达英-35联合不同胰岛素增敏剂对PCOS伴IR患者的临床疗效比较

Comparison of clinical effects between pioglitazone and metformin plus Diane-35 on polycystic ovary syndrome with insulin resistance

目的:比较吡格列酮和二甲双胍分别配伍达英-35治疗多囊卵巢综合征(P-COS)的内分泌异常以及对卵巢生殖功能恢复的疗效。方法:随机将91例PCOS合并胰岛素抵抗(IR)患者分为两组,吡格列酮配伍组47例口服达英-35和盐酸吡格列酮,二甲双胍配伍组44例口服达英-35和盐酸二甲双胍,两组均于治疗3个月后进行诱导排卵治疗3个周期。检测治疗前后性激素、IR程度、血脂水平以及观察诱导排卵的效果。结果:二甲双胍配伍组治疗后BM I明显降低(P<0.05)。两组治疗后F-G评分均显著降低(P<0.05),卵泡总数及卵巢体积均显著降低(P<0.01),LH、LH/FSH、A2均显著降低(P<0.01)。两组治疗后IR明显改善(P<0.01),吡格列酮配伍组FIN水平降低的更为显著(P<0.05)。吡格列酮配伍组治疗后TC显著下降(P<0.05),TG、LDL-C显著下降(P<0.01),HDL-C显著升高(P<0.05),二甲双胍配伍组治疗前后血脂无明显改变(P>0.05)。两组的周期排卵率、单卵泡发育率、妊娠结局无明显差异(P>0.05)。结论:达英-35与吡格列酮配伍或与二甲双胍联合应用,均能改善PCOS患者的IR和高雄激素症状,对于异常的糖脂代谢,吡格列酮的疗效要优于二甲双胍。

Objective：To compare the therapeutic effects of pioglitazone and metformin plus Diane-35 on endocrine, metabolism and reproduction functional recovery in polycystic ovary syndrome（PCOS） patients. Method： Ninety one PCOS patients with insulin resistance（IR） were randomly divided into two groups ：47 PCOS were treated with Diane-35 plus pioglitazone, and 44 PCOS were treated with Diane-35 plus metformin. After treatment of three months, they all accepted ovulation induction therapy for three cycles. The levels of sex hormone, insulin, blood-fat in serum before and after the treatment were examined and the results of ovulation in- duction were observed. Result： After the treatment, BMI of metformin plus Diane-35 group were significantly declined （P 〈 0.05 ）. In both groups, the score of F-G was significantly decreased （P 〈0.05 ） ,and the volumes and follicle numbers of bilateral ovary ,the levels of LH ,A2, LH/ FSH were significantly lower than before（ P 〈 0.01 ）, and the status of IR were significantly im- proved（P 〈0.01 ）. The level of fasting INS in pioglitazone plus Diane-35 group was decreased significantly than metformin plus Diane-35 group （ P 〈 0.05 ）. In pioglitazone plus Diane-35 group, the level of TC was lower（ P 〈 0.05 ）, and the levels of TG, LDL-C were also lower（ P 〈 0.01 ）, and the levels of HDL-C was higher（ P 〈 0.05 ） than before. But the abnormal lipid me- tabolism was not adjusted in metformin plus Diane-35 group（P 〉0.05）. There were no signifi- cant differences in the rate of ovulation per cycle, in the rate of single follicle development and in the result of pregnancy between the two groups. Conclusion： IR is improved and hyperandro- genemia is corrected both in pioglitazone plus Diane-35 group and metformin plus Diane-35 group. But abnormal lipid metabolism is adjusted only in pioglitazone plus Diane-35 group but not in metformin plus Diane-35 group.