二甲双胍联合促排卵药治疗耐氯米芬多囊卵巢综合征疗效观察

目的 探讨二甲双胍对多囊卵巢综合征治疗效果.方法 32例PCOS耐氯米芬患者服用二甲双胍和氯米芬治疗3个月后,观察血清促卵泡激素(FSH)、黄体生成素(LH)、睾酮(T)、空腹血糖及空腹胰岛素水平,体质指数(BMI)、排卵及妊娠情况.结果 治疗3个周期后,LH、T、空腹胰岛素水平均显著下降,BMI也有一定程度的降低,有59.37%(19/32)患者排卵;16.13%(6/32)患者妊娠.结论 氯米芬联合二甲双胍治疗多囊卵巢综合征是安全、有效、理想的新途径.     

二甲双胍联合促排卵药治疗耐氯米芬多囊卵巢综合征疗效观察

目的探讨二甲双胍对多囊卵巢综合征治疗效果。方法 32例PCOS耐氯米芬患者服用二甲双胍和氯米芬治疗3个月后,观察血清促卵泡激素（FSH）、黄体生成素（LH）、睾酮（T）、空腹血糖及空腹胰岛素水平,体质指数（BMI）、排卵及妊娠情况。结果治疗3个周期后,LH、T、空腹胰岛素水平均显著下降,BMI也有一定程度的降低,有59.37%（19/32）患者排卵;16.13%（6/32）患者妊娠。结论氯米芬联合二甲双胍治疗多囊卵巢综合征是安全、有效、理想的新途径。     

不同胰岛素增敏剂在非肥胖PCOS伴胰岛素抵抗患者中的应用价值比较

目的:比较二甲双胍与罗格列酮在非肥胖型多囊卵巢综合征(Polycystic ovary syndrome,PCOS)伴胰岛素抵抗患者中的应用价值.方法:以2020年1月～2021年3月期间河南科技大学第一附属医院收治的98例非肥胖PCOS伴胰岛素抵抗患者为研究对象,随机分组为二甲双胍组(n=49)和罗格列酮组(n=49),两组患者均接受常规生活方式干预,二甲双胍组口服二甲双胍治疗,罗格列酮组口服罗格列酮治疗,疗程均为3 m.比较治疗前后两组患者的血糖、胰岛素、性激素水平,记录两组患者治疗期间的不良反应发生情况.结果:治疗3 m,两组患者空腹血糖(Fasting blood-glucose,FPG)、糖化血红蛋白(Glycosylated hemoglobin,HbAlC)、空腹胰岛素(Fasting insulin,FINS)、胰岛素抵抗指数(Homeostasis model assessment,HOMA-IR)、睾酮(Testosterone,T)、促黄体生成激素(Leuteinizing hormone,LH)、LH/促卵泡生成激素(Follicle-stimulating hormone,FSH)比值均明显下降,FSH水平明显上升(P＜0.05);罗格列酮组患者不良反应发生率明显低于二甲双胍组(P＜0.05).结论:二甲双胍与罗格列酮均能有效控制非肥胖PCOS伴胰岛素抵抗患者胰岛素抵抗及血糖水平,对性激素水平调节有积极作用,临床应结合患者实际情况合理选用.     

PCOS合并胰岛素抵抗患者的内分泌特征及二甲双胍的治疗意义

目的 分析多囊卵巢综合征（PCOS）伴胰岛素抵抗患者的内分泌特征，探讨二甲双胍对该类患者临床症状及内分泌指标的影响。方法 按HOMA—IR将49例患者分为胰岛素抵抗组23例，非胰岛素抵抗组26例，比较BMI、FPG、FINS及FSH、LH及总T。对胰岛素抵抗组予二甲双胍治疗3个月，观察治疗前后临床症状及内分泌指标的改善情况。结果 胰岛素抵抗患者BMI、FPG及FINS明显高于非胰岛素抵抗组，二甲双胍治疗后BMI降低，多毛、痤疮有不同程度的减轻。FSH升高（P〈0．05），LH、FINS和HOMA—IR均明显降低（P〈0．01）。结论 胰岛素抵抗患者与非抵抗患者内分泌特征不同，二甲双胍可明显改善胰岛素抵抗的PCOS患者的临床症状和内分泌指标，胰岛素抵抗是二甲双胍治疗的适应证．     

