二甲双胍治疗多囊卵巢综合征有效性相关因素的探讨

目的:探讨二甲双胍在治疗多囊卵巢综合征(PCOS)中的作用,总结其治疗PCOS有效性的可能影响因素,为PCOS合理的临床治疗方案提供理论依据。方法:40例PCOS患者,应用二甲双胍500 mg/次,3次/d,连续3个月。比较治疗前后临床症状、内分泌和生化指标的改变。并根据临床症状是否改善分为有反应组和无反应组,比较两组治疗前后上述指标的不同。结果:38例完成了二甲双胍的治疗,有反应者24例(63.16%),无反应者14例(36.84%)。总体上治疗后,体重指数(BMI)、腰臀比(WHR)、LH、LH/FSH、T、空腹胰岛素(FINS)、胰岛素曲线下面积(IAUC),胰岛素敏感指数(ISI)有明显的提高,差异均有显著性或非常显著性(P<0.05,<0.01)。LH、LH/FSH比值、TF、INSI、AUCI、SI的明显改变只发生在有反应组。两组治疗前比较,有反应组月经失调的时间较短、程度较轻、体重指数较小I、SI较高、T水平明显低于无反应组(P<0.05)。结论:二甲双胍可改善临床症状,降低LH/FSH比值、LH、T水平,提高胰岛素的敏感性。月经失调时间越短、月经失调中月经稀发者、体重指数较小、T水平较低I、SI较高者对二甲双胍的反应性较好。

Study on Related Parameters of Metformin Treatment in Polycystic Ovary Syndrome

Objective: To assess the effects of metformin therapy on clinical and biochemical parameters in Polycystic ovary syndrome(PCOS) and to evaluate those parameters for providing a theoretical basis in the reasonable treatment of PCOS. Methods: Forty diagnosed PCOS patients were recruited.Menstrual and reproductive hormone patterns,glucose metabolic parameters,and side effects were determined before and after oral administration of metfomin 500mg three times daily for three months.Baseline characteristics were assessed initially and 3 months after metormin therapy:body mass index(BMI),waist hip ratio(WHR),serum follicule stimulating hormone(FSH),luteinizing hormone (LH),luteinizing hormone and follicule stimulating hormone(LH/FSH) ratio,estradiol(E_2),testosterone(T),fasting insulin(FINS),fasting serum glucose(FSG),insulin sensitivity index(ISI),,the area under the curve for insulin(IAUC).These patients were divided into responder which recovery menstruation or pregnancy and nonresponder that no mense improved,and compared the clinical and biochemical parameters between them. Results: There were thirty-eight cases of PCOS completed the treatment,24(63.16%) cases were responders and 14(36.84%) were nonresponders.A significant reduction occurred in BMI,WHR,LH,LH/FSH,T,FINS,IAUC,and apparent raise in ISI(P <0.05,P <0.01) in all patients.LH,LH/FSH,T,FINS,IAUC reduced significantly and ISI increment significantly only in responders. Conclusions: Three months of metformin therapy may be clinically useful in PCOS patients.It resulted in a decline in LH/FSH,LH,T levels,and improved insulin sensitivity.Oligomenorrhea,lower BMI and shorter time of menstrual dysfunction cases responded better.An initially higher ISI and lower T may predict greater success with metformin therapy.