is associated with significantly reduced gut microbial diversity and lower levels of fecal butyrate and propionate compared to healthy controls.
Women with phlegm-dampness PCOS exhibited significantly lower α-diversity in gut microbiota compared to healthy controls.
Distinct microbial profiles were observed, including an enrichment of Blautia wexlerae and a depletion of Faecalibacterium and Alistipes in phlegm-dampness PCOS.
Fecal concentrations of butyrate and propionate were markedly lower in phlegm-dampness PCOS compared to controls.
Blautia wexlerae showed positive correlations with body mass index (BMI), waist circumference, hirsutism, and acanthosis nigricans.
Alistipes shahii correlated with serum testosterone and insulin resistance as measured by HOMA-IR.
Non-phlegm-dampness PCOS exhibited intermediate values for microbial diversity and , but most differences from controls were not significant after adjusting for BMI and age.
Simplified
BACKGROUND: Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder characterized by hyperandrogenism, insulin resistance, and reproductive dysfunction. Accumulating evidence indicates that gut microbiota and their metabolites, particularly (SCFAs), contribute to PCOS pathogenesis. However, subtype-specific alterations, especially in Traditional Chinese Medicine (TCM)-defined , remain insufficiently explored.
OBJECTIVE: This study aimed to comprehensively compare gut microbial composition, SCFA concentrations, and their associations with anthropometric, clinical, and biochemical indicators in women with phlegm-dampness PCOS, non-phlegm-dampness PCOS, and healthy controls.
METHODS: In this cross-sectional analysis, 54 women were recruited and stratified into phlegm-dampness PCOS (n = 17), non-phlegm-dampness PCOS (n = 18), and healthy control (n = 19) groups. Anthropometric measurements, reproductive and metabolic indices, and serum hormones were assessed. Fecal SCFAs were quantified via gas chromatography, and gut microbial profiles were characterized using 16 S rRNA gene sequencing. Bioinformatic and statistical analyses included diversity indices, taxonomic abundance, principal component and clustering analyses, and correlation networks linking microbiota, SCFAs, and host phenotypes.
RESULTS: Phlegm-dampness PCOS exhibited significantly reduced α-diversity compared with controls (p < 0.05) and distinct microbial profiles across multiple taxonomic levels. Key alterations included enrichment of Blautia wexlerae and depletion of Faecalibacterium and Alistipes. Fecal butyrate and propionate levels were markedly reduced in phlegm-dampness PCOS versus controls (p < 0.01). Correlation analyses revealed Blautia wexlerae was positively associated with BMI, waist circumference, hirsutism, and acanthosis nigricans, while Alistipes shahii correlated with serum testosterone and HOMA-IR. Distinct correlation networks highlighted microbiota-metabolite-host interactions specific to phlegm-dampness PCOS. Compared with healthy controls, the non-phlegm PCOS group (Group B) exhibited intermediate values for microbial diversity and SCFAs; however, most Group B vs. control differences were not significant after adjustment for BMI and age with FDR correction.
CONCLUSION: Women with phlegm-dampness PCOS demonstrate more profound , SCFA depletion, and distinct microbiota-clinical correlations than non-phlegm-dampness PCOS and healthy controls. These findings underscore the biological relevance of TCM-based subtype stratification and suggest that precision microbiota-targeted interventions may enhance therapeutic outcomes in PCOS.
CLINICAL TRIAL NUMBER: NA.
Key numbers
p < 0.05
Decrease in α-diversity
Comparison of α-diversity between and healthy controls.
835.4 ng/mg feces
Lower butyrate concentration
Fecal butyrate levels in vs. healthy controls.
1056.3 ng/mg feces
Lower propionate concentration
Fecal propionate levels in vs. healthy controls.
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Declarations. Human ethics and consent to participate: The study protocol was reviewed and approved by the Institutional Ethics Committee of Hainan Women and Children’s Medical Center vide letter No. HNWCMC2022 . All procedures were conducted in accordance with the Declaration of Helsinki (2013 revision), and written informed consent was obtained from all participants. Consent to publish: NA. Competing interests: The authors declare no competing interests.
