CN113304157B - Active composition for treating polycystic ovarian syndrome (PCOS) - Google Patents

Active composition for treating polycystic ovarian syndrome (PCOS) Download PDF

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CN113304157B
CN113304157B CN202110661404.5A CN202110661404A CN113304157B CN 113304157 B CN113304157 B CN 113304157B CN 202110661404 A CN202110661404 A CN 202110661404A CN 113304157 B CN113304157 B CN 113304157B
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active composition
polycystic ovarian
ovarian syndrome
pcos
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CN113304157A (en
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朱小琳
韩亚光
韩延华
冯博懿
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Heilongjiang University of Chinese Medicine
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/56Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/57Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
    • A61K31/573Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/185Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19Carboxylic acids, e.g. valproic acid
    • A61K31/194Carboxylic acids, e.g. valproic acid having two or more carboxyl groups, e.g. succinic, maleic or phthalic acid
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/4427Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
    • A61K31/4439Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. omeprazole
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00Drugs for genital or sexual disorders; Contraceptives
    • A61P15/08Drugs for genital or sexual disorders; Contraceptives for gonadal disorders or for enhancing fertility, e.g. inducers of ovulation or of spermatogenesis

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Abstract

The invention belongs to the technical field of medicines, and particularly relates to an active composition for treating polycystic ovarian syndrome (PCOS). The active composition of the invention comprises the following raw material components in percentage by weight: 30-50% of dexamethasone, 30-50% of pioglitazone and 10-30% of crocetin. The active composition consisting of dexamethasone, pioglitazone and crocetin in a specific proportion is adopted to treat patients with polycystic ovarian syndrome, and the results show that the combined drug administration group has more remarkable clinical curative effect on the polycystic ovarian syndrome, can adjust the reproductive hormone level in the bodies of the patients, promotes the gonadal hormone and androgen of the patients to recover normal levels, improves the ovulation rate, and can reduce the recurrence rate while ensuring the use safety. The invention provides a foundation for providing the pharmaceutical composition for treating polycystic ovarian syndrome with remarkable curative effect.

