【目的】基于肠道菌群调节机制探讨加味半夏泻心汤对胃热脾虚型多囊卵巢综合征（PCOS）患者炎症因子的影响。【方法】将 86例胃热脾虚型PCOS患者随机分为对照组45例和观察组41例。对照组给予常规西药治疗，观察组在对照组的基础上给予 加味半夏泻心汤治疗。1个月经周期为1个疗程，连续治疗3个月经周期。观察2组患者治疗前后中医证候积分、子宫内膜厚 度、血清炎症因子[肿瘤坏死因子 α（TNF-α）、C 反应蛋白（CRP）、白细胞介素 6（IL-6）]、性激素[黄体生成素（LH）、雌二 醇（E2）、卵泡刺激素（FSH）和LH/ FSH]水平以及肠道菌群的变化情况，比较2组患者的临床疗效和妊娠率。【结果】（1）治疗3个 月经周期后，观察组的总有效率为87.80%（36/41），对照组为68.89%（31/45），组间比较（χ2检验），观察组的临床疗效明显优 对照组（P < 0.05）。（2）治疗后，2 组患者的中医证候积分均较治疗前降低（P < 0.05），且观察组的降低幅度明显优于对照组 （P < 0.01）。（3）治疗后，2组患者的子宫内膜厚度均较治疗前增加（P < 0.05），且观察组的增加幅度明显优于对照组（P < 0.01）。 （4）观察组的妊娠率为92.68%（38/41），明显高于对照组的73.33%（33/45），差异有统计学意义（P < 0.05）。（5）治疗后，2组患 者血清E2、LH水平与LH/ FSH值均较治疗前降低（P < 0.05），而血清FSH水平均治疗前后变化不明显（P > 0.05）；组间比较， 观察组对血清E2、LH水平与LH/ FSH的降低幅度均明显优于对照组（P < 0.01）。（6）治疗后，2组患者血清CRP、IL-6、TNF-α水平 均较治疗前降低（P < 0.05），且观察组降低幅度均明显优于对照组（P < 0.01）。（7）治疗后，2组患者肠道菌群中的双歧杆菌、乳 酸杆菌水平均较治疗前升高（P < 0.05），粪肠球菌、拟杆菌水平均较治疗前降低（P < 0.05），而肠杆菌水平均治疗前后变化不 明显（P > 0.05）；组间比较，观察组对双歧杆菌、乳酸杆菌水平的升高幅度及对粪肠球菌、拟杆菌水平的降低幅度均明显优 于对照组（P < 0.05或P < 0.01）。【结论】 加味半夏泻心汤治疗胃热脾虚型PCOS临床疗效显著，可通过调节肠道菌群，改善患 者临床症状，减轻炎症程度。

Objective To observe the effect of modified Banxia Xiexin Decoction on inflammatory factors in patients with polycystic ovary syndrome（PCOS） of stomach heat and spleen deficiency type through the regulatory mechanism of intestinal flora. Methods A total of 86 patients with PCOS of stomach heat and spleen deficiency type were randomly divided into control group（45 cases）and observation group（41 cases）. The control group was treated with conventional western medicine，and the observation group was treated with modified Banxia Xiexin Decoction on the basis of treatment for the control group. One menstrual cycle constituted a course of treatment， and the treatment lasted for three continuous menstrual cycles. The two groups were observed in the changes of traditional Chinese medicine（TCM）syndrome score，endometrial thickness，serum inflammatory factors of tumor necrosis factor α（TNF-α），C-reactive protein（CRP）and interleukin-6（IL-6），sex hormone levels of luteinizing hormone（LH），estradiol（E2），follicle stimulating hormone（FSH）and LH/FSH，as well as the intestinal flora before and after treatment. The clinical efficacy and pregnancy rate of the two groups were compared after treatment. Results（1）After 3 menstrual cycles of treatment，the total effective rate of the observation group was 87.80% （36/41），and that of the control group was 68.89%（31/45）. The intergroup comparison（tested by chi-square test） showed that the clinical efficacy of the observation group was significantly superior to that of the control group （P < 0.05）.（2）After treatment，the scores of TCM syndromes in the two groups were decreased when compared with those before treatment（P < 0.05），and the decrease in the observation group was more significant than that in the control group（P < 0.01）.（3）After treatment，the endometrial thickness in the two groups was increased when compared with that before treatment（P < 0.05），and the increase in the observation group was superior to that in the control group（P < 0.01）.（4）The pregnancy rate of the observation group was 92.68%（38/41），which was significantly higher than 73.33%（33 / 45）of the control group， and the difference was statistically significant （P < 0.05）.（5）After treatment，the levels of serum E2，LH and LH/FSH in the two groups were decreased when compared with those before treatment（P < 0.05），but there was no significant change in the level of serum FSH before and after treatment（P > 0.05）. The comparison between the two groups showed that the decrease of serum E2， LH and LH /FSH levels in the observation group was significantly superior to that in the control group （P < 0.01）.（6）After tieatment， the levels of serum CRP， IL-6， TNF - α in patients of the two groups were decreased compared with those before treatment（P < 0.05），and the decrease in the observation group was superior to that in the control group（P < 0.01）.（7）After treatment，the levels of Bifidobacteria and Lactobacilli in the intestinal flora of the two groups were higher than those before treatment（P < 0.05），and the levels of Enterococcus faecalis and Bacteroides were lower than those before treatment（P < 0.05），while the levels of Enterobacter did not change significantly before and after treatment（P > 0.05）. The comparison between the two groups showed that the increase of the levels of Bifidobacteria and Lactobacilli and the decrease of the levels of Enterococcus faecalis and Bacteroides in the observation group were significantly superior to those in the control group（P < 0.05 or P < 0.01）. Conclusion Modified Banxia Xiexin Decoction has a significant clinical effect in the treatment of PCOS of stomach heat and spleen deficiency type. The decoction is effective on improving the clinical symptoms and inflammatory factor levels of patients by regulating intestinal flora.

R271.9

海南省自然科学基金青年项目（编号：822QN484）；海南省临床医学中心建设项目（编号：琼卫医函 【2021】 75号）