罗格列酮和二甲双胍治疗多囊卵巢综合征随机对照研究

将40例多囊卵巢综合征(PCOS)患者随机分为两组,A组口服二甲双胍联合克罗米芬治疗,B组口服罗格列酮联合克罗米芬治疗,两组用药时间均为3个月经周期,比较用药后血脂、血糖、胰岛素、胰岛素抵抗指数、睾酮、瘦素、脂联素、BMI等指标变化和排卵率的改善情况.结果 提示罗格列酮比二甲双胍能更好地降低PCOS患者的胰岛素抵抗,提高促排卵率,但对血糖、血脂、睾酮、瘦素、脂联素的改善与二甲双胍相似,对体质量下降的影响不如二甲双胍.     

二甲双胍治疗多囊卵巢综合征36例报告

多囊卵巢综合征（PCOS）是育龄妇女最常见的疾病。2004年2月～2008年2月，我们采用二甲双胍治疗PCOS共36例，疗效满意。现报告如下。     

二甲双胍治疗多囊卵巢综合征的代谢组学研究

目的基于非靶向气相色谱-质谱串联(NTGC-MS)平台研究二甲双胍治疗多囊卵巢综合征(PCOS)前后整体代谢物的改变。方法观察41例二甲双胍治疗PCOS(POCS组)前后临床生化特征变化,应用NTGC-MS平台检测代谢相关指标。结果 PCOS患者存在糖脂和氨基酸代谢异常;健康对照组(NC,n=65)与PCOS组存在63种代谢差异物,二甲双胍治疗前后存在27种代谢差异物;PCOS主要存在丙氨酸,天冬氨酸和谷氨酸代谢、柠檬酸循环、丙酮酸代谢等通路的改变,二甲双胍能改善牛磺酸和亚牛磺酸代谢、丙氨酸,天冬氨酸和谷氨酸代谢等通路。结论二甲双胍能降低PCOS患者的体重并增强其IS,能改善糖脂及氨基酸代谢异常;NTGC-MS是研究PCOS整体代谢差异物、评估药物干预效果的有效工具。     

二甲双胍在多囊卵巢综合征患者妊娠期的应用

二甲双胍通过改善胰岛素抵抗（IR）、降低雄激素水平、调节脂代谢等作用,调节多囊卵巢综合征（PCOS）患者月经周期、促进排卵、减轻体重,从而增加妊娠率,在临床治疗中广泛应用.PCOS患者妊娠后由于IR加重,面临妊娠早期流产、妊娠糖尿病（GDM）、妊娠高血压及子痫前期等不良并发症,二甲双胍能减少PCOS患者妊娠早期流产、延缓GDM的发生,且对胎儿结局及出生后生长发育无明显影响.     

二甲双胍治疗多囊卵巢综合征30例临床分析

选择PCOS患者30例。13服二甲双胍,500mg,每日3次,于餐后30min服,共6个月。测量患者体重并计算体重指数（BMI）,测定患者血清卵泡刺激素（FSH）、黄体生成素（LH）、睾酮（T）、空腹血糖（FBG）及胰岛素（FBI）水平,计算空腹血糖与胰岛素的比值（GIR）,并进行治疗前后的比较。结果用药后两组血胰岛素和雄激素水平均降低,胰岛素敏感指数上升,差异有显著性（P〈0．01）。结论二甲双胍可有效地改善PCOS患者的胰岛素抵抗,降低血雄激素水平。     

二甲双胍在多囊卵巢综合征促排卵治疗中的作用

多囊卵巢综合征(PCOS)是育龄妇女常见的内分泌紊乱性疾病,持续无排卵、雄激素水平过高和胰岛素抵抗是其主要特征,是导致患者无排卵性不孕的首要原因,约占女性无排卵性不孕的50%～70%〔1〕。本文就我院对PCOS促排卵治疗的患者应用二甲双胍的临床作用进行评价。     

二甲双胍改善多囊卵巢综合征患者的胰岛素抵抗及炎症

40例PCOS患者分为肥胖组和非肥胖组,检测Met治疗前后患者的血脂谱、胰岛素抵抗指数(HOMA-IR)、C反应蛋白(CRP)及白介素2(IL-2)的变化。结果:肥胖组的血脂谱和HOMA-IR高于非肥胖组,两组的CRP及IL-2差异没有统计学意义。经过16周Met治疗后,两组的血脂谱、HOMA-IR、CRP及IL-2明显下降。结论:Met可以改善PCOS的患者的IR及炎症。     

