZJZhaoHHeLetal．Genome－wideassociationstudyidentifiessusceptibilitylociforpolycysticovarysyndromeonchromosome2pl6．32p2land9q33．3J．NatGenet201143155－59．26．J．2013533498－101．27MichaelMDKulkarniＲNPosticCetal．Lossofinsulinsig-nalinginhepatocytesleadstosevereinsulinresistancea