吡格列酮二甲双胍复合制剂治疗胰岛素抵抗性多囊卵巢综合征不孕的临床研究

Clinical study of fixed-dose combination of pioglitazone and metformin in treating infertile patients with insulin resistance PCOS

目的比较吡格列酮二甲双胍复合制剂和二甲双胍单独治疗胰岛素抵抗性多囊卵巢综合征(PCOS)不孕患者的临床疗效。方法选取2015年1月2017年6月佛山市第一人民医院诊治的胰岛素抵抗性PCOS不孕患者77例为研究对象,随机分为观察组39例[吡格列酮二甲双胍复合制剂15 mg/500 mg(1片),2次/d]和对照组38例(二甲双胍500 mg/片,2次/d)。比较两组患者治疗3个月前后胰岛素抵抗指标、性激素水平、周期排卵率及半年内妊娠率。结果治疗后观察组患者胰岛素抵抗指数(HOMA-IR)、睾酮(T)、黄体生成素(LH)水平及LH/FSH(促卵泡素)与对照组比较,差异有统计学意义(P<0.05),观察组低于对照组;治疗后观察组促卵泡素(FSH)与雌二醇(E2)水平与对照组比较,差异无统计学意义(P>0.05);治疗后观察组患者成熟卵泡数、排卵率及妊娠率高于对照组(P<0.05)。治疗后HOMA-IR与优势卵泡数(r=-0.491,P=0.000)、排卵(r=-0.331,P=0.003)、妊娠(r=-0.318,P=0.005)呈负相关。结论吡格列酮二甲双胍复合制剂治疗胰岛素抵抗性PCOS不孕可更有效地减轻胰岛素抵抗,改善性激素水平,并能提高不孕患者的排卵率和妊娠率。

Objective To investigate the effects of metformin alone or the fixed-dose combination of pioglitazone and metformin in treating infertile patients with insulin resistance polycystic ovary syndrome(PCOS).Methods A total of 77 infertile patients with insulin resistance PCOS were selected as research objects from January 2015 to June 2017 in our reproductive medicine center,and randomly divided into the observation group(including 39 cases treated with the fixed-dose combination of pioglitazone and metformin)and the control group(including 38 cases treated with metformin).The insulin resistance index(HOMA-IR),levels of sex hormone,ovulation rate and pregnancy rate were compared between the two groups.Results After 3 month's treatment,HOMA-IR,the levels of testosterone(T),luteinizing hormone(LH),and LH/FSH in the observation group were significantly decreased as compared to those in the control group(P<0.05);there was no significantly difference of the levels of folliclestimulating hormone(FSH)and estradiol(E2)between two groups(P>0.05).The number of mature follicles,ovulation rate and pregnancy rate in the observation group were significantly higher than in the control group(P<0.05).Furthermore,HOMA-IR were negatively associated with the number of mature follicles(r=-0.491,P=0.000),ovulation rate(r=-0.331,P=0.003)and pregnancy rate(r=-0.318,P=0.005)after treatment.Conclusions The fixed-dose combination of pioglitazone and metformin was more effective than metformin in decreasing insulin resistance,improving levels of sex hormone,and increasing ovulation and pregnancy rates in treating infertile patients with insulin resistance PCOS.