克罗米芬联合二甲双胍治疗多囊卵巢综合征的临床疗效研究

目的观察克罗米芬联合二甲双胍治疗多囊卵巢综合征(PCOS)的临床疗效。方法选取2015—2016年在湖北省中西医结合医院妇科门诊治疗的PCOS患者80例,随机分为对照组和治疗组,各40例。对照组患者单纯给予克罗米芬治疗,治疗组患者在对照组基础上加用二甲双胍,均连续治疗3个月经周期。比较两组患者治疗后内分泌激素指标、临床疗效、排卵及妊娠情况。结果治疗后治疗组睾酮(T)、雌二醇(E2)、黄体生成素(LH)、促卵泡激素(FSH)水平低于对照组(P0.01);治疗组患者总有效率和妊娠率高于对照组(P0.05);治疗后治疗组患者妊娠率高于对照组(P0.05);两组患者排卵率和早孕流产率比较,差异无统计学意义(P0.05)。结论克罗米芬联合二甲双胍治疗PCOS的临床疗效确切,能有效改善患者内分泌激素水平,提高妊娠率。     

二甲双胍在多囊卵巢综合征中应用的新认识

多囊卵巢综合征(PCOS)的一个重要发生机制是胰岛素抵抗.二甲双胍可增加胰岛素敏感性,重建月经周期,促进排卵,减轻高雄激素血症,降低体重.预防和延缓妊娠糖尿病以及2型糖尿病的发生、发展,减少心脑血管疾病的危险因素.与克罗米芬、口服避孕药、手术等传统治疗方法相比,二甲双胍具有明显的优势,可作为PCOS患者的一种长期治疗方案.     

二甲双胍联合罗格列酮治疗多囊卵巢综合征34例

多囊卵巢综合征（PCOS）是育龄妇女最常见的内分泌紊乱性疾病,病因复杂。研究认为,胰岛素抵抗可能是病情的始动因素和中心环节。2007年1月～2008年1月,我们采用二甲双胍联合罗格列酮治疗PCOS34例。现报告如下。     

Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is the most common reproductive endocrinopathy of women during their childbearing years. A significant degree of controversy exists regarding the etiology of this syndrome, but there is a growing consensus that the key features include insulin resistance, androgen excess, and abnormal gonadotropin dynamics. Familial and genetic factors cause predisposition to PCOS. Insulin resistance and adiposity put women with PCOS at a higher risk for diabetes, hypertension, dyslipidemia, and cardiovascular disease. Even though the adverse health consequences associated with PCOS are substantial, most women are not aware of these risks. Early recognition and treatment of metabolic sequelae should be the main focus of clinicians. Lifestyle modifications, mainly a balanced diet, weight loss, and regular exercise, are of utmost importance. On the pharmacologic front, various therapies including metformin, thiazolidinediones, and others appear to be very promising in the management of cardiometabolic aspects of PCOS.     

Polycystic ovarian syndrome and the metabolic syndrome

Polycystic ovarian syndrome (PCOS), first described in 1937, was defined by specific ovarian histopathology and a constellation of signs and symptoms. Through the years, the etiology remained elusive, with heated debates focusing in turn on the ovary and then the pituitary as the causative agents. In the last several decades, it has become clear that insulin resistance makes up a very important component of this syndrome. With this knowledge, new therapies have emerged along with the realization that PCOS and the metabolic syndrome are closely related through their shared insulin resistance. In this review, the diagnosis, pathophysiology, and therapy of PCOS are discussed and upon this background, those areas held in common by PCOS and the metabolic syndrome are explored.     

Polycystic ovarian syndrome: the commonest cause of hyperandrogenemia in women as a risk factor for metabolic syndrome

Polycystic ovarian syndrome (PCOS), the commonest endocrine disorder of women, is currently emerging as a potential facet of the metabolic syndrome (MBS) in women. Available data suggest that the MBS or, alternatively, individual metabolic risk factors may be overly present and most importantly that MBS may arise at a significantly younger age among PCOS women. The concept that a conventionally considered reproductive disorder may entail a significant metabolic impact on affected women has warranted medical interest on the mechanisms underlying the multiplicative sequelae of PCOS. Although obesity indisputably compounds the clinical course of women with PCOS, this appears to be just the tip of the iceberg. Insulin resistance and hyperinsulinemia have been intuitively involved as a critical link due to their contribution to the pathophysiology and clinical presentation of both PCOS and MBS. Hyperandrogenemia, the predominant endocrine hallmark of PCOS, has also been implicated as a contributing factor to the suggested interrelationship.     

