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基于“共同土壤”学说探讨多囊卵巢综合征与2型糖尿病之间的关系
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Abstract:
多囊卵巢综合征(PCOS)是一种多见于育龄期女性的内分泌疾病,常并发糖脂代谢异常,引起2型糖尿病(T2DM)、高血脂等并发症。PCOS也被认为是T2DM的高危因素之一,二者之间并非独立存在。“共同土壤”学说指出某些代谢疾病之间存在相同的病理生理基础。本文基于该学说从中西医角度探讨PCOS与T2DM病因病机的关联性,以期为二者的诊疗提供新的思路。
Polycystic Ovary Syndrome (PCOS) is an endocrine disease most commonly seen in women of childbearing age and is often associated with abnormalities of glucose and lipid metabolism, resulting in complications such as Type 2 Diabetes Mellitus (T2DM), hyperlipidemia, etc. PCOS is also considered to be one of the high-risk factors for T2DM, and the two disorders are related to each other. The theory of “common soil” indicates that certain metabolic diseases have the same pathophysiologic basis. Based on this theory, this article discusses the correlation between the etiology and pathogenesis of PCOS and T2DM from the perspective of Chinese and Western medicine, with a view to providing new ideas for the diagnosis and treatment of the two diseases.
[1] | Teede, H.J., Tay, C.T., Laven, J., Dokras, A., Moran, L.J., Piltonen, T.T., et al. (2023) Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Obstetrical & Gynecological Survey, 78, 742-743. https://doi.org/10.1097/ogx.0000000000001233 |
[2] | Moran, L.J., Misso, M.L., Wild, R.A. and Norman, R.J. (2010) Impaired Glucose Tolerance, Type 2 Diabetes and Metabolic Syndrome in Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis. Human Reproduction Update, 16, 347-363. https://doi.org/10.1093/humupd/dmq001 |
[3] | Stern, M.P. (1995) Diabetes and Cardiovascular Disease: The “Common Soil” Hypothesis. Diabetes, 44, 369-374. https://doi.org/10.2337/diab.44.4.369 |
[4] | 王方方, 陈家旭, 侯雅静, 等. 异病同治, 辨主证为要[J]. 北京中医药大学学报, 2017, 40(12): 978-981. |
[5] | 《中医辞典》编辑委员会. 简明中医辞典[M]. 北京: 人民卫生出版社, 1979: 384. |
[6] | 杨贤菊, 杨志寅, 胡大一. 行为医学与行为心脏病学(二) [J]. 中华医学信息导报, 2007, 22(16): 16-17. |
[7] | 杨大伟, 王民登, 吴标良, 等. 胰岛素抵抗的研究进展[J]. 右江医学, 2019, 47(6): 472-475. |
[8] | 刘菏婧, 张楚楚, 刘雪峰, 等. 基于PI3K/AKT通路研究针药结合治疗PCOS-IR大鼠的作用机制[J]. 时珍国医国药, 2022, 33(12): 2852-2857. |
[9] | Chen, Z., Yan, Q., Zhang, R., et al. (2023) Identification of Novel Candidate Biomarkers Related to Immune Cell Infiltration in Peri‐Implantitis. Wiley. |
[10] | Sadeghi, H.M., Adeli, I., Calina, D., Docea, A.O., Mousavi, T., Daniali, M., et al. (2022) Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. International Journal of Molecular Sciences, 23, Article 583. https://doi.org/10.3390/ijms23020583 |
[11] | Kazemi, M., Kim, J.Y., Wan, C., Xiong, J.D., Michalak, J., Xavier, I.B., et al. (2022) Comparison of Dietary and Physical Activity Behaviors in Women with and without Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of 39 471 Women. Human Reproduction Update, 28, 910-955. https://doi.org/10.1093/humupd/dmac023 |
[12] | Liu, M., Yan, J., Wu, Y., Zhu, H., Huang, Y. and Wu, K. (2022) The Impact of Herbal Medicine in Regulating Intestinal Flora on Female Reproductive Disorders. Frontiers in Pharmacology, 13, Article 1026141. https://doi.org/10.3389/fphar.2022.1026141 |
[13] | Patel, S. (2018) Polycystic Ovary Syndrome (PCOS), an Inflammatory, Systemic, Lifestyle Endocrinopathy. The Journal of Steroid Biochemistry and Molecular Biology, 182, 27-36. https://doi.org/10.1016/j.jsbmb.2018.04.008 |
[14] | Wang, K., Li, F., Cui, Y., Cui, C., Cao, Z., Xu, K., et al. (2019) The Association between Depression and Type 1 Diabetes Mellitus: Inflammatory Cytokines as Ferrymen in between? Mediators of Inflammation, 2019, Article ID: 2987901. https://doi.org/10.1155/2019/2987901 |