Description

Active composition for treating polycystic ovarian syndrome (PCOS)
Technical Field
The invention belongs to the technical field of medicines, and particularly relates to an active composition for treating polycystic ovarian syndrome (PCOS).
Background
Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrine disorders in adolescent and younger women, and its clinical manifestations mainly include hirsutism, obesity, anovulation, menstrual disorder or amenorrhea, infertility, Polycystic change of bilateral ovary enlargement, insulin resistance, etc., and has serious long-term complications such as: metabolic syndrome, tumor, cardiovascular disease, etc. The prevalence in women of childbearing age is about 5% to 10%. Most patients with polycystic ovarian syndrome do not ovulate and a few suffer from symptoms of thin ovulatory egg or corpus luteum insufficiency. Most patients suffer from primary infertility due to ovulation failure. Hirsutism refers to the abnormal phenomenon of excessive hair growth on the face or body surface of a patient, and the hair is characterized by being thick, hard and long. Acne, which is the initial manifestation of acne and gradually changes into papules, pustules, nodules, cysts, scars, and the like, easily occurs on the face, chest, back, and the like of many patients. The incidence rate of obesity is about 70%, wherein abdominal obesity is common, and obese people are often accompanied by complications such as insulin resistance, hyperinsulinemia and the like.
The cause of polycystic ovarian syndrome is not clear, but the concept of genetic and environmental co-action polygenic genetic diseases is now widely accepted. The etiology can be roughly classified into follicular developmental disorder, ovarian hormone synthesis abnormality, hyperinsulinemia, genetic factors and environmental factors. However, according to related researches, experts show that the disease is related to hyperinsulinemia, hyperandrogenism and hyperleptin, has a phenomenon of family aggregation, and is presumed to be a disease controlled by multiple genes, and partial environmental factors such as intrauterine hyperandrogenism, antiepileptic drugs, regions, nutrition, life style and the like are probably main causes of polycystic ovarian syndrome.
Due to the complex and undefined etiology of polycystic ovarian syndrome, no uniquely effective treatment is currently available. Lifestyle intervention is the primary strategy for the treatment of polycystic ovarian syndrome. The specific method is to reduce the weight of the patient by adjusting the diet of the patient and the regular exercise of the patient. Weight management is not only effective in reducing inflammatory response factor secretion from adipocytes, but also in improving ovarian function in patients. When the clinical effect of this treatment modality is not significant, further medication is required for the patient. The current treatment scheme mainly aims at endocrine abnormality of patients, and is used for symptomatic treatment and ovulation-promoting treatment. It is necessary and of great practical significance to study novel pharmaceutical compositions for the treatment of polycystic ovarian syndrome.
Disclosure of Invention
The invention aims to overcome the defects of lack of radical cure, great side effect and the like in the existing treatment of polycystic ovarian syndrome, and provides an active composition for treating polycystic ovarian syndrome (PCOS), a pharmaceutical preparation containing the active composition and pharmaceutical application.
In order to achieve the purpose, the technical scheme of the invention is as follows:
an active composition for treating polycystic ovary syndrome (PCOS) comprises the following raw material components in percentage by weight: 30-50% of dexamethasone, 30-50% of pioglitazone and 10-30% of crocetin.
Preferably, the active composition consists of the following raw material components in percentage by weight: 35-45% of dexamethasone, 35-45% of pioglitazone and 15-25% of crocetin.
Preferably, the active composition consists of the following raw material components in percentage by weight: dexamethasone 40%, pioglitazone 40% and crocetin 20%.
Further, the invention also provides the use of the active composition in the preparation of a medicament for the treatment of polycystic ovary syndrome (PCOS).
Further, the invention also provides a pharmaceutical preparation for treating polycystic ovary syndrome (PCOS), which comprises an effective amount of the active composition and pharmaceutically acceptable auxiliary material components.
Preferably, the weight percentage of the active composition in the pharmaceutical preparation is 5-10%.
Preferably, the pharmaceutically acceptable adjuvant comprises one or more of corn starch, lactose, glucose, microcrystalline cellulose, magnesium stearate, beta-cyclodextrin, sorbitol, xylitol, glycerol, poloxamer, deionized water, propylene glycol, and anhydrous ethanol.
Preferably, the dosage form of the pharmaceutical preparation is capsule, dripping pill, tablet, granule or oral liquid.
Dexamethasone is effective in inhibiting excessive secretion of adrenal androgen, and has effects on luteinizing hormone activity and ovarian steroid hormone synthesis. For patients suffering from polycystic ovarian syndrome infertility, the medicine has remarkable effect of improving ovulation disorder of the patients.
Pioglitazone is a commonly used insulin sensitizer that has therapeutic effects on both endocrine and reproductive dysfunction. Some patients with PCOS infertility exhibit a state of high insulin secretion and insulin resistance. Increased levels of insulin increase ovarian androgen synthesis, and excess insulin acts on the corresponding receptor in the ovary, resulting in unprominant folliculogenesis in patients with PCOS infertility. Insulin sensitizer treatment is currently given to patients with insulin resistance due to PCOS infertility.
Saffron is a perennial corm herbaceous plant of crocus of iridaceae, is native to the mediterranean coastal countries such as iran, greek, spain, turkey and the like, and is cultivated in China, Japan, India and other countries at present. The saffron plant has 75 kinds of saffron, and its medicinal part is dry stigma of style, and has the functions of promoting blood circulation to disperse blood clots, cooling blood, detoxicating, resolving stagnation, tranquilizing, etc. and may be used in treating amenorrhea, palpitation, mania, depression, etc. Research shows that the crocetin can improve the fluctuation of the estrus cycle rhythm of a polycystic ovarian syndrome model mouse, reduce the weight of ovaries and the number of locked ovaries, increase the number of corpus luteum, antrum follicles and mature antrum follicles, and has good effect of preventing and treating polycystic ovarian syndrome.
Compared with the prior art, the invention has the beneficial effects that:
the active composition consisting of dexamethasone, pioglitazone and crocetin in a specific proportion is adopted to treat patients with polycystic ovarian syndrome, and the results show that the combined drug administration group has more remarkable clinical curative effect on the polycystic ovarian syndrome, can adjust the reproductive hormone level in the bodies of the patients, promotes the gonadal hormone and androgen of the patients to recover normal levels, improves the ovulation rate, and can reduce the recurrence rate while ensuring the use safety. The invention provides a foundation for providing the pharmaceutical composition for treating polycystic ovarian syndrome with remarkable curative effect.
Detailed Description
The technical solutions in the embodiments of the present invention are clearly and completely described below, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention. The materials, reagents and the like used are, unless otherwise specified, commercially available reagents and materials.
Example 1
An active composition for treating polycystic ovary syndrome (PCOS) comprises the following raw material components in percentage by weight: dexamethasone 45%, pioglitazone 45% and crocetin 10%.
The active composition and pharmaceutically acceptable auxiliary materials are prepared into tablets by using the conventional preparation technology in the field, and the weight percentage of the active composition in the tablets is 6%.
Example 2
An active composition for treating polycystic ovary syndrome (PCOS) comprises the following raw material components in percentage by weight: 35% of dexamethasone, 35% of pioglitazone and 30% of crocetin.
The active composition and pharmaceutically acceptable auxiliary materials are prepared into tablets by using the conventional preparation technology in the field, and the weight percentage of the active composition in the tablets is 6%.
Example 3
An active composition for treating polycystic ovary syndrome (PCOS) comprises the following raw material components in percentage by weight: dexamethasone 40%, pioglitazone 40% and crocetin 20%.
The active composition and pharmaceutically acceptable auxiliary materials are prepared into tablets by using the conventional preparation technology in the field, and the weight percentage of the active composition in the tablets is 6%.
Comparative example 1
