夏璐 张真真 万贵平

[摘要]多囊卵巢综合征（PCOS）好发于育龄期妇女，以月经失调、不孕等为主要临床表现，发病率逐年升高。目前西医治疗以降低雄激素、改善胰岛素抵抗、促排卵为主，但有一定的局限性，包括疗效欠佳、并发症多等。多项研究发现，PCOS 发生发展与肠道菌群相关。肠道菌群被称为“人类第二大基因组”“被遗忘的器官”，近年来成为感染性、免疫性以及代谢性疾病的研究热点。本文主要从肠道菌群失调所致的高雄激素血症、胰岛素抵抗、慢性炎症及代谢综合征探讨与 PCOS 发生和发展的相关性。中医运用中药复方、针灸等方式调和胃肠肝脾、平衡肠道菌群、维持肠道内环境稳态，为 PCOS 病因病机的认识及治疗提供新的切入点。[关键词]多囊卵巢综合征;肠道菌群;相关性;中医治疗

[中图分类号] R614.2;R-1  [文献标识码] A   [文章编号]2095-0616（2021）24-0077-04

Role of intestinal flora in polycystic ovary syndrome and the research progress of TCM treatment

XIA  Lu1，2      ZHANG  Zhenzhen1，2      WAN  Guiping1，2

1. Department of Obstetrics and Gynecology， Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine， Jiangsu， Nanjing 210028， China;2. Jiangsu Province Academy of Traditional Chinese Medicine， Jiangsu， Nanjing 210028， China

[Abstract] Polycystic ovary syndrome （PCOS） occurs frequently in women of childbearing age， with menstrual disorder and infertility as the main clinical manifestations， and the incidence is increasing year by year. At present， western medicine mainly reduces androgen， improves insulin resistance and promotes ovulation， but it has some limitations， including poor curative effect and many complications. Many studies have found that the occurrence and development of PCOS is related to intestinal flora. Intestinal flora is called "the second largest human genome" and "forgotten organ"， and it has become the research focus of infectious， immune and metabolic diseases in recent years. This article mainly discusses the correlation between hyperandrogenism， insulin resistance， chronic inflammation and metabolic syndrome caused by intestinal flora imbalance and the occurrence and development of PCOS. The use of traditional Chinese medicine （TCM） compound prescription， acupuncture and other methods to regulate the stomach， intestine， liver and spleen， balance the intestinal flora， maintain the homeostasis of the intestinal environment， and provide a new breakthrough point for the understanding and treatment of the etiology and pathogenesis of PCOS.

[Key words] Polycystic ovary syndrome; Intestinal flora; Correlation; TCM treatment

多囊卵巢綜合征（polycystic ovary syndrome，PCOS）以月经稀发、高雄激素血症、糖脂代谢紊乱等为主要特征，是一种常见的生殖内分泌代谢性疾病[1]，全球发病率为6%～10%[2]。PCOS 的病因和发病机制尚不明确，目前认为与下丘脑-垂体-卵巢轴失调、肾上腺分泌功能异常、遗传和环境[3]等因素密切相关。Tremellen等[4]提出肠道菌群失调并发的肠屏障功能障碍和内毒素血症可以驱动高雄激素血症、慢性炎症及胰岛素抵抗的假说。由于肠道菌群数量庞大，生理作用广泛，近年来对其相关领域的研究越发受到重视。肠道菌群数量及结构的改变与人体内分泌及代谢水平密切相关。因此，基于肠道菌群新角度认识 PCOS 的发生发展的可能性，并对中医药治疗肠道菌群失调的方法进行综述，为 PCOS 的辅助治疗提供参考。……