目的 观察加味逍遥丸联合左甲状腺素钠片和二甲双胍治疗肝气郁结型多囊卵巢综合征(PCOS)合并甲状腺机能减退的临床疗效。方法 选取2012年7月-2014年9月天津中医药大学第一附属医院内分泌科就诊的肝气郁结型PCOS合并甲状腺功能减退患者60例,随机分为对照组和治疗组,每组各30例。对照组口服左甲状腺素钠片50μg/次,1次/d;同时口服盐酸二甲双胍片0.5 g/次,3次/d。治疗组在对照组的基础上口服加味逍遥丸6 g/次,2次/d,两组均连续治疗8周。观察两组患者的临床疗效,同时比较治疗前后两组患者的空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(IRI)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、黄体生成素(LH)、卵泡生成激素(FSH)、LH/FSH、睾酮、雌二醇(E₂)、孕酮、催乳激素(PRL)、血清游离甲状腺素(FT₃)、游离三碘甲状腺原氨酸(FT₄)和促甲状腺激素(TSH)的变化情况。结果 治疗后,对照组和治疗组的总有效率分别为73.33%、93.33%,两组比较差异有统计学意义(P<0.05)。治疗后,两组的FBG、FINS和IRI均明显下降,与治疗前比较差异有统计学意义(P<0.05、0.01);治疗组的FBG、FINS和IRI的降低程度明显优于对照组(P<0.05、0.01)。治疗组的TC、TG和LDL-C均明显降低,与治疗前比较差异有统计学意义(P<0.01),治疗组的HDL-C有升高的趋势,但与治疗前比较差异没有统计学意义;治疗组的TC、TG和LDL-C降低程度均明显优于对照组(P<0.01),HDL-C与对照组比较差异没有统计学意义。两组的LH、FSH、LH/FSH、睾酮和PRL均明显降低,E₂和孕酮明显升高,与治疗前比较差异有统计学意义(P<0.01);治疗组LH、FSH、睾酮、E₂、孕酮和PRL的改善程度均优于对照组(P<0.05、0.01),LH/FSH与对照组比较差异无统计学意义。两组的FT₃、FT₄均明显升高,TSH明显降低,与治疗前比较差异有统计学意义(P<0.01)。治疗组FT₃、FT₄和TSH的改善程度均优于对照组,差异具有统计学意义(P<0.01)。结论 加味逍遥丸联合左甲状腺素钠片和二甲双胍治疗肝气郁结型多囊卵巢综合征合并甲状腺机能减退疗效显著。

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.