青春期多囊性卵巢综合征的病因和治疗初探

Etiology and Treatment of Polycystic Ovary Syndrome in Adolescent Girls

目的:探讨青春期多囊性卵巢综合征(PCOS)患者血清胰岛素(sINS)及睾酮(sT)升高的关系和治疗。方法:对10例肥胖、多毛、闭经已1～4年诊为PCOS的15～19岁少女,检测体重指数(BMI)、sINS、sT、OGTT、馒头耐量试验(OBTT)、胰岛素敏感指数的自然对数(ISI LN)。用α糖苷酶抑制剂-拜唐苹(Acarbose)治疗,其中4例合用二甲双胍。结果:与对照组及治疗前后比较:治疗后体重、BMI显著下降。治疗前后各项测值分别为:sT(46.51±7.57)pmol/L和(16.70±6.75)pmol/L;2h馒头耐量试验测值,曲线下INS面积分别为(408.81±222.57)mU/L和(95.08±20.41)mU/L(P<0.01);INI由-7.5±0.6升到-5.6±0.6获得显著改善(P<0.01)。7例恢复自发月经,其中3例显示已排卵3次以上,2例分别停药20和26个月,仍然规律地行经。3例启动自发月经失败。结论:α糖苷酶抑制剂或(和)二甲双胍可降低血糖,改善INS抵抗,sINS水平下降伴sT正常有利于改善垂体卵巢轴的功能。治疗期中未见明显毒副作用。

Objective:To investigate the etiology and treatment of polycystic ovary syndrome(PCOS)in adolescent girls.Methods: Ten girls with PCOS aged 15-19 years served as a treatment group, while 10 healthy girls served as a control group. They were examined by BMI, sINS, sT, OGTT, OB(bread)TT and ISI LN. All patients were treated with acarbose(a glucosidose inhibitor) for 5-31 monthes, and metforin was added in 4 patients. Results: After treatment, the sT level decreased from(46. 51 + 7. 57)pmol/L to (16. 70 + 6.75)pmol/L, the sum of OB(bread)TT 0-2 h: INS square decreased from(408.81 + 222. 57)mU/L to (95.08+ 20.41)mU/L and the INI LN level increased from-7.5+0.6 to-5.6+0.6(all P<0.01) .After treatment, regulatory menstrual cycles recovered in 7 patients, among whom drugs were sloped for 20 or 26 monthes in 2 patients. This cycle failed to recover in 3 patients.Conclusion: The glucosidose inhibitor and/or metforin may decrease circulating glucose and ISN levels and improve ovarian function.