PCOS患者停用复方口服避孕药治疗后无排卵复发的影响因素分析

Analysis on influential factors on the recurrence of anovulation of PCOS patients who stop the treatment of combined oral contraceptive

目的研究多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者停用复方口服避孕药(combined oral contraceptive,COC)治疗后无排卵复发的影响因素。方法从2018年4月至2020年4月期间,对259例在同济大学附属第一妇婴保健院就诊的原无排卵并经3个月COC降雄激素治疗的PCOS患者开展前瞻性观察研究,进行无排卵复发的随访,使用生存分析法进行统计,分析无排卵复发的影响因素。结果COX多元回归显示,对COC治疗前超重者来说,治疗期间减重幅度达5%以上(HR=0.539,P=0.001)可推迟复发,停用COC时存在糖和胰岛素代谢异常(HR=1.829,P=0.008)为促进复发因素;对COC治疗前非超重者来说,停用COC时仍存在高雄激素血症(HR=2.268,P=0.030)为促进复发因素。K-M检验显示,50例COC治疗期间减重幅度达5%及以上的原超重患者中,停用COC后体质量反增者,复发时间更早[1.0(1.0,2.0)个周期比3.0(2.0,8.0)个周期,P=0.001];35例停用COC时糖和胰岛素代谢恢复正常者,其中停药后继续维持剂量口服二甲双胍者的复发时间晚于未再服用二甲双胍者[2.0(1.0,4.0)个周期比1.0(0.0,3.0)个周期,P=0.022]。结论为推迟PCOS停用COC后无排卵复发,建议超重患者减重一定幅度,并纠正糖和胰岛素代谢异常后再停药;停用COC时糖和胰岛素代谢恢复正常者,宜继续口服维持剂量二甲双胍;非超重患者待雄激素水平降至正常后停药。

Objective To study the influential factors on the relapse of anovulation of polycystic ovary syndrome(PCOS)patients who stop the treatment of combined oral contraceptive(COC).Methods In the prospective observational study from April 2018 to April 2020,259 anovulatory PCOS patients who vistited in Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University were followed up after their androgen lowering therapy via COC for 3 months finished and survival analysis was adopted to analyze the influencing factors of anovulation recurrence.Results COX multivariate regression showed that for super heavy patients before COC treatment,reducing weight not less than 5%(HR=0.539,P=0.001)could relay the relapse whereas glycometabolism and insulin metabolism anormality at withdrawal time was promoting factor of relapse(HR=1.829,P=0.008);for non super heavy patients,hyperandrogenism at withdrawal time may promote relapse of anovulation.K-M test showed that for 50 super heavy patients before COC treatment who reduced weight not less than 5%during treatment,the weight gain after COC withdrawal indicated the shorter relapse time[1.0(1.0,2.0)cycle vs.3.0(2.0,8.0)cycles,P=0.001].Among 35 patients whose glucose and insulin metabolism had returned to normal at withdrawal time,those who used maintenance dosage of Metformin after withdrawal had later relapse of anovulation[2.0(1.0,4.0)cycles vs.1.0(0.0,3.0)cycle,P=0.022]than those who did not.Conclusion To relay the relapse of anovulation after COC treatment,we suggest that super heavy patients reduce weight moderately and remedy glycometabolism anormality,and non super heavy patients reduce androgen to normal before withdrawal.For the patients whose glucose metabolism return to normal at withdrawal time,it is better to continue using maintenance dosage of Metformin after withdrawal.