吡格列酮联合他莫昔芬治疗多囊卵巢综合征的疗效观察

目的探讨盐酸吡格列酮片联合枸橼酸他莫昔芬片治疗多囊卵巢综合征的临床疗效。方法选取2014年9月—2017年10月江油市人民医院妇科收治的多囊卵巢综合征患者100例为研究对象,将所有患者随机分为对照组和治疗组,每组各50例。对照组患者于月经周期开始的第5天口服枸橼酸他莫昔芬片,20 mg/次,1次/d。治疗组患者在对照组治疗的基础上早餐后口服盐酸吡格列酮片,30 mg/次,1次/d。以21 d为1个疗程,两组患者均连续治疗3个疗程。比较两组治疗前后排卵情况、临床症状、卵巢情况、性激素水平、胰岛素抵抗指标和不良反应发生情况。结果治疗后,对照组患者成熟卵泡数为(1.6±0.5)个,排卵率为64.0%;治疗组患者成熟卵泡数为(2.2±0.5)个,排卵率为88.0%,两组排卵情况比较差异有统计学意义(P0.05)。治疗后,两组月经稀发、痤疮、多毛例数均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组临床症状例数均显著少于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组卵巢体积显著降低,子宫内膜厚度显著增加,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组卵巢情况显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组黄体生成素(LH)、睾酮(T)水平明显降低,促卵泡激素(FSH)、雌二醇(E2)水平明显升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组性激素水平改善显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组胰岛素抵抗指标显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组不良反应发生率为6.0%,明显低于对照组的16.0%,两组比较差异具有统计学意义(P0.05)结论盐酸吡格列酮片联合枸橼酸他莫昔芬片治疗多囊卵巢综合征疗效显著,可显著改善患者的临床症状,促进性激素紊乱和胰岛素抵抗情况的恢复,具有一定的临床推广应用价值。

Clinical observation of pioglitazone combined with tamoxifen in treatment of polycystic ovary syndrome

Objective To investigate the clinical efficacy of Pioglitazone Hydrochloride Tablets combined with Tamoxifen Citrate Tablets in treatment of polycystic ovary syndrome. Methods Patients (100 cases) with polycystic ovary syndrome in Jiangyou People''s Hospital from September 2014 to October 2017 were randomly divided into control and treatment groups, and each group had 50 cases. Patients in the control group were po administered with Tamoxifen Citrate Tablets in the period of 5th day of the menstrual cycle, 20 mg/time, once daily. Patients in the treatment group were po administered with Pioglitazone Hydrochloride Tablets on the basis of the control group after breakfast, 30 mg/time, once daily. A course of treatment had 21 d, and patients in two groups were treated for 3 courses of treatment. The ovulation, clinical symptoms, ovarian situation, sex hormone levels, insulin resistance index, and adverse reaction in two groups before and after treatment were compared. Results After treatment, the number of mature follicles and ovulation rate in the control group were (1.6 ±0.5) and 64.0%, and the number of mature follicles and ovulation rate in the treatment group were (2.2 ±0.5) and 88.0%, and there were differences between two groups (P < 0.05). After treatment, the numbers of oligomenorrhea, acne and hirsutism in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And clinical symptoms in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05).After treatment, the ovarian volume in two groups were significantly decreased, but the endometrial thickness were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And ovarian situation in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05).After treatment, LH and T levels in two groups were significantly decreased, but FSH and E₂ levels were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And the sex hormone levels in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the levels of FPG, FINS, and HOMA-IR in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the levels of insulin resistance index in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). During the treatment, the incidence of adverse reactions in the treatment group was 6.0%, which was significantly lower than 16.0% in the control treatment group, with significant difference between two groups (P < 0.05). Conclusion Pioglitazone Hydrochloride Tablets combined with Tamoxifen Citrate Tablets has clinical curative effect in treatment of polycystic ovary syndrome, can significantly improve clinical symptoms of patients, promote the recovery of sex hormone disorders and insulin resistance, which has a certain clinical application value.