二甲双胍联合小剂量阿司匹林治疗复发性流产伴胰岛素抵抗的临床疗效

目的：观察二甲双胍联合小剂量阿司匹林治疗复发性流产伴胰岛素抵抗患者的临床疗效。方法：本研究纳入90 例复发性流产伴胰岛素抵抗患者，随机分为三组，即基础干预组、二甲双胍组（基础干预+二甲双胍组）、观察组（基础干预+二甲双胍+小剂量阿司匹林组）。治疗三个月后评估并比较三组患者的身体质量指数（BMI）、稳态模型胰岛素抵抗指数（HOMA-IR）、纤溶酶原激活物抑制剂（PAI-1）、同型半胱氨酸（HCY）、空腹胰岛素（FINS）水平及治疗后半年内的妊娠率。结果：与治疗前相比，三组治疗后BMI、HOMAIR、FINS均下降，差异有统计学意义（P ＜0.05），且观察组与基础干预组比较差异有统计学意义（P ＜0.05），但与二甲双胍组相比差异无统计学意义（P ＞0.05）；治疗后三组血清PAI-1、HCY水平均降低，观察组下降明显，与二甲双胍及基础干预组相比差异均有统计学意义（P ＜0.05）；观察组和二甲双胍组治疗后半年内妊娠率与基础干预组比较差异均有统计学意义（P ＜0.05），但两组间差异无统计学意义（P ＞0.05）。结论：二甲双胍联合小剂量阿司匹林可改善复发性流产伴胰岛素抵抗患者的胰岛素抵抗状态，降低患者的血清PAI-1、HCY水平，提高临床妊娠率，且不良反应较少。

Clinical observation of metformin combined with low-dose aspirin in the treatment of patients with recurrent abortion and insulin resistance

Objective: To observe the clinical efficacy of metformin combined with low-dose aspirin in the treatment of patients with recurrent abortion and insulin resistance. Methods: In this study, 90 patients with recurrent abortion and insulin resistance were randomly divided into three groups: basic intervention group,metformin group (basic intervention & metformin group), and observation group (basic intervention & metformin &low-dose aspirin group). After 3-month treatment, body mass index (BMI), homeostasis model insulin resistance index (HOMA-IR), plasminogen activator inhibitor (PAI-1), homocysteine (Hcy), fasting insulin (FINS) level and pregnancy rate within 6 months after treatment were evaluated and compared among the three groups. Results:Compared with indexes before treatment, BMI, HOMA-IR and FINS were decreased in the three groups after treatment, with statistical difference (P<0.05). There was significant difference between the observation group and the basic intervention group (P<0.05), but there was no statistical difference between the observation group and the metformin group (P>0.05). After treatment, serum PAI-1 level and Hcy level decreased in three groups,especially significant in the observation group, and compared with the metformin and basic intervention group,the difference was significant (P<0.05). The pregnancy rate of the observation group and the metformin group was significantly different from that of the basic intervention group within 6 months after treatment (P<0.05),but there was no significant difference between the two groups (P>0.05). Conclusion: Metformin combined with low-dose aspirin can improve insulin resistance, reduce serum PAI-1 and Hcy levels and improve clinical pregnancy rate in patients with recurrent abortion and insulin resistance, with fewer adverse reactions.