An active composition for treating polycystic ovary syndrome (PCOS) comprises the following raw material components in percentage by weight: 80% of dexamethasone and 20% of crocetin.
The active composition and pharmaceutically acceptable auxiliary materials are prepared into tablets by using the conventional preparation technology in the field, and the weight percentage of the active composition in the tablets is 6%.
Comparative example 2
An active composition for treating polycystic ovary syndrome (PCOS) comprises the following raw material components in percentage by weight: 80% of pioglitazone and 20% of crocetin.
The active composition and pharmaceutically acceptable auxiliary materials are prepared into tablets by using the conventional preparation technology in the field, and the weight percentage of the active composition in the tablets is 6%.
Comparative example 3
An active composition for treating polycystic ovary syndrome (PCOS) comprises the following raw material components in percentage by weight: 50% of dexamethasone and 50% of pioglitazone.
The active composition and pharmaceutically acceptable auxiliary materials are prepared into tablets by using the conventional preparation technology in the field, and the weight percentage of the active composition in the tablets is 6%.
Effect of active compositions on insulin resistance in polycystic ovary syndrome (PCOS) rats
60 female SD rats with the age of 9-10 weeks and more than two continuous regular estrus cycles are selected, the weight of the rats is about 200g, and the rats are raised in cages by racks. The groups were randomly divided into a blank control group (10) and a model group (50). The blank control group is fed with basal feed and is free to drink water; the model groups were given a high fat diet and were given plain drinking water before treatment, with 5% dextrose in water during treatment. Rats were injected with insulin (6U/d) and HCG (1.5U, 2 times/d) using insulin in combination with HCG until day 23. After 23 days, the control group was fed with basal diet and the model group was fed with high-fat diet. The molding effect was evaluated by continuing to week 6. After successful modeling, the model rats (50) were randomly divided into a model control group (10) and a drug-treated group (40). After the experimental rats were raised in a standard environment with free diet and water intake and adaptively fed with basal feed for 7 days, the rats of the model control group and the drug-treated group were given high-fat feed, and the basal feed was continued to be given to the blank control group. After feeding the high fat diet for 4 weeks, the drug-treated rats were administered 1 tablet (0.3g) of example 3 and comparative examples 1 to 3 per day with the diet for 4 weeks. Fasting is started at 20 hours in the evening of week 4, glucose solution is administered at 8 hours in the morning of the next day according to the quality of 3g/kg, blood from rat tail tip is taken at 0h, 1h and 2h after glucose administration, and fasting blood glucose (FPG, mmol/L) is obtained at 0 h. Immediately cutting off the neck and taking blood after measuring the blood sugar for 2 hours, centrifuging the blood sample at 2500r/min and taking the supernatant. Serum insulin was measured by radioimmunoassay. Insulin resistance (HOMA) index FINS (μ U/mL) × Fasting Plasma Glucose (FPG) (mmol/L)/22.5. The results of the experiment are shown in table 1.
TABLE 1 comparison of glucose tolerance and HOMA index in various groups of rats
Figure BDA0003115494530000051
The experimental data in table 1 show that the polycystic ovary syndrome insulin resistance model rats intervened by each drug treatment group have obvious recovery tendency of impaired glucose tolerance, the HOMA index is reduced, which shows that the drug intervention has obvious improvement effect on the polycystic ovary syndrome insulin resistance, and the treatment group in the example 3 has more obvious improvement degree than the comparative examples 1-3, which shows that the active composition consisting of dexamethasone, pioglitazone and crocetin in a specific proportion has synergistic effect on the aspect of improving the polycystic ovary state, the use of a small amount of crocetin can improve the use effect of dexamethasone and pioglitazone, and the insulin resistance symptom and the ovarian function are obviously improved.
(II) clinical study of active compositions for the treatment of polycystic ovary syndrome (PCOS)
Diagnostic criteria: the diagnostic criteria for PCOS, proposed by experts in the American society for reproductive medicine (ESHRE/ASRM) at the meeting of Luteddan 2003, were referenced to the European society for human reproduction and embryo:
firstly, dilute ovulation or no ovulation;
② the clinical manifestation and/or biochemical signs of hyperandrogenism;
and thirdly, the ovarian polycystic change is found through ultrasonic inspection: more than 12 follicles with the diameter of 2-9cm in one side or two sides of the ovary, and/or the volume of one side of the ovary is more than 10 ml.
The above 3 items have 2 items, and can be used for diagnosis by excluding other causes, and excluding anovulation due to low gonadotropic activity and premature ovarian failure.
Inclusion criteria were: age 18 to 40 years; the standard meets the diagnosis standard of Western medicine PCOS; the diagnosis standard of kidney-yang deficiency syndrome in traditional Chinese medicine is met; hormone medicine is not taken in nearly 3 months; eliminating menoxenia caused by other reasons; the patients in the cohort indicated an informed and consented treatment regimen.
Case confirmation: 80 patients meeting the case selection standard are selected, the group of the patients is determined by adopting a random number table method according to the sequence of hospitalization treatment time of the patients, and the patients are divided into a treatment group and a control group, wherein each group comprises 20 patients.
The treatment method comprises the following steps: the pharmaceutical tablets prepared in example 3 and comparative examples 1 to 3 were prepared, 1 tablet per day, taken at the same time each day for 21 consecutive days starting on day 5 of the menstrual cycle or on day 5 of progesterone withdrawal bleeding, and taken for the next cycle after day 8 of withdrawal. 3 cycles of continuous treatment are 1 course.
Serum sex hormone level index comparison
Each administration group respectively takes blood before and after treatment once, wherein the blood is taken before treatment on the 2 nd-5 th day of the menstrual cycle, the blood is taken after treatment on the 1 st month after 1 treatment course, the 2 nd-5 th day of the menstrual cycle, the two blood taking are performed in the early morning on an empty stomach, the median venous blood of the elbow is extracted, and Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), testosterone (T) and dehydroepiandrosterone sulfate (DHEAS) are determined. The results of the experiment are shown in table 2.
TABLE 2 comparison of sex hormones before and after treatment
Figure BDA0003115494530000061
B-ultrasonic observation of changes in ovarian volume and number of follicles
When a patient with menstrual cycle at day 2 or a patient with menstrual disorder and amenorrhea comes to a hospital for a doctor, the conditions of the uterus and bilateral appendages are examined by the same person and the same color ultrasound instrument by transvaginal vaginal ultrasound (asexual life person by transrectal ultrasound), the total number of ovarian antral follicles at the two sides is counted, the maximum radial line of the length, the width and the thickness of the ovary is detected, and the ovary volume is calculated according to an ellipse volume calculation formula. The results of the experiment are shown in table 3.
TABLE 3 comparison of ovarian volume and number of follicles before and after treatment
Figure BDA0003115494530000071
As can be seen from the experimental data in tables 2 and 3, the values of serum T, LH, DHEAS, mean ovarian volume, total number of ovarian antral follicles of both sides and the like after treatment of the patients in each administration group are reduced compared with those before treatment, and the reduction degree of the treatment group in example 3 is more obvious compared with the control group in comparative examples 1 to 3, which shows that the treatment group has better curative effect on the improvement of hyperandrogenism and polycystic ovarian state than the control group. In conclusion, the active composition consisting of the crocetin, the dexamethasone and the pioglitazone is used for treating patients with the polycystic ovarian syndrome, and the results show that the combined medication has remarkable clinical curative effect on the polycystic ovarian syndrome, can adjust the reproductive hormone level in the patients, promote the gonadal hormone and the androgen of the patients to recover normal levels, improve the ovulation rate, and reduce the recurrence rate while ensuring the use safety.
The above description is only a preferred embodiment of the present invention, and it should be noted that, for those skilled in the art, several modifications or equivalents may be made to the technical solution without departing from the principle of the present invention, and these modifications or equivalents should also be regarded as the protection scope of the present invention.

