Effect and Mechanisms of Kaiyu Zhongyutang on Insulin Resistance， Glucose and Lipid Metabolism， Psychological State， and Embryo Outcome in Infertile Patients with PCOS Due to Liver Depression and Kidney Deficiency / 中国实验方剂学杂志

ABSTRACT

ObjectiveTo explore the effects and mechanisms of Kaiyu Zhongyutang on insulin resistance， glucose and lipid metabolism， psychological state， and embryo outcome in the infertile patients with polycystic ovary syndrome （PCOS） due to liver depression and kidney deficiency. MethodThe 126 infertile patients with PCOS due to liver depression and kidney deficiency who underwent in vitro fertilization-embryo transfer （IVF-ET） in the Department of Reproduction of the affiliated hospital of Nanjing university of Chinese medicine were randomly assigned into the observation （Kaiyu Zhongyutang + metformin） and control （metformin） groups. The two groups were compared in terms of traditional Chinese medicine （TCM） syndrome scores， body mass index （BMI）， glucose and lipid metabolism， homeostasis model assessment-insulin resistance （HOMA-IR）， interleukin （IL）-6， IL-8， C-reactive protein （CRP）， self-rating depression scale （SDS） score， self-rating anxiety scale （SAS） score， and clinical and laboratory scores of IVF after treatment. Result① After treatment， the observation group showed decreased scores of primary and secondary TCM syndromes and total TCM syndrome score （P < 0.05）， and the control group presented decreased scores of irritability and depression and total TCM syndrome score （P<0.05）. Compared with the control group， the observation group demonstrated reduced primary and secondary syndrome scores and total score after treatment （P<0.05）. ② After treatment， both groups showed decreased BMI， lowered levels of fasting insulin （FINS）， fasting plasma glucose （FPG）， cholesterol （TC）， triglyceride （TG）， low-density lipoprotein （LDL）， and HOMA-IR （P<0.05）， and elevated high-density lipoprotein （HDL） level （P<0.05）. Moreover， the observation group had lower BMI， FINS， FPG， TC， TG， LDL， and HOMA-IR and higher HDL than the control group （P<0.05）. ③ The treatment in both groups lowered the levels of IL-6， IL-8， and CRP and decreased SDS and SAS scores （P<0.05）. Moreover， the declines in the observation group were more obvious than those in the control group （P<0.05）. ④ Correlation analysis before treatment， IL-6， IL-8， and CRP had positive correlations with BMI， HOMA-IR， TC， TG， LDL， SDS， and SAS （P<0.05） and a negative correlation with HDL （P<0.05）. ⑤ The observation group showed reduced gonadotropin （Gn） using days and total Gn dose and higher two-pronuclear （2PN） fertilized oocytes， 2PN cleavage rate， normal fertilization rate， D3 transferable embryo number， D3 high-quality embryo number， high-quality embryo rate， and blastocyst formation rate than the control group （P<0.05）. ConclusionKaiyu Zhongyutang can treat PCOS patients by improving the emotional and reproductive functions and alleviating insulin resistance and glucose and lipid metabolism disorders. Moreover， it can reduce the Gn dose and Gn using days in the IVF process， improve the quality and maturity of eggs， increase the egg fertilization rate， enhance the potential of embryo development， and increase the rate of blastocyst formation by inhibiting inflammation.