多囊卵巢综合征患者使用糖皮质激素的疗效观察

Observation of the Therapeutic Effect of Low-dose Prednisone on PCOS Women

目的:探讨在采取饮食和生活方式指导及二甲双胍治疗的多囊卵巢综合征(PCOS)患者中应用小剂量强的松对于降低雄激素的效果,以及对排卵率、妊娠率的影响。方法:通过一个前瞻、随机、双盲、安慰剂对照的研究,50例PCOS患者随机分成两组:服用5mg/d强的松或安慰剂各26周,在整个治疗过程中,所有患者均接受饮食及生活方式的指导及二甲双胍500mg/次,每日3次的治疗。主要测量指标包括:雄激素水平、体质量指数(BMI)、空腹胰岛素、口服75g糖后2h胰岛素、空腹血糖及血脂。使用t检验及相关分析进行分析。结果:小剂量强的松治疗(研究组)与对照组比较,研究组患者37%睾酮、25%雄烯二酮、69%硫酸脱氢表雄酮(DHEA-S)和37%游离睾酮指数(FTI)降低,BMI、空腹胰岛素、餐后2h胰岛素、空腹血糖及血脂则未受影响。随后结合氯米芬(CC)及人绝经期促性腺激素(hMG)促排卵治疗,成熟卵泡发育率(94.7%比68.2%)、排卵率(78.9%比54.5%)、妊娠率(63.2%比45.5%)均比对照组升高。结论:在使用二甲双胍治疗的PCOS患者使用小剂量的强的松能更有效地降低雄激素水平并增加了患者的排卵率和妊娠率。

Objective： To investigate the effect of low-dose prednisone on reducing androgen levels, and its influence on ovulation rate and pregnancy rate in women with polycystic ovary syndrome （PCOS） treated using mefformin and suggested by diet and lifestyle advices. Methods： A prospective, randomized, double blind and placebo-controlled study was adopted. Fifty PCOS women were randomly divided into two groups： the study group and the control group. All women of both groups were respectively administered prednisone （15 mg/d） and placebo orally, for 26 weeks. During the whole progress, all patients were guided by diet and lifestyle advices and treated with mefforrnin （1 500 mg/d）. The main measurement indexes contained： androgen level, body mass index （BMI）, fasting insulin, postprandial-two-hour insulin, fasting blood glucose and serum lipid. All data were analyzed using t-test. Results： Compared with the control group, the testosterone level of the study group was reduced by 37%, androstenedione by 25%, dehydroepiandrosterone-sulfate （DHEA-S） by 69% and free testosterone index （FTI） by 37%. And BMI, fasting insulin, postprandial-two-hour insulin, fasting blood glucose and serum lipid levels were unaffected. Then together with the inducing ovulation treatment of clomiphen citrate （CC） and human menopausal gonadotropin （hMG）, prednisone increased the mature oocytes development rate （94.7% vs 68.2%）, ovulation rate （78.9% vs 545%）, and pregnancy rate （63.2% vs 453%）, compared with the control group. Conclusion： Low-dose prednisone can effectively reduce the androgen level and improve the ovulation rate and preguaney rate in PCOS women treated with metformin.