复方环丙孕酮与胰岛素增敏剂治疗多囊卵巢综合症的临床研究

Diane-35 combined with insulin sensitizer for polycystic ovary dyndrome

目的 探讨应用复方环丙孕酮分别与胰岛素增敏剂盐酸二甲双胍和马来酸罗格列酮治疗多囊卵巢综合症（PCOS）的临床效果.方法 选择在我院就诊的PCOS患者45例,随机分成两组,A组（复方环丙孕酮和盐酸二甲双弧）25例,B组（复方环丙孕酮和马来酸罗格列酮）20例,治疗疗程3个月经周期.比较两组患者用药前后体重、血糖及胰岛素水平、生殖激素水平变化及排卵和月经改善情况.结果 A组治疗后患者体重降低（P＜0.05）,两组治疗后体重比较,差异有统计学意义（P＜0.05）;两组患者空腹胰岛素、胰岛素抵抗指数等显著下降,B组治疗后数值低于A组（P＜0.05）;两组患者治疗后血清睾酮较治疗前明显降低,与治疗前相比,差异有高度统计学意义（P＜0.01）,但两者之间差异无统计学意义（P＞0.05）;两组患者治疗后排卵率比较,B组高于A组,差异有统计学意义（P＜0.05）.结论 应用复方环丙孕酮与胰岛素增敏剂治疗PCOS患者,可以明显改善患者的胰岛素抵抗、内分泌及代谢紊乱.盐酸二甲双胍有轻微降低体重的作用,价格便宜;马来酸罗格列酮减轻胰岛素抵抗及提高排卵率效果优于盐酸二甲双胍,但因用药安全性问题及价格较贵,仍以盐酸二甲双胍为一线用药.

Objective To explore the efficacy of cyproterone acetate （CPA） combined with metformin or rosiglitazone for polycystic ovary syndrome （PCOS）. Methods 45 women with PCOS were randomized to receive CPA plus either metformin （25 patients, group A） or rosiglitazone （20 patients, group B） for 3 months.Body weight, plasma levels of glucose, insulin, and sex homones, ovulation, and menstruation were compared after treatment. Results As compared with group B, body weight significantly decreased in group A （P〈0.05）. The fasting insulin level and insulin resistance index were significantly decreased in the two groups and these changes were more marked in group B （P〈0.05）. Serum testosterone levels were significantly decreased in both groups but did not differ significantly between these two groups （P〉0.05）. The ovulation rate was higher in group B than in group A （P〈0.05）. Conclusions Insulin sensitizer combined with Diane-35 can markedly improve insulin resistance and impaired endocrine and metabolic function. Metformin has a slight weight lowering effect is less expansive; where as rosiglitazone has a better therapeutic effect on insulin resistance and ovulation rate. Metformin is used as the first-line agent because, rosiglitazone is expensive and has more side effects.