二甲双胍对肥胖型多囊卵巢不孕症患者的影响

Effect of metformin in patients with obese polycystic ovary infertility

目的探究二甲双胍(MET)对肥胖型多囊卵巢综合征(PCOS)不孕症的临床疗效、糖脂代谢、生殖内分泌、子宫内膜受容性、卵巢反应性和妊娠的影响。方法回顾性分析2021年6月至2024年1月武汉市第六医院收治的肥胖型PCOS不孕症患者的临床资料。根据用药方案分为对照组[来曲唑(LET)]和联合组(MET和LET)。比较治疗后(3个月)两组患者治疗有效率、糖脂代谢指标[胆固醇(TC)、甘油三酯(TG)、空腹血糖(FPG)、空腹胰岛素(FIN)和胰岛素抵抗指数(HOMA-IR)]、生殖内分泌指标[睾酮(T)、雌二醇(E2)、黄体生成素(LH)、卵泡生成激素(FSH)、抗米勒管激素(AMH)和LH/FSH]、子宫内容受容性[子宫内膜厚度、子宫内膜螺旋动脉搏动指数(PI)和阻力指数(RI)]、卵巢反应性(卵泡形成时间、优势卵泡数量和排卵率)和妊娠率,并记录治疗期间药物相关不良反应评估安全性。结果研究共纳入患者99例,联合组53例,对照组46例。联合组治疗有效率显著高于对照组(P<0.05)。治疗前,两组体重指数(BMI)、TC、TG、FPG、FIN、HOMA-IR、T、E2、LH/FSH、AMH、子宫内膜厚度、PI和RI差异无统计学意义(P>0.05);治疗后,两组患者BMI、TC、TG、FPG、FIN、HOMA-IR、T、E2、LH/FSH、AMH、子宫内膜厚度、PI和RI均较治疗前显著降低(P<0.05),且联合组低于对照组(P<0.05)。此外,联合组卵泡形成时间短于对照组,优势卵泡数量多于对照组,排卵率和周期妊娠率显著高于对照组(P<0.05);两组患者不良反应发生率差异无统计学意义(P>0.05)。结论MET可调节多囊卵巢不孕症患者糖脂代谢、生殖内分泌指标,提高子宫内膜受容性、改善卵巢反应,提高排卵率和妊娠率。

Objective To explore the clinical efficacy,glucose and lipid metabolism,reproductive endocrine system,endometrial receptivity,ovarian responsiveness,and pregnancy effects of metformin(MET)on obese polycystic ovary syndrome(PCOS)with infertility.Methods Clinical data of obese PCOS patients with infertility admitted to Wuhan Sixth Hospital from June 2021 to January 2024 were retrospective ana lyzed.According to the medication regimens,they were divided into a control group(letrozole,LET)and a combination group(MET and LET).The treatment efficacy,glucose and lipid metabolism indicators[cholesterol(TC),triglycerides(TG),fasting blood glucose(FPG),fasting insulin(FIN),and insulin resistance index(HOMA-IR)],reproductive endocrine indicators[testosterone(T),estradiol(E2),luteinizing hormone(LH),follicle stimulating hormone(FSH),anti-miller’s hormone(AMH),and LH/FSH],uterine content tolerance[endometrial thickness,spiral artery pulsatility index(PI),and resistance index(RI)],ovarian responsiveness[follicle formation time interval,the number of dominant follicles and ovulation rates],as well as pregnancy rate were compared after the treatment(3 months).In addition,adverse reactions related to drugs during treatment were recorded to evaluate the safety.Results A total of 99 patients were included in the study,with 53 in the combined group and 46 in the control group.The treatment efficiency of the combined group was significantly higher than that of the control group(P<0.05).Before treatment,the differences in body mass index(BMI),TC,TG,FPG,FIN,HOMA-IR,T,E2,LH/FSH,AMH,endometrial thickness,PI and RI between the two groups were not statistically significant(P>0.05);after treatment,BMI,TC,TG,FPG,FIN,HOMA-IR,T,E2,LH/FSH,AMH,endometrial thickness,PI and RI of the patients in both groups were significantly lower than before treatment(P<0.05),and these indicators of the combined group were lower than those of the control group(P<0.05).In addition,the follicle formation time of the combined group was shorter than that of the control group,the number of dominant follicles was more than that of the control group,and the ovulation rate and cycle pregnancy rate were significantly higher than those of the control group(P<0.05);the difference in the incidence rates of adverse reactions between the two groups was not statistically significant(P>0.05).Conclusion MET can regulate glucose and lipid metabolism,reproductive endocrine indicators,improve endometrial receptivity,improve ovarian response,and thus increase ovulation and pregnancy rates.