二甲双胍联合复方醋酸环丙孕酮预治疗对多囊卵巢综合征不育患者促排卵疗效的影响

The effect of pretreatment with compound cyproterone acetate-metformin combination on the outcome of ovulation induction in the infertility women with polycystic ovarian syndrome

目的观察多囊卵巢综合征(PCOS)患者经二甲双胍联合复方醋酸环丙孕酮预治疗后的内分泌、糖及脂代谢变化及随后促排卵效果.方法测定65例PCOS患者的基础内分泌、糖及脂代谢指标并与30例非PCOS不育患者比较.对50例PCOS患者给予二甲双胍联合复方醋酸环丙酮治疗,3个月后复查内分泌、糖及脂代谢指标,停药后给予克罗米芬(CC)及人绝经期促性腺激素(HMG)促排卵(观察组);未经上述药物治疗的15例PCOS患者直接行促排卵治疗(对照组).比较各组卵泡发育、排卵及妊娠情况.结果65例PCOS患者基础促黄体生成素(LH)、睾酮(T)、雌二醇(E2)、空腹胰岛素(FI)、空腹血糖/空腹胰岛素比值(FG/FI)及甘油三脂(T-Ch)、总胆固醇(TG)水平高于非PCOS不育患者(P＜0.001～P＜0.05),高密度脂蛋白胆固醇(HDL-C)水平低于非PCOS不育患者(P＜0.05);观察组经治疗后LH、T及E2分别下降58.9%、38%及30.1%,载脂蛋白B(apoB)及HDL-C上升17.2%及20%(P＜0.001～P＜0.05),FI及FG/FI虽有不同程度下降及上升,但差异无显著性.促排卵结果:排卵率71.7%、妊娠率38%,均明显高于对照组(P＜0.05).结论二甲双胍联合复方醋酸环丙孕酮治疗可有效改善PCOS患者内分泌及糖、脂代谢紊乱,改善卵巢对促排卵药物的敏感性,提高排卵率及临床妊娠率,对PCOS不育妇女不失为良好的预治疗方法.

Objective： To observe the effects of cyproterone acetate （CPA） in combination with metformin on the endocrinologic, metabolic changes and the outcomes of ovulation induction in the infertility women with polycystic ovarian syndrome （PCOS）. Methods： A prospective study recruited 65 PCOS patients and 30 non-PCOS infertility women. The body mass index （BMI）, waist.hip ratio （WHR）, Ferriman-Gallwey score, gonadotrophin, testosterone （T）, fasting glucose, fasting insulin, triglyceride, total cholesterol, apoA, apoB and HDL-cholesterol were determined in all patients before the treatment and served as the baseline. At the end of 12-week therapy, these parameters were re-measured. 50 PCOS infertile patients as study group were treated with combination of CPA with metformin for three months. Clomiphene citrate （CC） and human menopause gonadotrophin （HMG） were added for three cycles to induce ovulation. Other 15 PCOS cases as control group directly underwent the ovulation induction with CC and HMG for three cycles. Results： The PCOS patients had higher levels of LH, T, Ez, fasting insulin, FG/FI, total cholesterol and triglyceride, and lower levels of HDL-cholesterol when compared with the non PCOS women （P〈 0. 001～P〈0. 05）. After treatment, the levels of LH, T, E2 were significantly decreased （58.9%, 38% and 30.1%, respectively） and the levels of apoB and HDL C were significantly increased （17.2% and 20%, respectively） in the study group （P〈0. 001-P〈0.05）. FI and FG/FI showed a slight change in the study group, but no significant difference was found. The rates of ovulation and pregnancy were higher than those in control group 71% vs 60.5% and 38% vs13.3%, respectively）. Conclusion： Metformin m combination with CPA therapy may normalize the endocrine and metabolic abnormalities, and improve the ovarian response to ovulation induction drugs and increase the pregnancy rate of infertility patients with PCOS.