二肽基肽酶4抑制剂治疗多囊卵巢综合征合并糖代谢异常患者的初步临床研究

Pilot clinical study on the efficacy of DPP-4 inhibitor in treating polycystic ovary syndrome patients with abnormal glucose metabolism

目的比较二肽基肽酶4(DPP-4)抑制剂与二甲双胍对多囊卵巢综合征(PCOS)合并糖代谢异常患者代谢和内分泌参数的影响。方法将24例PCOS合并糖代谢异常患者分为二甲双胍组和DPP-4抑制剂组,各12例。分别服用二甲双胍500mg,3次/d和DPP-4抑制剂100mg,1次/d,治疗12周。评估治疗前后各项代谢指标和性激素水平的变化。结果与治疗前比较,两组HbA1c水平和胰岛素抵抗指数(HOMA-IR)均降低[HbA1c:(5.8±0.7)%vs(6.9±1.7)%,(5.8±0.3)%vs(6.5±1.1)%;HOMA-IR:4.0(3.0,5.2)vs 2.3(1.1,4.2),7.1(5.4,8.6)vs 5.7(3.9,6.7),P<0.05]。二甲双胍组血清睾酮(T)水平降低[1.8(1.2,2.8)vs 1.1(0.7,1.7)nmol/L,P<0.05],DPP-4抑制剂组血清T水平也有降低的趋势,但差异无统计学意义。结论 DPP-4抑制剂可改善PCOS合并糖代谢异常患者的高血糖和IR,并可能有助于改善高雄激素血症。

Objective To investigate the efficacy of DPP-4 inhibitor versus metformin on metabolic and endocrine parameters in polycystic ovary syndrome （PCOS） patients with abnormal glucose metabolism.Methods 24 PCOS patients with abnormal glucose metabolism were divided into metformin and DPP-4 inhibitor group in this study.All subjects were given metformin 500 mg thrice daily or DPP-4 inhibitor 100 mg once daily for 12 weeks,respectively.Metabolic parameters and sexual hormones were evaluated before and after treatments.Results Both metformin and DPP-4 inhibitor significantly reduced HbA1 c levels and insulin resistance index （HOMA-IR）from the baseline [HbA1 c of post-vs pre-metformin：（5.8±0.7）％ vs （6.9±1.7）％,post-vs pre-DPP-4 inhibitor：（5.8±0.3）％ vs （6.5±1.1） ％ ; HOMA-IR of post-vs pre-metformin：4.0（3.0,5.2） vs 2.3（1.1,4.2）,post-vs pre-DPP-4 inhibitor：7.1（5.4,8.6） vs 5.7（3.9,6.7）,P＜0.05].Moreover,metformin significantly reduced serum testosterone level [1.8（1.2,2.8） vs 1.1（0.7,1.7）nmol/L,P＜0.05].DPP-4 inhibitor also had a trend in decreasing serum testosterone level,but without statistically significant difference.Conclusion DPP-4 inhibitor can attenuate hyperglycemia and insulin resistance in PCOS patients with abnormal glucose metabolism,and may also be helpful to improve hyperandrogenism.