胰岛素增敏剂治疗多囊卵巢综合征伴胰岛素抵抗临床疗效观察

Clinical observation of insulin sensitizers on treatment of women with polycystic ovary syndrome-insulin resistance

目的 了解二甲双胍和阿卡波糖在多囊卵巢综合征 ( PCOS)伴高胰岛素( HI)血症和餐后高血糖 ( PHG)中的药理作用和临床疗效。 方法 46例 PCOS-HI患者口服二甲双胍 1 2周 ,1 4例 PCOS-PHG患者应用阿卡波糖 1 2周 ,采用自身对照法观察各试验组治疗前、后临床症状、血生殖激素水平、血糖和胰岛素水平的变化。 结果 与治疗前比较 ,二甲双胍组中 3 4例 ( 74% )恢复排卵性月经 ,5例 ( 1 1 % )妊娠 ;血清游离睾酮( FT)水平下降 55% ,硫酸脱氢表雄酮 ( DHEAS)水平下降 51 % ,空腹胰岛素水平 ( FINS)下降 42 % ,胰岛素敏感指数 ( ISI)上升 52 % ,有显著性差异 ( P<0 .0 5)。阿卡波糖组中 1 2例 ( 86 % )恢复排卵 ,4例 ( 2 9% )妊娠 ;FT水平下降 50 % ,糖负荷后 2 h血糖降低 46 % ,空腹血糖和空腹胰岛素比值 ( FSG/FINS)升高 1倍 ,有显著性差异 ( P<0 .0 5)。 结论 二甲双胍能有效地改善 PCOS-HI患者胰岛素抵抗 ,降低血雄激素水平并恢复生育功能 ;阿卡波糖可缓解

Objectives: To investigate the pharmacological role and clinical effect of metformin and acarbose on improving hyperinsulinemia (HI)and postprandial hyperglycemia (PHG) in women with polycystic ovary syndrome (PCOS). Methods: Metformin and acarbose were administered in 46 women with PCOS-HI and 14 patients with PCOS-PHG for 12 weeks respectively. The clinical features, reproductive hormones, serum glucose and insulin levels were observed before and after treatment. The differences were detected by using self-controlled studies. Results: (1)In metformin group, 34 of 46(74%) cases recovered ovulation and 5 (11%) got pregnancy. Serum free testosterone (FT) reduced by 55% (P<0.05), DHEAS decreased by 51% (P<0.05) and fasting insulin level (FINS) reduced by 42% (P<0.05). Insulin sensitivity index (ISI) increased by 52% (P<0.05). (2)In acarbose group, 12 of 14(86%) cases recovered ovulation, and 4(29%) conceived. 50% plasma FT level and 46% glucose 2 hours post-glucose loading were decreased (P< 0.05) respectively. Fasting serum glucose to fasting insulin ratio (FSG/FINS) was doubled (P<0.05). Conclusion: Metformin may effectively improve insulin resistance, reduce serum androgen levels, and recover ovulation function in women with PCOS-HI, whereas acarbose may suppress postprandial hyperglycemia in women with PCOS-PHG.