克罗米酚联合二甲双胍治疗多囊卵巢综合征的疗效及其对性激素、胰岛素抵抗水平的影响

Efficacy of clomiphene citrate combined with metformin in the treatment of polycystic ovary syndrome and its influence on sex hormone and insulin resistance

目的探讨克罗米酚联合二甲双胍治疗多PCOS的疗效及其对性激素、胰岛素抵抗水平的影响。方法选择定边县人民医院妇产科2015年4月至2016年6月期间收治的88例PCOS不孕患者为研究对象,根据随机数表法将患者分为观察组与对照组,每组44例。对照组患者予克罗米酚治疗,观察组同时联合应用二甲双胍治疗,疗程均为3个月。比较两组患者治疗前后的血清FSH、LH、T水平以及HOMA-IR的变化;治疗后随访3个月,记录促排卵疗效及妊娠率。结果治疗后,观察组患者的血清LH、T水平及HOMA-IR分别为(8.89±1.46)U/L、(1.94±0.73)nmol/L、(2.23±0.72),均明显低于对照组的(11.68±1.84)U/L、(2.28±0.69)nmol/L、(2.76±0.76),差异均有统计学意义(P<0.05);随访3个月,观察组患者的卵泡成熟时间为(11.05±1.18)d,明显短于对照组的(12.27±1.23)d,排卵率、妊娠率分别为75.00%、35.64%,均明显高于对照组的52.27%、18.18%,差异均有统计学意义(P<0.05)。结论克罗米酚联合二甲双胍治疗PCOS不孕可有效调节患者性激素水平,改善胰岛素抵抗,提高促排卵效果及妊娠率。

Objective To investigate the clinical efficacy of clomiphene citrate combined with metformin in the treatment of polycystic ovary syndrome （PCOS） and its influence on sex hormone level and insulin resistance. Methods A total of 88 PCOS patients with infertility, who admitted to our hospital from April 2015 to June 2016, were selected and divided into the observation group and the control group according to the random number table meth-od, with 44 cases in each group. The control group was treated with clomiphene, and the observation group was treated with additionally with metformin. The treatment course for the two groups was 3 months. The levels of sex hormone in-cluding serum follicle-stimulating hormone （FSH）, luteinizing hormone （LH）, total testosterone （T） and homeostasis model assessment for insulin resistance index （HOMA-IR） between the two groups were compared before and after the treatment. The patients were followed up for 3 months after treatment, and the outcome of ovulation induction and preg-nancy rate were recorded. Results After the treatment, the levels of serum LH, T and HOMA-IR in the observation group were （8.89±1.46） U/L, （1.94±0.73） nmol/L, （2.23±0.72）, respectively, which were significantly lower than （11.68± 1.84） U/L, （2.28 ± 0.69） nmol/L, （2.76 ± 0.76） in the control group （P〈0.05）. After 3 months of follow-up, the follicular maturation in the observation group was （11.05±1.18） d, which was significantly shorter than （12.27±1.23） d in the con-trol group. The ovulation rate and pregnancy rate in the observation group were 75.00%and 35.64%, which were signifi-cantly higher than 52.27%and 18.18%in the control group （P〈0.05）. Conclusion In the treatment of PCOS and infer-tility, the combination of clomiphene citrate with metformin can effectively regulate the level of sex hormone, improve insulin resistance, and improve the effect of ovulation and pregnancy rate.