[15] | Wang, X., Bao, W., Liu, J., OuYang, Y., Wang, D., Rong, S., et al. (2012) Inflammatory Markers and Risk of Type 2 Diabetes: A Systematic Review and Meta-Analysis. Diabetes Care, 36, 166-175. https://doi.org/10.2337/dc12-0702 |
[16] | Rotter, V., Nagaev, I. and Smith, U. (2003) Interleukin-6 (IL-6) Induces Insulin Resistance in 3T3-L1 Adipocytes and Is, Like IL-8 and Tumor Necrosis Factor-α, Overexpressed in Human Fat Cells from Insulin-Resistant Subjects. Journal of Biological Chemistry, 278, 45777-45784. https://doi.org/10.1074/jbc.m301977200 |
[17] | Schroder, K., Zhou, R. and Tschopp, J. (2010) The NLRP3 Inflammasome: A Sensor for Metabolic Danger? Science, 327, 296-300. https://doi.org/10.1126/science.1184003 |
[18] | Zhou, R., Tardivel, A., Thorens, B., Choi, I. and Tschopp, J. (2009) Thioredoxin-Interacting Protein Links Oxidative Stress to Inflammasome Activation. Nature Immunology, 11, 136-140. https://doi.org/10.1038/ni.1831 |
[19] | Böni-Schnetzler, M., Boller, S., Debray, S., Bouzakri, K., Meier, D.T., Prazak, R., et al. (2009) Free Fatty Acids Induce a Proinflammatory Response in Islets via the Abundantly Expressed Interleukin-1 Receptor I. Endocrinology, 150, 5218-5229. https://doi.org/10.1210/en.2009-0543 |
[20] | Facchinello, N., Tarifeño-Saldivia, E., Grisan, E., Schiavone, M., Peron, M., Mongera, A., et al. (2017) TCF7L2 Plays Pleiotropic Roles in the Control of Glucose Homeostasis, Pancreas Morphology, Vascularization and Regeneration. Scientific Reports, 7, Article No. 9605. https://doi.org/10.1038/s41598-017-09867-x |
[21] | Rashid, R., Shah, I.A., Makhdoomi, M.J., Rashid, A., Godha, M., Ganai, B.A., et al. (2023) Association of TCF7L2 Gene Variant (rs12255372) with Polycystic Ovary Syndrome and Its Effect Modification of the Disease Phenotype. Indian Journal of Clinical Biochemistry, 39, 373-379. https://doi.org/10.1007/s12291-023-01115-6 |
[22] | Kaur, S., Archer, K.J., Devi, M.G., Kriplani, A., Strauss, J.F. and Singh, R. (2012) Differential Gene Expression in Granulosa Cells from Polycystic Ovary Syndrome Patients with and without Insulin Resistance: Identification of Susceptibility Gene Sets through Network Analysis. The Journal of Clinical Endocrinology & Metabolism, 97, E2016-E2021. https://doi.org/10.1210/jc.2011-3441 |
[23] | 周仲瑛. 中医内科学[M]. 第2版. 北京: 中国中医药出版社, 2007: 146. |
[24] | 胡春宇. 糖尿病与消渴病关系诠释及糖尿病辨治理念的探索[D]: [博士学位论文]. 北京: 中国中医研究院, 2005. |
[25] | 陈栋明. 肾气丸治疗消渴(糖尿病)的文献研究[D]: [硕士学位论文]. 北京: 北京中医药大学, 2007. |
[26] | 秦刚新, 苏衍进, 刘金响, 等. 益肾养阴固精方对2型糖尿病肾病气阴两虚证患者TGF-β1、S1P、NLRP3炎症小体及胰岛β细胞功能的影响[J]. 广州中医药大学学报, 2025, 42(1): 78-85. |
[27] | 金美英. 基于IRE1/JNK通路探讨解毒通络调肝方对2型糖尿病大鼠改善胰岛素抵抗及胰岛细胞凋亡的机制研究[D]: [博士学位论文]. 长春: 长春中医药大学, 2019. |
[28] | 赵志祥, 简小兵, 王文英. 玉液汤对2型糖尿病肥胖患者肠道菌群及脂质代谢的影响[J]. 世界中医药, 2020, 15(19): 2959-2962. |
[29] | 熊倩, 田雪梅, 陈美佳, 等. 浅谈徐晓娟教授运用补肾化痰法治疗肥胖型多囊卵巢综合征的经验[J]. 成都中医药大学学报, 2021, 44(3): 44-47. |
[30] | 张淼, 肖艳, 朱丽丽, 等. 消渴健脾方治疗脾虚湿盛型2型糖尿病的疗效及对炎症因子的调节作用[J]. 新疆医科大学学报, 2024, 47(10): 1425-1430. |
[31] | Palmert, M.R., Gordon, C.M., Kartashov, A.I., Legro, R.S., Emans, S.J. and Dunaif, A. (2002) Screening for Abnormal Glucose Tolerance in Adolescents with Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism, 87, 1017-1023. https://doi.org/10.1210/jcem.87.3.8305 |
[32] | Andersen, M. and Glintborg, D. (2018) Diagnosis and Follow-Up of Type 2 Diabetes in Women with PCOS: A Role for OGTT? European Journal of Endocrinology, 179, D1-D14. https://doi.org/10.1530/eje-18-0237 |