二甲双胍对多囊卵巢综合征患者胰岛素样生长因子-1的影响

Effect of metformin on the serum IGF-1 in patients with PCOS

目的探讨二甲双胍对多囊卵巢综合征（PCOS）患者血清胰岛素样生长因子-1（IGF-1）及胰岛素样生长因子结合蛋白-1（IGFBP-1）水平的影响及其作用机制，明确二甲双胍治疗的临床效果。方法2002年1—11月对山西医科大学第二医院24例PCOS患者给予二甲双胍500mg，一日3次，8～24周治疗，比较治疗前后血清IGF-1、IGFBP-1、空腹胰岛素及睾酮水平，并对月经恢复、排卵、妊娠情况进行分析。结果二甲双胍可降低血清空腹胰岛素及睾酮水平，能显著升高IGFBP-1水平，治疗前后血清IGF—1水平差异无显著性。单纯二甲双胍治疗后月经恢复率为41．67％（10／24）；自然排卵率为25．00％（6／24），自然妊娠率为12．50％（3／24）。二甲双胍加促排卵治疗共18个周期，排卵周期率66．67％（12／18），妊娠周期率为11．11％（2／18）。结论二甲双胍可以降低血清空腹胰岛素及睾酮水平，增高IGFBP-1水平，可以改善卵泡微环境，有助于月经恢复，提高促排卵和妊娠率．是治疗PCOS的重要手段。

Objective To investigate whether metformin affected serum IGF-1 and IGFBP-1 levels and to explore the mechanisms of therapy with mefformin and its clinical effects. Methods Twenty-four PCOS women participated in the study and were administered metformin at a dose of 500mg three times a day. Treatment was continued for 8 - 24 weeks. Serum IGF-1, IGFBP-1, insulin and testosterone were evaluated before and after 8 weeks of metformin therapy. In addition,the effects of mefformin on menstruation, ovulation and pregnancy were analyzed. Results Mefformin led to a significant decrease in serum insulin and testosterone levels. A significant increase in serum IGFBP-1 level was observed after mefformin, with no significant difference in serum IGF-1. Ten out of 24 had more regular menstrual cycles, 6 patients had ovulation and 3 patients conceived. After metformin therapy, CC or CC ＋ HMG induced ovulation 18 cycles, ovulation rate and pregnancy rate being 66. 67% and 11.11% respectively. Conclusion Mefformin can decrease serum insulin and testosterone levels, improve the microenvironment of follicles, increase menstrual cyclicity, improve ovulations and promote fertility. So mefformin is an important therapy for PCOS.