Polycystic ovary syndrome and cardiovascular disease risk

Women with polycystic ovary syndrome (PCOS), an endocrinopathy consisting of oligo-ovulation, excess androgen, and polycystic ovaries, commonly have an adverse cardiovascular risk profile. This profile is exacerbated by obesity, which is common among women with the syndrome, especially in the United States. Recent articles from cohort and case-control studies support an increased risk of cardiovascular disease events in postmenopausal women with PCOS, though the diagnosis of PCOS in menopause is problematic. Treatment of cardiovascular risk factors, including insulin resistance, lipids, and serum markers of atherosclerosis (most commonly C-reactive protein) is receiving increasing clinical focus. While weight loss with lifestyle therapy is a universal goal in obese women, the role of additional pharmaceutical treatment of metabolic risk factors such as hyperinsulinemia and dyslipidemia is uncertain.     

Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women during their reproductive ages, associated with a plethora of cardiometabolic consequences, with obesity, insulin resistance and hyperandrogenemia playing a major role in the degree of such manifestations. These consequences include increased risk of glucose intolerance and diabetes mellitus (both type 2 and gestational), atherogenic dyslipidemia, systemic inflammation, non-alcoholic fatty liver disease, hypertension and coagulation disorders. Whether this cluster of metabolic abnormalities is also translated in increased cardiovascular disease (CVD) morbidity and mortality in later life, remains to be established. Data so far based on markers of subclinical atherosclerosis as well as retrospective and prospective cohort studies indicate a possible increased CVD risk, mainly for coronary heart disease. Future studies are needed to further elucidate this issue.     

Polycystic ovary syndrome, metabolic syndrome, cardiovascular risk and the role of insulin sensitizing agents

The Polycystic Ovary Syndrome (PCOS) affects 6 to 10% of women of childbearing age. Insulin resistance and hyperinsulinemia are present in nearly all PCOS patients and play a central role in the development of both hyperandrogenism and metabolic syndrome (MS). MS occurs in approximately 43% of PCOS patients, raising the cardiovascular risk to up seven fold in these patients. Several serum, functional and structural markers of endothelial dysfunction and subclinical atherosclerosis were described in PCOS patients, even those young and non-obese. However, despite the fact that PCOS adversely affects the cardiovascular profile, long-term studies did not demonstrate a consistent raise in cardiovascular mortality, which seems to be more observed in the post-menopausal period. Recently, oral contraceptives are being substituted for insulin sensitizing agents (metformin and glitazones) in the PCOS treatment, due to their effects on insulin resistance and cardiovascular risk.     

Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management

BACKGROUND: Women with polycystic ovarian syndrome (PCOS) commonly consult endocrinologists or gynaecologists and it is not known whether these specialty groups differ in their approach to management. OBJECTIVE: To compare the investigation, diagnosis and treatment practices of endocrinologists and gynaecologists who treat PCOS. DESIGN AND SETTING: A mailed questionnaire containing a hypothetical patient's case history with varying presentations--oligomenorrhoea, hirsutism, infertility and obesity--was sent to Australian clinical endocrinologists and gynaecologists in teaching hospitals and private practice. RESULTS: Evaluable responses were obtained from 138 endocrinologists and 172 gynaecologists. The two specialty groups differed in their choice of essential diagnostic criteria and investigations. Endocrinologists regarded androgenization (81%) and menstrual irregularity (70%) as essential diagnostic criteria, whereas gynaecologists required polycystic ovaries (61%), androgenization (59%), menstrual irregularity (47%) and an elevated LH/FSH ratio (47%) (all P-values < 0.001). In investigation, gynaecologists were more likely to request ovarian ultrasound (91%vs. 44%, P < 0.001) and endocrinologists more likely to measure adrenal androgens (80%vs. 58%, P < 0.001) and lipids (67%vs. 34%, P < 0.001). Gynaecologists were less likely to assess glucose homeostasis but more likely to use a glucose tolerance test to do so. Diet and exercise were chosen by most respondents as first-line treatment for all presentations. However, endocrinologists were more likely to use insulin sensitizers, particularly metformin, for these indications. In particular, for infertility, endocrinologists favoured metformin treatment whereas gynaecologists recommended clomiphene. CONCLUSIONS: There is a lack of consensus between endocrinologists and gynaecologists in the definition, diagnosis and treatment of PCOS. As a consequence, women may receive a different diagnosis or treatment depending on the type of specialist consulted.