二甲双胍联合炔雌醇环丙孕酮片对多囊卵巢综合征患者糖链抗原125及胰岛素抵抗的影响

Effect of metformin combined with ethinylestradiol and cyproterone acetate tablets on carbohydrate antigen 125 and insulin resistance in patients with polycystic ovary syndrome

目的观察炔雌醇环丙孕酮片联合二甲双胍对多囊卵巢综合征(PCOS)患者血清糖链抗原125(CA125)及胰岛素抵抗的影响。方法将PCOS患者120例随机分为对照组和试验组,每组60例。对照组于月经第5天开始口服炔雌醇环丙孕酮片2 mg·d^-1;试验组在对照组基础上给予二甲双胍,每次0.5 g,每天3次,口服。2组均治疗3个月经周期。检测2组患者的性激素水平、血脂水平、胰岛素抵抗及CA125水平。结果治疗后,试验组和对照组卵泡刺激素(FSH)分别为(3.21±0.66),(5.27±1.24)U·L^-1,促黄体生成素(LH)分别为(5.22±1.19),(8.71±1.68)U·L^-1,睾酮(T)分别为(2.16±0.27),(4.09±1.35)mmol·L^-1,总胆固醇(TC)分别为(3.91±0.18),(4.37±0.68)mg·dL^-1,三酰甘油(TG)分别为(1.05±0.39),(1.41±0.52)mg·dL^-1,空腹胰岛素(FIN)分别为(14.24±5.29),(18.17±5.36)mU·L^-1,空腹血糖(FBG)分别为(4.05±0.29),(5.18±1.18)mmol·L^-1,胰岛素抵抗指数(HOMA-IR)分别为1.17±0.54,1.78±0.75,胰岛β细胞功能指数(HOMA-β)分别为4.31±0.26,5.98±0.87,CA125水平分别为(19.23±7.51),(30.51±9.14)U·mL^-1,雌二醇(E2)分别为(96.23±14.22),(72.47±13.42)pmol·L^-1,高密度脂蛋白(HDL)水平分别为(1.84±0.53),(1.65±0.41)mg·dL^-1,差异均有统计学意义(均P<0.05)。试验组和对照组的药物不良反应发生率分别为20.11%,11.67%,差异无统计学意义(P>0.05)。结论 PCOS患者应用二甲双胍联合炔雌醇环丙孕酮片可有效调控性激素和血脂水平,减轻胰岛素抵抗。

Objective To investigate the effect of ethinylestradiol and cyproterone acetate tablets combined with metformin on carbohydrate antigen 125(CA125) and insulin resistance in patients with polycystic ovary syndrome(PCOS). Methods A total of 120 patients with PCOS were randomly divided into control group and treatment group, with 60 cases in each group. Control group was given ethinylestradiol and cyproterone acetate tablets 2 mg·d^-1, oral. Treatment group was given metformin 0.5 g·time-1, 3 times·d^-1, orally on the basis of control group. Two groups were all treated for 3 menstrual cycles. The levels of sex hormone, blood lipid, insulin resistance and CA125 in two groups were detected. Results After treatment, the levels of follicle stimulating hormone( FSH) in treatment group and control group were( 3. 21 ± 0. 66),( 5. 27 ± 1. 24) U · L^-1,luteinizing hormone( LH) were( 5. 22 ± 1. 19),( 8. 71 ± 1. 68) U·L^-1,testosterone( T) were( 2. 16 ± 0. 27),( 4. 09 ± 1. 35)mmol· L^-1,total cholesterol( TC) were( 3. 91 ± 0. 18),( 4. 37 ± 0. 68) mg·d L^-1,triglyceride( TG) were( 1. 05 ± 0. 39),( 1. 41 ± 0. 52) mg·d L^-1,fasting insulin( FIN) were( 14. 24 ± 5. 29),( 18. 17 ± 5. 36) mU ·L^-1,fasting blood glucose( FBG) were( 4. 05 ± 0. 29),( 5. 18 ± 1. 18) mmol·L^-1,insulin resistance index( HOMA-IR)were 1. 17 ± 0. 54,1. 78 ± 0. 75,islet β cell function index( HOMA-β) were 4. 31 ± 0. 26,5. 98 ± 0. 87,CA125 were( 19. 23 ± 7. 51),( 30. 51 ± 9. 14) U · mL^-1,estradiol( E2) were( 96. 23 ± 14. 22),( 72. 47 ± 13. 42)pmol·L^-1,high density lipoprotein( HDL) were( 1. 84 ± 0. 53),( 1. 65 ± 0. 41) mg·dL^-1,all with significant difference( all P < 0. 05). The incidence of adverse drug reactions in treatment group and control group were 20. 00%,11. 67%,with no significant difference( P > 0. 05). Conclusion The clinical effect of metformin combined with ethinylestradiol and cyproterone acetate tablets in the treatment of PCOS is significant,which can effectively improve the level of sex hormones and dyslipidemia in patients.