利拉鲁肽联合生活方式干预在肥胖型PCOS合并不孕患者中的应用效果

Application effects of liraglutide combined with lifestyle intervention in patients with obesity PCOS complicated by infertility

目的观察利拉鲁肽联合生活方式干预在肥胖型多囊卵巢综合征(PCOS)合并不孕患者中的应用效果。方法选择2020年1月至2021年1月收治的80例PCOS合并不孕患者,随机分为对照组和联合组,每组40例。对照组给予二甲双胍治疗,联合组在对照组基础上给予利拉鲁肽联合生活方式干预。比较2组临床疗效及治疗前后体重指数(BMI)、卵巢体积、糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)]、脂代谢指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、性激素[促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)]、脂肪因子[内脂素(Visfatin)、网膜素-1(Omentin-1)]、炎性因子[白介素6(IL-6)、白介素18(IL-18)、肿瘤坏死因子α(TNF-α)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]变化。结果联合组总有效率为90.00%优于对照组的75.00%(P<0.05)。治疗前2组BMI、卵巢体积、FPG、2hPG、HbA1c、HOMA-IR、TC、TG、LDL-C、HDL-C、FSH、LH、E2、Visfatin、Omentin-1、IL-6、IL-18、TNF-α、MDA、SOD、GSH-Px比较差异均无统计学意义(P>0.05);治疗后2组BMI、卵巢体积、FPG、2hPG、HbA1c、HOMA-IR、TC、TG、LDL-C、Visfatin、IL-6、IL-18、TNF-α、MDA均显著低于治疗前,HDL-C、FSH、LH、E2、Omentin-1、SOD、GSH-Px均显著高于治疗前,差异有统计学意义(P<0.05),且联合组改善程度优于对照组,差异有统计学意义(P<0.05)。结论利拉鲁肽联合生活方式干预应用于PCOS合并不孕患者能够显著提高临床疗效,纠正糖脂代谢紊乱,改善性激素水平,机制与其调节脂肪因子和炎性因子分泌,抑制氧化应激有关。

Objective To investigate the application effects of liraglutide combined with lifestyle intervention in patients with obesity polysystic ovarian syndrome(PCOS)complicated by infertility.Methods A total of 80 patients with PCOS complicated by infertility were randomly divided into combination intervention group and control group,with 40 cases in each group.The patients in control group were treated by metformin,however,those in combination intervention group,on th ebasiss of control group,were treated by liraglutide combined with lifestyle intervention.The clinical efficacy,BMI levels,ovarian volume,glucose metabolism indexes(FPG,2hPG,HbA1c and HOMA-IR),lipid metabolism indexes(TC,TG,LDL-C and HDL-C),sex hormones(FSH,LH and E2),adipocytokines(Visfatin and Omentin-1),inflammatory cytokines(IL-6,IL-18 and TNF-α),oxidative stress indexes(MDA,SOD and GSH-Px)before and after intervention were observed and compared between the wto groups.Results The total effective rate combination intervention group was 90.00%,which was significantly higher than that(75.00%)in control group(P<0.05).Before treatment,there were no significant differences in BMI,ovarian volume,and the levels of FPG,2hPG,HbA1c,HOMA-IR,TC,TG,LDL-C,HDL-C,FSH,LH,E2,Visfatin,Omentin-1,IL-6,IL-18,TNF-α,MDA,SOD and GSH-Px between the two groups(P>0.05).After treatment,the BMI,ovarian volume,and the levels of FPG,2hPG,HbA1c,HOMA-IR,TC,TG,LDL-C,Visfatin,IL-6,IL-18,TNF-αand MDA in both groups were significantly decreased,however,the levels of HDL-C,FSH,LH,E2,Omentin-1,SOD and GSH-Px were significantly increased(P<0.05).Moreover the improvement degree in combination intervention group was more significant than that in control group(P<0.05).Conclusion Liraglutide combined with lifestyle intervention for patients with obesity PCOS complicated by infertility can improve curative effects,and correct the disorder of glucose and lipid metabolism,and improve the sex hormone levels,and its action mechanism may be related to the regulation of adipocytokines and inflammatory cytokines as well as the inhibition of oxidative stress.