多囊卵巢综合征综合治疗疗效的评价

Evaluation of preliminary efficacy of comprehensive treatment for polycystic ovary syndrome

目的对多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者进行综合治疗,为PCOS的规范治疗提供理论依据。方法选取2012年8月至2013年5月因月经不规律和/或不孕在首都医科大学附属北京妇产医院确诊为PCOS的患者30例。采取个体化营养、运动及药物综合治疗。根据静态代谢率测定及体成分运动功能测定等,给予个体化营养及运动指导。药物治疗:服用炔雌醇环丙孕酮片(达英-35)3个周期;对血糖和胰岛素高者同时加服二甲双胍3个月。分别在治疗前后测量身高、体质量、腰围、臀围、腹部矢状径、全身脂肪含量;测定卵泡刺激素、黄体生成素、睾酮、空腹血糖、空腹胰岛素、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、载脂蛋白A-Ⅰ、载脂蛋白B及C反应蛋白等。结果综合治疗3个月后,体质指数,全身脂肪含量,黄体生成素/卵泡刺激素,睾酮,空腹血糖及胰岛素抵抗指数均降低(P<0.05);腰臀比值,腹部矢状径,胰岛素敏感指数及血脂水平差异无统计学意义(P>0.05)。结论综合治疗对PCOS的疗效及预后有重要作用,为PCOS的规范治疗提供了初步的理论依据。

Objective To provide clinical evidence for standardized strategy through the comprehensive treatment for polycystic ovary syndrome（PCOS） patients. Methods A total of 30 participants were recruited from PCOS patients who came to Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University for irregular menstruation and/or infertility between August 2012 and May 2013. The comprehensive treatment included individualized nutrition, exercise, and drug therapy. The individualized nutrition and exercise guidance were based on static metabolic rate and motor function of body composition measured. Drug therapy included ethinylestradiol and eyproterone acetate tablets （ Diane-35 ） for three cycles ; metformin for 3 months continuously for patients whose fasting plasma glucose and/or insulin was high, combined with diet, exercise and modifications in lifestyle. Their clinical and biochemical parameters were measured, including height, weight, waist circumference （ WC ） , hip circumference （ HC ）, sagittal abdominal diameter （ SAD ）, body fat （ BF）, follicle stimulating hormone （ FSH）, luteinizing hormone （ LH）, testosterone （ T）, fasting plasma glucose （ GLU）, fasting insulin [ INS（OH） ], total cholesterol （ TC ）, triglyeeride （ TG ）, high density lipoprotein-cholesterol （ HDL-C ）, low density lipoprotein-cholesterol（ LDL-C）, apolipoprotein A- I （ Apo A- I ）, apolipoprotein B（ Apo B） and C reactive protein（CRP）. Results Comprehensive treatment for 3 months, BMI, BF, LH/FSH, T, GLU and HOMA-IR were lower, P〈0.05 ; WHR, SAD, ISI and blood lipid level had no significant difference, P〉0.05. Condusion Comprehensive treatment has an important role in efficacy and prognosis for PCOS and provide preliminary clinical evidences for standardized treatment of PCOS.