达英-35联合二甲双胍治疗伴胰岛素抵抗型多囊卵巢综合征疗效观察

Observation on the curative effect of Diane-35 combined with metformin in treatment of polycystic ovarian syndrome with insulin resistance

目的:观察达英-35和二甲双胍对伴胰岛素抵抗的多囊卵巢综合征(PCOS)患者内分泌的影响,评估其对PCOS的治疗价值。方法:选取72例有胰岛素抵抗及排卵障碍的PCOS患者,随机分为A、B、C三组,A组应用二甲双胍,B组应用达英-35,C组联合应用二甲双胍及达英-35。分别于治疗前及治疗后月经周期第3天行阴道超声检查及激素化验,观察治疗前后卵巢体积、体重指数(BMI)、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)、空腹血糖(FPG)及空腹胰岛素(FINS)等相关指标变化,并比较各组月经恢复情况、排卵率及妊娠率的差别。结果:三组患者经治疗卵巢体积、BMI、LH、T、FINS、FPG及胰岛素抵抗指数(HOMA-IR)水平等均有不同程度改善,而FSH水平无显著性变化。治疗后C组患者各项指标改善明显优于A、B两组治疗后,差异有统计学意义(P<0.05)。C组患者治疗后月经恢复、排卵率及妊娠率均显著高于A、B两组,差异有统计学意义(P<0.05)。结论:达英-35和二甲双胍单独应用均可以不同程度地改善PCOS患者的内分泌与代谢异常,促进恢复正常月经,诱发排卵。但单独应用有一定局限性,二者联合应用能更有效地降低LH、T及胰岛素水平,增强纠正PCOS代谢紊乱、改善胰岛素抵抗的效率,提高排卵率和妊娠率,是治疗PCOS理想的治疗方案。

Objective：To observe the effects of Diane-35 and metformin on the endocrine function of patients with polycystic ovarian syndrome（PCOS） combined with insulin resistance,evaluate their curative values for PCOS.Methods：Seventy-two patients with insulin resistance and ovulation barrier were selected and divided into group A,group B,and group C randomly.The patients in group A were treated with metformin,the patients in group B were treated with Diane-35,and the patients in group C were treated with Diane-35 combined with metformin.Transvaginal ultrasonography and hormones detection were conducted before treatment and on the third day of menstrual cycle after treatment;the changes of indexes,including ovarian volume,body mass index（BMI）,follicle stimulating hormone（FSH）,luteinizing hormone（LH）,testosterone（T）,fasting blood glucose（FBG）,and fasting insulin（FINS）,were observed before and after treatment;the differences of recovery of menstruation,the ovulation rate,and the pregnancy rate were compared among the three groups.Results：After treatment,ovarian volumes,BMI,levels of LH,T,FINS,FBG,and insulin resistance indexes in the three groups increased to varying degrees,but FSH levels didn＇t change significantly.After treatment,the improvements of various indexes in group C were superior to those in group A and group B,there was significant difference（P0.05）.The degree of menstrual recovery,ovulation rate,and pregnancy rate in group C after treatment were significantly higher than those in group A and group B（P0.05）.Conclusion：Diane-35 or metformin used alone can improve the endocrine disorder and metabolic disorder of the patients with PCOS to varying degrees,promote the recovery of normal menstruation,and induce ovulation.But there are a certain limitations,combined Diane-35 and metformin can reduce the levels of LH,T,and insulin,correct metabolic disorder,improve the efficacy of insulin resistance,increase ovulation rate and pregnancy rate more efficiently,which is an ideal therapy for PCOS.