二肽基肽酶4抑制剂治疗初诊PCOS患者临床效果及对血脂代谢影响

The effect of dipeptidyl peptidase 4 inhibitor for treating women with polycystic ovary syndrome initial diagnosed and its influence on lipid metabolism

目的:观察二肽基肽酶-4(DPP-4)抑制剂对初诊多囊卵巢综合征(PCOS)患者血清重组β细胞营养因子(betatrophin)及糖代谢指标的影响。方法:选取初诊PCOS患者225例随机分为A组、B组和C组各75例。A组采用DPP-4抑制剂西格列汀治疗,B组采用西格列汀联合达英-35治疗,C组采用二甲双胍联合达英-35治疗,疗程均为3个月。比较3组治疗前后体质指数(BMI)、腰臀比(WHR)、糖脂代谢指标、性激素指标及血清betatrophin水平变化。结果:治疗后,A组和B组的月经改善优于C组,B组和C组的痤疮/多毛改善效果优于A组,A组和B组的BMI、WHR低于C组(均P<0.05)。A、B两组的糖化血红蛋白(HbAlc)、餐后血糖漂移(PPGE)、平均血糖漂移幅度(MAGE)、稳态模型胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及betatrophin均低于C组,胰岛β细胞功能指数(HOMA-■)高于C组(均P<0.05),但WHR、空腹血糖(FPG)、餐后2h血糖(2hPG)、24h平均血糖(MBG)、空腹胰岛素(FINS)、高密度脂蛋白胆固醇(HDL-C)3组比较未见差异(P>0.05)。A、B两组的卵泡雌激素(FSH)、黄体生成素(LH)、睾酮(T)、雄烯二酮(A)水平低于C组(P<0.05),雌二醇(E_2)、孕酮(P)水平3组比较无差异(P>0.05)。A、B两组无不良反应发生,与C组发生率(16.0%)比较有差异(P<0.05)。结论:DPP-4抑制剂治疗初诊PCOS安全有效,能够改善患者的IR、高雄激素血症及糖脂代谢紊乱。

Objective: To observe the influence of dipeptidyl peptidase 4 (DPP-4) inhibitor on serum levels of betatrophin and lipidmetabolism of women with polycystic ovary syndrome (PCOS) initial diagnosed. Methods: 225 women with PCOS initial diagnosed were randomly divided into group A, B and C (75 cases in each group). The women in group A were treated by sitagliptin (DPP-4 inhibitor), the women in group B were treated by sitagliptin combined with diane-35, and the women in group C were treated by metformin combined withdiane-35. All the women were treated for 3 months. Body mass index (BMI), waist-to-hip ratio (WHR), glycolipid metabolism indexes, sex hormones levels and serum betatrophin levels were compared before and after treatment. Results: After treatment, the menstrual improvement of women in group A and B was better than that of women in group C, the improvement of acne or hirsutism of women in group B and C was better than that of women in group A ( P <0.05). The values of BMI and WHR of women in group A and B were significant lower than those of women in group C ( P <0.05).The levels of HbAlc, PPGE, MAGE, HOMA-IR, TC, TG, LDL-C and betatrophin of women in group A and B were significant lower than those of women in group C, and the level of HOMA-βwas significant higher ( P <0.05), while there were no significant different in the levels of WHR, FPG, 2hPG, MBG, FINS, and HDL-C among the three groups ( P >0.05). The levels of FSH, LH, T and A of women in group A and B were significant lower than those of women in group C ( P <0.05), while the E 2 and P levels had no significant different among the three groups ( P >0.05). There was no any woman with adverse reaction in group A and B, which was significant lower than that (16.0%) of women in group C ( P <0.05). Conclusion: DPP-4 inhibitor is safe and effective for treating women with PCOS initial diagnosed, which can alleviate IR, hyperandrogenemia, and glycolipid metabolism disorder of women.