复方环丙孕酮联合罗格列酮、二甲双胍治疗多囊卵巢综合征伴重度胰岛素抵抗疗效观察

Effects of cyproterone acetatea combined with rosiglitazone and metformin therapy in severe insulin resistant patients with polycystic ovary syndrome

目的探讨复方环丙孕酮(CPA)联合二甲双胍与罗格列酮,治疗多囊卵巢综合征(PCOS)伴重度胰岛素抵抗(IR)患者内分泌、代谢异常的疗效。方法2007年1月至2008年6月在哈尔滨医科大学附属第一医院生殖科就诊的84例PCOS伴重度IR患者按不同的治疗方案进行分组,A组33例给予CPA、二甲双胍及罗格列酮治疗;B组26例给予CPA和罗格列酮治疗;C组25例给予CPA和二甲双胍治疗,疗程为3个月。比较3组患者用药前后的临床表现、性激素、血糖和胰岛素水平的变化。结果用药3个月A、B、C组血清雄激素水平均较治疗前明显下降,但3者之间无统计学意义(P>0.05),A、B、C3组治疗后HomaIR、Homaβ、AUCINS均有不同程度下降,B组与C组比较无统计学意义(P>0.05),A组与B、C组比较有统计学意义(P<0·05),HomaIR、Homaβ、AUCINS明显改善。结论对于PCOS合并重度IR的患者,CPA联合二甲双胍和罗格列酮治疗效果较好,比二甲双胍、罗格列酮分别单独与CPA联合用药有明显的优势。

Objective To discuss the therapeutic effects of cyproterone acetatea （CPA） combined with metformin and/or rosiglitazone on endocrine and metabolism in PCOS patients with severe insulin resistance. Methods In First Affiliated Hospital of Harbin Medical University, 84 PCOS patients with severe insulin resistance from January 2007to June 2008 were randomly divided into group A, B and C. 33 patients in group A were given CPA combined with metformine and rosiglitazone for 3 months ; 26 patients in group B were given rosiglitazon and CPA for 3 months. 25 patients in group C were given metformin and CPA for 3 months. The clinical feature, reproductive hormone, serum glucose and insulin levels were observed before and after treatment. Results After 3 months treatment, the serum T level decreased in A, B and C groups, but there was no significant difference among 3 groups（P 〉 0.05）. The index of glucose metabolism and insulin resistance were significantly decreased after treatment in three groups, but there was no significant difference among 3 groups（ P 〉 0.05 ）. Moreover, group A therapeutic effects on Homa IR,Homaβ ,AUCINS were much better than group B, C, there being significant difference（P 〈 0.05）. Conclusion CPA combined with rosiglitazone and metformin used to treat PCOS with severe insulin resistance and hyperinsulinemia more effectively than rosiglitazone and metformin respectively.