达英-35联合二甲双胍与促排卵治疗胰岛素抵抗型多囊卵巢综合征的临床探讨

目的探讨达英-35与二甲双胍联合应用对胰岛素抵抗型多囊卵巢综合征(PCOS)患者生殖激素变化及排卵、妊娠率的作用。方法将90例PCOS伴胰岛素抵抗不孕患者随机分为2组,A组(达英-35)35例,B组(联合用药)55例。两组患者均服药3个周期后用克罗米芬(CC)促排卵治疗。结果 B组治疗后LH、T、LH/FSH、FINS水平显著下降,且周期排卵率和妊娠率显著高于A组(P<0.05)。结论达英-35联合二甲双胍治疗PCOS能调整生殖激素水平,提高排卵率和妊娠率,是治疗PCOS伴胰岛素抵抗不孕患者的理想方案。     

复方环丙孕酮联合胰岛素增敏剂对非肥胖多囊卵巢综合征伴有胰岛素抵抗患者治疗效果的观察

目的探讨比较单独应用复方环丙孕酮（CPA）与CPA联合胰岛素增敏剂治疗非肥胖多囊卵巢综合征（P-COS）伴有胰岛素抵抗患者治疗效果的差异,以及二甲双胍和罗格列酮两种胰岛素增敏剂对于上述患者治疗效果的差异。方法68例非肥胖PCOS合并胰岛素抵抗（IR）患者随机分成3组,A组26例,单独应用CPA3个周期;B组23例。应用CPA＋MTE治疗3个周期;C组19例,应用CPA＋罗格列酮治疗3个周期。采取自身对照及组间对照法,比较用药前后血清胰岛素水平、IR指数、体重指数（BMI）、性激素等指标的差异。结果3组病人治疗后T及LH／FSH均较治疗前明显降低,B组、C组病人空腹胰岛素,IR指数等显著改善,B组、C组之间上述指标无显著差异。结论非肥胖型PCOS伴有IR患者应用胰岛素增敏剂,可以明显改善内分泌、代谢紊乱,二甲双胍与罗格列酮比较无显著差异。     

多囊卵巢综合征胰岛素抵抗相关治疗进展

 胰岛素抵抗（IR）是多囊卵巢综合征（PCOS）重要发病机制之一。临床上应用二甲双胍或噻唑烷二酮类药物可改善PCOS患者IR,纠正其代谢紊乱和高雄激素血症,故有助于恢复正常月经,增加排卵率及妊娠率,且孕期应用二甲双胍可能减少流产、妊娠高血压病、妊娠糖尿病等并发症。     

二甲双胍对多囊卵巢综合征患者胰岛素抵抗及排卵的影响

目的探讨胰岛素增敏剂二甲双胍对多囊卵巢综合征（PCOS）的胰岛素抵抗及排卵的治疗效果。方法把60例月经稀发或闭经的PCOS患者，随机分成三组，20例给予克罗米酚治疗（克罗米酚组），20例给予二甲双胍治疗（二甲双胍组），20例给予二甲双胍及克罗米酚联合治疗，在用药8周后比较各组治疗前后体重指数、腰臀比、黄体生成素（LH）、黄体生成素（LH）与卵泡刺激素（FSH）比值、睾酮及血清胰岛素水平与排卵率的变化。结果经用二甲双呱治疗8周后，测定血LH、LH／FSH、睾酮、血清胰岛素水平有明显下降，差异有显著性（P〈0．01）。二甲双胍组中有8例诱发排卵，克罗米酚组有12例诱发排卵，联合治疗组有18例诱发排卵。结论二甲双胍能改善并诱发排卵功能，并增强多囊卵巢综合征患者对克罗米酚的敏感性。     

二甲双胍治疗克罗米芬抵抗的多囊卵巢综合征56例疗效观察

目的 观察二甲双胍治疗克罗米芬抵抗的多囊卵巢综合征（PCOS）患者的疗效。方法 将56例克罗米芬抵抗的PCOS患者，随机分成A组和B组。每组均为28例，A组单用二甲双胍治疗，B组联合服用二甲双胍和克罗米芬治疗，疗程均为3个月。比较两组患者用药前后的FSH，LH、T、FG（空腹血糖）、FINS（空腹胰岛素）水平、排卵率和妊娠率。结果 服用二甲双胍后，能使LH、T和FINS水平下降，与用药前相比，差异有非常显著性意义（P〈0．01），A组有10例排卵，排卵率为35．7％，5例妊娠，妊娠率为17．9％，B组有18例排卵，排卵率为64．3％，13例妊娠，妊娠率为46．4％，两组排卵率、妊娠率比较，差异有显著性意义（P〈0．05）。结论 二甲双胍能降低克罗米芬抵抗的PCOS患者LH、T和FINS水平，并能使部分患者恢复排卵和妊娠，与克罗米芬联用，能提高排卵率和妊娠率。     