Claims (5)

1. Use of an active composition for the preparation of a pharmaceutical formulation for the treatment of polycystic ovary syndrome (PCOS), wherein the active composition consists of the following raw material components in percentage by weight: dexamethasone 40%, pioglitazone 40% and crocetin 20%.
2. Use according to claim 1, characterized in that the pharmaceutical preparation comprises an effective amount of the active composition and pharmaceutically acceptable auxiliary ingredients.
3. Use according to claim 2, wherein the active composition is present in the pharmaceutical preparation in a percentage by weight of between 5 and 10%.
4. The use according to claim 2, wherein the pharmaceutically acceptable excipient ingredients comprise one or more of corn starch, lactose, glucose, microcrystalline cellulose, magnesium stearate, beta-cyclodextrin, sorbitol, xylitol, glycerol, poloxamer, deionized water, propylene glycol, anhydrous ethanol.
5. The use of claim 2, wherein the pharmaceutical preparation is in the form of capsule, drop pill, tablet, granule or oral liquid.
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CN102302668A (en) * 2011-09-13 2012-01-04 上海泰坤堂中医医院有限公司 Pharmaceutical composition for treating polycystic ovary syndrome (PCOS)

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CN107982269B (en) * 2017-11-17 2020-03-17 南京医科大学 Application of crocetin in preparation of medicine for preventing and treating polycystic ovarian syndrome

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