用于治疗多囊卵巢综合征的中药药理学作用机制研究进展

周娴颖+周莉+孙祖越

[摘要]多囊卵巢综合征（polycystic ovary syndrome，PCOS）是一种异质性内分泌紊乱性疾病，以高雄激素、胰岛素抵抗和持续无排卵为特征，是青春期和育龄期妇女常见的内分泌系统与代谢系统疾病之一，严重威胁着患者的健康。目前国内外西医主要通过降低雄激素、改善胰岛素抵抗、诱发排卵等手段改善患者症状，但西药不良反应较大，长期治疗不能为患者所接受。近年来中医药治疗PCOS已经取得了一定疗效，中医药具有多靶点、多环节、多途径效应，可以同时调节PCOS 患者内分泌与代谢紊乱，且相对安全。该文通过查阅临床和动物实验方面的文献，阐述了中医对PCOS的认识、用药分析和中药对PCOS治疗的药理学机制，发现中药在调节下丘脑-垂体-性轴功能、纠正性激素紊乱、影响基因及调控因子的表达、改善胰岛素抵抗、纠正糖脂代谢紊乱、改善子宫内膜容受性、提高妊娠率和改善卵巢形态等方面发挥作用。该文对中医对PCOS的认识及中医药在PCOS治疗方面的积极作用加以归纳总结，为中医药防治PCOS的推广应用提供科学依据。

[关键词]多囊卵巢综合征； 中药； 机制

[Abstract]Polycystic ovary syndrome （PCOS） is a heterogeneous endocrine disorder， which is characterized by hyperandrogenism， insulin resistance and chronic anovulation， and has become a serious threat to the health of adolescents and women of childbearing age.At present，lowering androgen， improving insulin resistance and inducing ovulation are the main methods adopted by doctors to treat the disease， but the adverse reactions of the western medicine and the long-term treatment are hard to be accepted by the patients. PCOS treated by traditional Chinese medicine has achieved a certain effect in recent years.Traditional Chinese medicine is relatively safe and has more effect in many links and targets in improving the symptom of endocrine and metabolic disorder in patients with PCOS. This paper expounds the traditional Chinese medicine pathogenesis of PCOS through clinical and experimental aspects of the literature research：correcting endocrine hormone disorder，the effects of the expression of gene and regulatory factors，improving insulin resistance，correcting lipid metabolic disorder，improving the pregnancy outcome and improving ovarian morphology to summarize the treatment of traditional Chinese medicine in PCOS research results in recent years.

[Key words]polycystic ovary syndrome； traditional Chinese medicine； mechanism

doi：10.4268/cjcmm20162003

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是女性最常见的内分泌紊乱性疾病，是以高雄激素、胰岛素抵抗和持续无排卵为基本特征的内分泌代谢疾病，占育龄妇女的6%～20%^[1-2]，PCOS不孕症患者已占因排卵障碍性不孕症的50%～70%^[3]。PCOS临床表现主要有月经不调或闭经、不孕，且多伴有痤疮、黑棘皮症、多毛、肥胖等症状。随着年龄的增长，可有日益明显的胰岛素抵抗（insulin resistance，IR）、高胰岛素血症和糖脂代谢异常，远期还可并发代谢综合征及乳腺癌、子宫内膜癌等妇科肿瘤疾病^[4]。……