二甲双胍用于多囊卵巢综合征患者促排卵周期的疗效观察

目的探讨二甲双胍对多囊卵巢综合征有胰岛素抵抗患者促排卵治疗的效果.方法将2002年7月至2003年7月58例患者随机分为A、B两组,分别给予促排卵药和促排卵药与二甲双胍合用,比较两组排卵率的变化.结果B组用二甲双胍治疗后的PCOS患者排卵率明显增加(P＜0.05).结论二甲双胍能有效地改善胰岛素抵抗,提高排卵率.     

Sequential treatment of metformin and clomiphene citrate in clomiphene-resistant women with polycystic ovary syndrome: a randomized,controlled trial

BACKGROUND: Recognition of the importance of insulin resistance in clomiphene-resistant women with polycystic ovary syndrome (PCOS) has led to the use of insulin sensitizers. METHODS: A randomized, controlled trial was conducted to compare efficacy of sequential treatment with metformin and clomiphene citrate with conventional gonadotrophins. Sixty clomiphene-resistant women with PCOS were randomized to two groups (n = 30 each), using computer-generated tables. Group I received metformin for 6 months, followed by ovulation induction with clomiphene citrate; group II received hMG for ovulation induction. Hormonal profiles were evaluated at the onset and after completion of treatment. RESULTS: There was no significant difference in pregnancy rates between the two groups (16.7 versus 23.3%). In group I, there was a significant improvement in menstrual function and ovulation after treatment (40%, P < 0.001; and 46.7%, P < 0.001), with a significant decrease in fasting insulin levels (P < 0.05). There were no changes in other biochemical parameters. The ovulation rate in group II was 43.3%, with a high drop-out rate. The cost-effective analysis for medications per pregnancy in group I was US$ 71 +/- 3 versus US$ 277 +/- 171 in group II. CONCLUSIONS: Sequential treatment with metformin and clomiphene citrate is an effective and safe option for clomiphene-resistant women with PCOS.     

Homocysteine levels in women with polycystic ovary syndrome treated with metformin versus rosiglitazone: a randomized study

BACKGROUND: Elevated levels of plasma homocysteine (Hcy) have been implicated as a significant risk factor for cardiovascular disease. Although long-term treatment with metformin can increase Hcy levels in patients with type II diabetes mellitus or coronary heart disease, it is becoming an increasingly accepted and widespread medication in polycystic ovary syndrome (PCOS). In the literature, only one study has demonstrated that metformin increases Hcy levels in PCOS patients, but the effect of other insulin sensitizers on Hcy levels have not been reported previously in women with PCOS. We aimed to assess the effects of metformin and rosiglitazone on plasma Hcy levels in patients with PCOS. METHODS: Thirty women were randomized to two groups: 15 women in group 1 received 850 mg of metformin twice daily for 3 months. In group 2, 15 women received 4 mg of rosiglitazone for 3 months. In both groups, body mass index, menstrual pattern, and plasma total Hcy, insulin, glucose and lipid metabolism parameters were recorded at baseline and at 3 months. RESULTS: Hcy levels increased from 8.93+/-0.49 to 11.26+/-0.86 micromol/l (P = 0.002) and from 10.70+/-0.86 to 12.36+/-0.81 micromol/l (P = 0.01) in the metformin and rosiglitazone groups, respectively. Apolipoprotein (Apo) A1 levels increased from 127.10+/-6.85 to 145.7+/-7.18 mg/dl (P = 0.018) in the metformin group. Total cholesterol (total-C), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) and Apo B levels decreased in the metformin group, but the change was not significant. Total-C levels decreased from 161.15+/-8.94 to 150.23+/-8.73 mg/dl (P = 0.026), HDL-C decreased from 43.13+/-2.65 to 39.15+/-2.52 mg/dl (P = 0.005) and LDL-C levels decreased from 93.83+/-6.06 to 80.7+/-2.30 mg/dl (P = 0.021) in the rosiglitazone group. CONCLUSION: Treatment with insulin sensitizers in women with PCOS may lead to increases in Hcy levels.     

