炔雌醇环丙孕酮联合二甲双胍对多囊卵巢综合征患者排卵的影响

Effects of Ethinylestradiol and Cyproterone Acetate Combined with Metformin on Ovulation Induction of Patients with Polycystic Ovarian Syndrome

目的：探讨炔雌醇环丙孕酮联合二甲双胍对多囊卵巢综合征（PCOS）患者排卵的影响。方法：184例PCOS患者随机分为对照组（92例）和观察组（92例）。对照组患者于月经开始第5天起口服炔雌醇环丙孕酮片1片，每日1次，连用21d后停药，并于撤退性出血第5天起开始下一周期治疗，连续治疗3个月经周期。观察组患者在对照组治疗的基础上口服二甲双胍片3片，每日1次，月经期间不停药，连用3个月经周期。治疗3个月经周期后，两组患者均开始促排卵治疗[（第4个月经周期的月经开始第5天起，口服克罗米芬50～100mg，连用5d，或肌内注射人绝经后促性腺激素75～150U，待优势卵泡直径为（19.0±2.0）mm时肌内注射人绒毛膜促性腺激素10000U，继续监测排卵情况，同时观察是否发生卵巢过度刺激综合征（OHSS）]。观察两组患者治疗前后的体质量指数（BMI）、卵泡刺激素（FSH）、黄体生成素（LH）、催乳素（PRL）、雌二醇（E2）、睾酮（T）、空腹血糖（FPG）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR），记录妊娠率、排卵率、OHSS发生率及不良反应发生情况。结果：治疗前，两组患者BMI、FSH、LH、PRL、E2、T、FPG、FINS、HOMA-IR比较，差异均无统计学意义（P＞0.05）。治疗后，观察组患者BMI、LH、PRL、E2、T、FPG、FINS、HOMA-IR及对照组LH、E2、FINS均显著低于同组治疗前，且观察组BMI、PRL、E2、T、FPG、FINS、HOMA-IR低于对照组，差异均有统计学意义（P＜0.05）。观察组患者排卵率、妊娠率均显著高于对照组，OHSS发生率显著低于对照组，差异均有统计学意义（P＜0.05）。两组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：炔雌醇环丙孕酮联合二甲双胍可有效改善POCS患者胰岛素抵抗的状态，恢复性激素分泌水平，有效促进排卵，提高妊娠率，且安全性较好。

OBJECTIVE:To discuss the effect of Ethinylestradiol and cyproterone acetate tablet combined with metformin onovulation induction of patients with polycystic ovarian syndrome(PCOS). METHODS:184 PCOS patients were randomly dividedinto control group(92 cases)and observation group(92 cases). Control group orally received 1 Ethinylestradiol and cyproterone acetatetablet in 5 d of menstruation,once a day,it stopped after 21 d,the next cycle of treatment was started on the 5th of withdrawalbleeding. Observation group additionally received 3 Metformin tablet,once a day,without drug withdrawal during menstruation,and lasted for 3 menstrual cycles. After 3 menstrual cycles,all patients received ovulation induction treatment [(50-100 mgclomiphene was orally given from the 5th day of the 4th menstrual cycle,for 5 days,or 75-150 U postmenopausal gonadotropin byintramuscular injection,when the dominant follicle diameter was(19.0±2.0)mm,10 000 U human chorionic gonadotropin(HCG)was intramuscularly injected,the ovulation was continuously monitored and whether there was ovarian hyperstimulation syndrome(OHSS)was observed]. Body mass index(BMI),follicle estrogen(FSH),luteinizing hormone(LH),prolactin(PRL),estradiol(E2)and testosterone(T)before and after treatment,fasting plasma glucose(FPG),fasting insulin(FINS),insulin resistance index(HOMA-IR),pregnancy rate,ovulation rate and the incidences of OHSS and adverse reactions in 2 groups were observed.RESULTS:Before treatment,there were no significant differences in the BMI,FSH,LH,PRL,E2,T,FPG,FINS and HOMA-IRbetween 2 groups(P>0.05). After treatment,BMI,LH,PRL,E2,T,FPG,FINS and HOMA-IR in observation group and LH,E2 and FINS in control group were significantly lower than before,and BMI,PRL,E2,T,FPG,FINS and HOMA-IR in observationgroup were lower than control group,the differences were statistically significant(P<0.05). The pregnancy rate and ovulationrate in observation group was significantly higher than control group,the incidence of adverse reactions was significantly lowerthan control group,the differences were statistically significant(P<0.05). And there was no significant difference in the incidenceof adverse reactions between 2 groups(P>0.05). CONCLUSIONS:Ethinylestradiol and cyproterone acetate combined with metformincan effectively improve insulin resistance of POCS patients,recovery sex hormone secretion,promote ovulation and improvepregnancy rate,with good safety.