联合应用复方醋酸环丙孕酮和二甲双胍治疗多囊卵巢综合征

Treatment of Polycystic Ovary Syndrome by Cyproterone Acetate in Combination with Metformin

目的 探讨联合应用复方醋酸环丙孕酮 (CPA)和二甲双胍治疗多囊卵巢综合征 (PCOS)的临床疗效。方法 4 5例PCOS患者于自然月经或撤退性出血第 5天服用复方CPA 3个周期和二甲双胍 3个月。服药前后观察临床表现、盆腔超声相、血清生殖激素和胰岛素水平、空腹血糖及血脂水平的变化。结果 服药后 ,皆有撤退性出血 ,11例患者恢复排卵性月经 ,并有 6例妊娠。血清黄体生成素 (LH)、黄体生成素 /促卵泡生成素比值 (LH/FSH)、睾酮(T)和雄烯二酮 (A)水平均显著下降 (P <0 0 1)。性激素结合蛋白 (SHBG)水平显著升高 (P <0 0 1)。血清胰岛素 (INS)水平显著下降 (P <0 0 1)。双侧卵巢体积和卵泡数目显著减少。高密度脂蛋白胆固醇 (HDL C)显著升高(P <0 0 1) ,低密度脂蛋白 (LDL)显著降低 (P <0 0 1)。结论 联合应用复方CPA和二甲双胍治疗PCOS ,可减轻临床症状 ,降低胰岛素水平 ,异常的血激素相。

Objective To assess the efficacy of compound cyproterone acetate (CPA) and metformin in the treatment of polycystic ovary syndrome (PCOS). Methods Forty five proven PCOS patients were treated with CPA for 3 cycles in combination with metformin for 3 months. Before and after treatment, serum luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), testosterone (T), androstenedione (A), sex hormone binding globulin (SHBG), insulin concentration, total cholesterol, triglycerides (TG), high density lipoprotein cholesterol (HDL C), low density lipoprotein cholesterol (LDL C), apolipoprotein A, apolipoprotein B and transvaginal pelvic ultrasonography were determined.Results All patients had regular uterine bleeding during treatment. Eleven patients restored ovulated menstruation, and 6 were in pregnancy. Serum LH, T, A concentrations and the ratio LH/FSH were decreased significantly ( P <0 01). Serum insulin and SHBG levels were decreased significantly ( P <0 01) also after treatment. Meanwhile, bilateral ovarian volumes shrunk and follicle numbers were decreased significantly ( P <0 01). As to the lipid profile, the HDL C was increased significantly ( P <0 01), while LDL C decreased significantly ( P <0 01) after treatment.Conclusion Combined use of CPA and metformin can effectively treat PCOS.