不同避孕药与二甲双胍联合对多囊卵巢综合征伴胰岛素抵抗患者的临床疗效比较

Clinical effect of oral contraceptive pill and metformine on polycystic ovary syndrome with insulin resistance

目的比较妈富隆或达英-35分别与二甲双胍联合治疗多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)的内分泌异常及生殖功能的临床转归。方法随机将79例PCOS伴IR患者分为两组,妈富隆联合治疗组39例,达英-35联合治疗组40例。两组均于治疗3个月前后对比子宫内膜变化,并进行诱导排卵3个周期。检测治疗前后性激素、IR程度及观察诱导排卵的效果。结果两配伍组治疗后,增生内膜均能逆转,临床转归好。妈富隆配伍组体重指数(BMI)明显降低(P<0.05),妈富隆配伍组空腹胰岛素(FIN)水平降低的更为显著(P<0.05)。卵泡总数及卵巢体积均显著降低(P<0.01),黄体生成素(LH)、黄体生成素/卵泡刺激素(LH/FSH)、雄烯二酮(A2)均显著降低(P<0.01)。两组治疗后IR明显改善(P<0.01)。妈富隆配伍组治疗后总胆固醇(TC)显著下降(P<0.05),甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)显著下降(P<0.01),高密度脂蛋白胆固醇(HDL-C)显著升高(P<0.05),达英-35配伍组治疗前后血脂无明显变化(P>0.05)。两组的单卵泡发育率、周期排卵率、妊娠结局差异无统计学意义(P>0.05)。结论妈富隆或达英-35分别与二甲双胍联合应用,均能改善PCOS患者的IR、并发子宫内膜增生症(EH)及高雄激素血症,对于异常糖脂代谢,妈富隆配伍组优于达英-35配伍组。

Objective To compare the clinical effects of combining marvelon or Diane-35 and metformine for polycystic ova-ry syndrome（PCOS） with insulin resistance（IR） the dyscrinism and recovery of reproduction function.Methods Seventynine patients with PCOS and IR were randomly divided into two groups： the marvelon group has 39 cases and the Diane-35 group has 40 cases.Two groups were induced ovulation 3 menstrual cycles in 3 months therapy,and were detected the levels of sex hormone,IR extent and the effectiveness of induced ovulation before and after therapy.In the same time,endometrial thickness were compared.Results After treatment,the endometrial hyperplasia had been reserved,and it had a better clinical outcome.the BMI was significantly decreased（P 0.05） and the FIN was more significantly decreased（P 0.05） in the marvelon group and the changes of F-G score,the number of ovarian follicles,the volume of the ovary,HL,HL/FSH,A2,IR,TC,TG,LDL-C and HDL-C had significant differences between the two groups.There was no significant difference in the blood fat in Diane-35 group（P 0.05）.There was no significant difference in the developmental rate of the mono-ovarian follicle,ovulation rate,or pregnancy outcome（P 0.05）.Conclusion Combining marvelon or Diane-35 and metformine can effectively inhibit the synthetic of androgens and the IR of the patients.The PCOS patients with abnormality of glycolipid metabolism treated with marvelon group might be more effective than in Diane-35 group.