二甲双胍在肥胖型多囊卵巢综合征不孕中的应用

The application of metformin to treat infertility in the obese women with polycystic ovary syndrome

目的探讨二甲双胍在肥胖型多囊卵巢综合征(PCOS)不孕中的应用。方法选择育龄期PCOS患者肥胖型PCOS组78例和正常对照组50例。比较各组内分泌激素水平、空腹血糖、空腹胰岛素、2 h血糖、2 h胰岛素。肥胖型PCOS组服二甲双胍治疗12周,比较治疗前后(A组、B组)体重指数(BMI)、内分泌激素水平、空腹血糖、空腹胰岛素、2 h血糖、2 h胰岛素、排卵率及妊娠率。结果肥胖型PCOS组与对照组患者比较,血清T、空腹血糖、2 h血糖、空腹胰岛素、2 h胰岛素差异均有显著性(P<0.05)。服二甲双胍治疗前后比较,BMI、血清T、空腹血糖、2 h血糖、2 h胰岛素均有显著性下降(P<0.05)。A组排卵率89%,妊娠率70%。B组排卵率40%,妊娠率20%。A组明显高于B组,差异有显著性(P<0.05)。结论肥胖型PCOS患者常伴有糖代谢异常和胰岛素抵抗,二甲双胍能改善胰岛素抵抗、降低胰岛素水平,使部分患者恢复排卵,提高妊娠率。

Objective To investigate the application of metformin in the infertility in obese PCOS. Methods Seventy-eight cases of obese women with PCOS and fifty cases of control group were reviewed regard- ing endocrinal hormone level, fasting glucose, fasting insulin ,2 b postprandial glucose and 2 h postprandial insu-lin. The obese group used mefformin for twelve weeks. And pre-and post-treatment（ A group and B group）were reviewed regarding body mess index（ BMI ）, endocrinal hormone level, fasting glucose, fasting insulin, 2 h post-prandial glucose and 2 h postprandial insulin, ovulating rate and pregnancy rate. Results The obese group was significantly different （ P 〈 0. 05 ） with control group in serum T, fasting glucose,2 h postprandial glucose, fasting insulin and 2 h postprandial insulin. After the Mefformin treatment,the BMI,serum T,fasting glucose,2 h post- prandial glucose,fasting insulin and 2 h postprandial insulin of obese group were significantly declined （P 〈 0. 05 ）. The ovulating rate and pregnancy rate of Group A were 89% and 70% respectively. However, there were 40% and 20% for group B. Group A were obviously high than group B in these two index and the difference was significantly（ P 〈 0. 05 ）. Conclusion Obese women with PCOS always accompanied with glucose metabolism abnormal and insulin resistance. However, the Mefformin can remedy insulin resistance and reduce the insulin level. This makes some patients recover ovulation and improve their pregnancy rate.