盐酸吡咯列酮治疗多囊卵巢综合征临床疗效分析

Effects of pioglitazone on women with polycystic ovary syndrome

目的探讨盐酸吡咯列酮对多囊卵巢综合征(PCOS)患者血清睾酮、血脂、空腹胰岛素、血糖的影响,为其临床应用提供依据。方法应用自身对照研究,对30例PCOS患者给予盐酸吡咯列酮每日30mg口服,3个月。进行服药前后的血清睾酮、血脂、空腹胰岛素、血糖及服糖后2h胰岛素和血糖的测定,同时于服药后记录月经周期、体重变化,服药后不适感及B超监测排卵。结果服药前后体重无明显变化(P>0.05)。服药后空腹胰岛素、服糖后2h胰岛素和血糖、HOMA指数均有下降(P<0.05)。服药后血清睾酮明显下降,特别是肥胖组下降明显(P<0.05),而非肥胖组无变化(P>0.05)。服药后高密度脂蛋白(HDL)升高,甘油三脂(TG)降低(P<0.05)。23例无排卵患者服药后观察69个周期,21个周期有排卵,排卵率为30.43%。26例月经异常者中20例得到改善,改善率为76.92%。不良反应中,乳房胀痛1例,胃痛1例,疲劳感1例,其余患者无不适主诉,未发现肝、肾功能异常。结论吡咯列酮可以改善PCOS患者胰岛素抵抗,降低血清睾酮水平,调节脂代谢、诱发排卵,短期应用未出现严重的不良反应。

Objective To evaluate the effects and safety of pioglitazone on clinical and endocrine - metabolic features of polycystie ovary syndrome （PCOS）. Methods Pioglitazone of 30mg/day for 3 m was administrated for 30 women with PCOS. Changes of total testosterone, blood lipid, oral glucose tolerance tests, serum insulin, body mass index （BMI）, menstrual cycle, ovulation rates and side effects were observed. Results No change was found in body weight. Administration of pioglitazone resulted in a remarkable decline in fasting serum insulin and both serum insulin and glucose after an oral glucose load at 2 h, as well as HOMA index. The total testosterone declined, especially in obsess PCOS （P〈0. 05）, but no statistic significance in non- obsess PCOS （P〈0.05）. HDL- C concentration increased and triglycerides concentration decreased after treatment. 23 anovulatory patients obtained 30.43% （21/69 cycles） of ovulation rate after administration of pioglitazone. The rate of menstruation improvement was 76.92% （20/26 patients）. One case presented mild mastopathy, 1 mild stomach pain and 1 tiredness. None showed impairment of liver or kidney. Conclusions Pioglitazone can improve insulin resistance, reduce serum glucose and total testosterone, administrate the metabolism of blood lipid and restore menstrual cycle, induced ovulation. Pioglitazone has no severe side effects in short term.