药物预处理对降低多囊卵巢综合征卵巢刺激高反应的效果观察

Effect of drug pretreatment to reduce the high ovarian response in women with polycystic ovary syndrome

目的观察药物预处理对降低多囊卵巢综合征(PCOS)卵巢刺激高反应性的效果。方法选择我院2013年1~12月收治的72例PCOS合并胰岛素抵抗(IR)不孕患者,采用隐匿数字随机法分为两组,A组36例给予吡格列酮联合环丙孕酮预处理,B组36例给予二甲双呱联合环丙孕酮预处理,两组患者均在预处理后行促排卵治疗,检测治疗前后糖代谢和性激素相关指标,比较促排卵效果。结果 1疗效:A组和B组患者的排卵率分别为80.49%(99/123),80.95%(102/126),妊娠率分别为41.67%(15/36)、44.44%(16/36),差异均无统计学意义(P>0.05);2卵巢刺激高反应性:治疗后两组患者稳态胰岛素指数(HOMA-IR)值、餐后2 h血糖(2 h PG)、餐后2 h胰岛素(2 h INS)均较治疗前明显降低,差异均有统计学意义(P<0.05);两组治疗后HOMA-IR、2 h PG、2 h INS比较差异均无统计学意义(P>0.05)。3副反应:A组体质量增加和水肿发生率分别为22.22%(8/36)、30.56%(11/36),B组均未发生,两组差异有统计学意义(P<0.05);B组体质量下降和胃肠道反应发生率为33.33%(12/36)、58.33%(21/36),高于A组的0和13.89%(5/36),差异有统计学意义(P<0.05)。结论吡格列酮和二甲双呱联合环丙孕酮预处理对降低PCOS患者促排卵治疗时卵巢刺激高反应性效果相当,但不良反应各异,建议在使用时根据患者情况选择合适的预处理药物,以减少副反应。

Objective To observe the effect of drug pretreatment to reduce the high ovarian response in women with polycystic ovary syndrome(PCOS). Methods From January 2013 to December 2013, 72 cases of infertility PCOS with insulin resistance(IR) who admitted to our hospital were randomly divided into A group(pretreatment of pioglitazone combined with cyproterone) and B group(pretreatment of pill gung combined with cyproterone) according to hidden numbers method, with 36 cases in each group. After the pretreatment, the two groups of patients were treated with stimulate ovulation, and the sugar metabolism and sex hormones related indexes before and after treatment of stimulate ovulation were measured and compared. Results(1) Curative effects: The ovulation rates of A group and B group were respectively 80.49%(99/123) and 80.95%(102/126), and the pregnancy rates were respectively 41.67%(15/36)and 44.44%(16/36), with no statistically significant difference(P>0.05);(2) High ovarian response: The homeostasis model assessment-estimated insulin resistance(HOMA-IR) value, 2 h postprandial plasma glucose(2 h PG) levels and2 h postprandial insulin(2 h INS) concentration after treatment in two groups were significantly lower than before treatment(P<0.05), while there were no significant differences between two groups in HOMA-IR, 2 h PG and 2 h INS(P>0.05).(3) Side effects: The weight gain and incidences of edema in A group [22.22%(8/36), 30.56%(11/36), respectively] were significantly higher than B group(0, 0), P<0.05; The weight loss and incidence of gastrointestinal reaction in B group [33.33%(12/36), 58.33%(21/36), respectively] were significantly higher than A group [0, 13.89%(5/36)], P<0.05. Conclusion The metformin and pioglitazone gung combined with cyproterone pretreatment can reduce the high ovarian response in women with polycystic ovary syndrome, which have the almost same effects, but different adverse reactions.In order to reduce side effects, it is recommended to choose suitable pretreatment drugs according to patients condition.