二甲双胍与复方醋酸环丙孕酮联合应用对多囊卵巢综合征患者内分泌及代谢的影响

Endocrine and metabolic effects of metformin in combination with compound cyproterone acetate in women with polycystic ovarian syndrome

目的 观察二甲双胍与复方醋酸环丙孕酮 (复方环丙孕酮 )联合应用 ,对多囊卵巢综合征 (PCOS)患者内分泌及代谢的影响。方法 对 4 5例患者进行前瞻性研究 ,为观察组 ;2 0例非PCOS不孕妇女为对照组。测定体重指数 (BMI)、腰臀围比值 (WHR)、多毛评分 (F G评分 )及生殖内分泌激素、糖、脂代谢指标等。观察组根据随机应用不同药物又分为复方环丙孕酮组、二甲双胍组及二甲双胍与复方环丙孕酮联合用药组 (联合用药组 ) ,每组各 15例。经 12周治疗后 ,比较上述各项指标的变化。结果 观察组治疗前BMI、WHR、F G评分、黄体生成激素 (LH)、睾酮 (T)、空腹胰岛素 (FI)、胰岛素抵抗 (IR)及甘油三酯等均较对照组增高 ;高密度脂蛋白胆固醇 (HDL C)较对照组降低 (P <0 0 1)。观察组 3组治疗前各项指标差异均无显著性 (P >0 0 5 )。治疗 12周后 ,联合用药组及二甲双胍组LH分别从 (13 9± 5 9)IU/L降低为 (5 8± 2 2 )IU/L ,从 (13 8± 7 6 )IU/L降低为 (11 8±6 5 )IU/L ;T分别从 (2 1± 0 8)nmol/L降低为 (1 2± 0 4 )nmol/L ,从 (2 2± 1 1)nmol/L降低为(1 8± 0 8)nmol/L ;游离睾酮 (FT)分别从 (2 8± 2 3)nmol/L降低为 (0 8± 0 5 )nmol/L ,从 (2 5±1 9)nmol/L降低为

Objective To study the endocrinologic and metabolic effects of metformin in combination with compound cyproterone acetate (CPA) on patients with polycystic ovarian syndrome (PCOS). Methods A prospective study involved total 45 PCOS patients as group A and 20 non-PCOS infertility patients as control (group B).Complete baseline work-up including body mass index(BMI), waist/hip ratio(WHR), ferriman-Gallwey score(FGS), gonadotrophin, testosterone(T), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate(Ds), insulin (FI) and glucose tolerance test, were performed in all patients. Patients in group A were treated with CPA alone(group A1),metformin alone (group A2) or combination of CPA with metformin (group A3), respectively by randomization.At the end of 12- week therapy, subjects were re-evaluated and above parameters were measured. Results Women in group A had significant increases in BMI, WHR, FGS,luteinizing hormone (LH), T, FI, insulin resistance, and significantly decrease in high-density lipoprotein(HDL)-C comparing with the control group ( P <0.01).No significant difference among A1, A2 and A3 was found at baseline.LH,T, free testosterone (FT) were significant decreased from (13.9±5.9) IU/L, (2.1±0.8) nmol/L and (2.8±2.3) nmol/L respectively to (5.8±2.2) IU/L, (1.2±0.4) nmol/L and (0.8±0.5) nmol/L respectively and SHBG was significant increased from (99±42) nmol/L to (187±64) nmol/L in group A3, when compared with LH,T and FT from (13.8±7.6) IU/L, (2.2±1.1) nmol/L and (2.5±1.9) nmol/L respectively to (11.8±6.5) IU/L, (1.8±0.8) nmol/L and (1.7±1.0) nmol/L respectively and SHBG from (99±40) nmol/L to (120±51) nmol/L in group A2 ( P <0.05～0.001).HDL-C were significantly increased from (1.5±0.3) mmol/L to (1.8±0.3) mmol/L in group A3 comparing with HDL-C from (1.5±0.4) mmol/L to (1.6±0.4) mmol/L in group A1 ( P <0.001).Conclusions The PCOS patients treated with metformin in combination with compound cyproterone acetate may be more effective in inhibiting hyperandrogen and hypersecretion of LH than metformin alone and more obvious in improving lipid profiles than CPA alone.