二甲双胍联合炔雌醇环丙孕酮片对多囊卵巢综合征患者性激素和胰岛素水平的影响

目的:研究二甲双胍联合炔雌醇环丙孕酮片对多囊卵巢综合征(Polycystic ovarian syndrome,PCOS)患者性激素和胰岛素水平的影响。方法:选取2018年3月至2019年10月于我院就诊的PCOS患者135例,按照随机数字表法分为两组,对照组患者67例予以炔雌醇环丙孕酮片(每天1片)口服,研究组68例在对照组的基础上增加二甲双胍(每天0.85 g)口服。治疗3个疗程后,观察两组患者临床疗效、性激素水平、胰岛素水平、自然受孕率、不良反应。结果:研究组患者治疗后的临床有效率、受孕率明显高于对照组(P<0.05)。治疗后研究组黄体生成素(Luteinizing hrmone,LH)、睾酮(Testosterone,T)、卵泡刺激素(Follicle-stimulating Hormone,FSH)、胰岛素抵抗指数(Homeostasis model assessment insulin resistance,HOMA-IR)、空腹胰岛素(Fasting serum insulin,FINS)、空腹血清葡萄糖(Fasting plasma glucose,FPG)均显著低于对照组(P<0.05),雌二醇(Estradiol,E2)显著高于对照组(P<0.05)。两组患者不良反应发生率无显著差异(P>0.05)。结论:二甲双胍联合炔雌醇环丙孕酮片应用于PCOS患者可通过纠正性激素紊乱、改善胰岛素抵抗来提高临床疗效及自然受孕率,可临床推广。     

Co-administration of metformin during rFSH treatment in patients with clomiphene citrate-resistant polycystic ovarian syndrome: a prospective randomized trial

BACKGROUND: This study aims to evaluate the impact of metformin on ovarian response when co-administered during recombinant (r)FSH using the low-dose step-up protocol in clomiphene citrate-resistant polycystic ovarian syndrome (PCOS) patients with normal glucose tolerance. METHODS AND RESULTS: Thirty-two patients were randomized to metformin (n = 16) and placebo (n = 16) groups. Hormonal assessment, a 75 g oral glucose tolerance test (OGTT) and a frequently sampled i.v. glucose tolerance test (FSIGTT) were performed before and after oral administration of metformin (850 mg twice daily) or placebo for 6 weeks. Recombinant FSH treatment was undertaken, thereafter, in women who did not ovulate on metformin (n = 10) or placebo (n = 15). There was no significant change in all insulin sensitivity indices in both groups. The only change noted was a decline in mean serum free testosterone concentration in the metformin group (P = 0.049). One patient on placebo and six patients on metformin ovulated spontaneously (P < 0.05). All parameters of ovarian response were comparable between the two groups during rFSH treatment. Combining the 6 week placebo or metformin-only period with a single rFSH treatment cycle, the overall ovulation rates were 75 and 94% in the placebo and metformin groups respectively (P > 0.05). The respective figures for pregnancy were 6.3 and 31.3% (P > 0.05). CONCLUSIONS: Metformin may restore ovulation with no improvement on insulin resistance in clomiphene citrate-resistant PCOS patients with normal glucose tolerance, but has no significant effect on ovarian response during rFSH treatment.     

The effects of rosiglitazone and metformin on oxidative stress and homocysteine levels in lean patients with polycystic ovary syndrome

BACKGROUND: Oxidative stress and hyperhomocysteinaemia are risk factors for cardiovascular diseases. The aim of this study was to assess the effects of rosiglitazone and metformin on cardiovascular disease risk factors such as insulin resistance, oxidative stress and homocysteine levels in lean patients with polycystic ovary syndrome (PCOS). METHODS: Fifty lean patients (BMI <25 kg/m2) with PCOS and 35 healthy subjects were included this study. Serum homocysteine, sex steroids, fasting insulin, fasting glucose and lipid levels were measured. Total antioxidant status (TAS; combines concentrations of individual antioxidants) and malonyldialdehyde concentration (MDA) were determined. Insulin resistance was evaluated by using the homeostasis model insulin resistance index (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), Area under the curve insulin (AUCI) and the insulin sensitivity index (ISI). Patients were divided into two groups. One group was treated with metformin (n = 25) and the other received rosiglitazone (n = 25) for 12 weeks. All measurements were repeated at the end of 12 weeks. RESULTS: Compared with healthy women, those with PCOS had significantly elevated serum MDA, homocysteine, HOMA-IR, AUCI and lipoprotein a levels, and significantly decreased serum TAS, QUICKI and ISI. Serum free testosterone levels showed a significant positive correlation with MDA, AUCI and HOMA-IR, and a negative correlation with TAS, ISI and QUICKI in PCOS patients. HOMA-IR and AUCI significantly decreased, while QUICKI and ISI significantly increased after treatment in both groups. Serum TAS level increased and serum MDA level decreased after the rosiglitazone treatment, but these parameters did not change after the metformin treatment. Serum homocysteine and lipid levels did not change in either group, while serum androgen levels and LH/FSH ratio significantly decreased after the treatment period in only the rosiglitazone-treated group. CONCLUSION: Elevated insulin resistance, oxidative stress and plasma homocysteine levels and changes in serum lipid profile (risk factors for cardiovascular disease) were observed in lean PCOS patients. Rosiglitazone seemed to decrease elevated oxidative stress when compared with metformin treatment in lean PCOS patients.     

胰岛素联合罗格列酮或二甲双胍随机对照治疗对2型糖尿病患者血清氨基末端脑钠肽的影响

比较胰岛素联合罗格列酮治疗与胰岛素联合二甲双胍治疗对2型糖尿病患者血清氨基末端脑钠肽(NT-BNP)水平的影响,了解血清NT-BNP水平是否可以作为罗格列酮诱发心衰的预测指标.符合纳入标准2型糖尿病患者60例,随机分成A、B两组.A组给予胰岛素联合罗格列酮(4 mg/d)治疗,B组给予胰岛素联合二甲双胍治疗,共8周,治疗前后分别测血清NT-BNP水平.结果,两组治疗前后血清NT-BNP平均水平无明显变化(P＞0.05).两组治疗前后血清NT-BNP差值比较无显著差异(P＞0.05).胰岛素联合罗格列酮组,3例出现水肿,其血清NT-BNP较治疗前升高108.99 fmol/ml,无心衰病例发生.胰岛素联合罗格列酮和胰岛素联合二甲双胍治疗,对2型糖尿病患者血清NT-BNP无明显影响.血清NT-BNP是否可以作为罗格列酮治疗2型糖尿病患者诱发心衰的早期预测指标有待更多的观察.     

Comparison of the effects of acarbose and metformin use on ovulation rates in clomiphene citrate-resistant polycystic ovary syndrome

BACKGROUND: The aim of this study was to evaluate the effects of metformin and acarbose on insulin resistance, hormone profiles and ovulation rates in patients with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). METHODS: Thirty clomiphene citrate-resistant patients were selected randomly and divided into two groups. Group I was treated with 100 mg/day clomiphene citrate and 300 mg/day acarbose 100 mg/day orally, for 3 months. Group II was treated with clomiphene citrate 100 mg/day and metformin 1700 mg/day orally, for 3 months. Serum fasting insulin and glucose, FSH, LH, estradiol, progesterone, prolactin and total testosterone levels plus body mass index (BMI) were measured before and after treatment. Follicle growth was followed by transvaginal ultrasonography. RESULTS: LH:FSH ratio and total testosterone concentrations decreased (P<0.05) and ovulation rates increased in both groups. Reduction in weight and BMI was only significant in the acarbose group. CONCLUSIONS: Both treatment modalities were effective in the treatment of insulin resistance and improving ovulation rates. Increase in the number of eumenorrhoeic and normoinsulinaemic cases and decrease in the number of insulin-resistant cases were significant in both groups (P<0.05). Ovulation rate was greater in the metformin group in the second month of therapy (P<0.05). Acarbose was found to be a safe and effective agent that could be used in cases with clomiphene-resistant PCOS.     

Insulin-sensitizing agents: use in pregnancy and as therapy in polycystic ovary syndrome

Treatment with insulin-sensitizing agents is a relatively recent therapeutic strategy in women with polycystic ovary syndrome (PCOS) and insulin resistance. The key areas addressed in this review include PCOS and the development of type 2 diabetes mellitus and gestational diabetes, as well as the use of insulin-sensitizing agents, particularly metformin, in the management of infertility in obese and non-obese PCOS women. Treatment with metformin in PCOS women undergoing IVF and the use of metformin during gestation will be discussed. The challenge for the health care professional should be the appropriate utilization of pharmacotherapies to improve insulin sensitivity and lower circulating insulin levels resulting in beneficial changes in PCOS phenotype. Further research into the potential role of other insulin-sensitizing agents, such as pioglitazone and rosiglitazone, in the treatment of infertile women with PCOS is needed.     

二甲双胍联合辛伐他汀治疗多囊卵巢综合征的临床疗效

目的:观察二甲双胍联合辛伐他汀在多囊卵巢综合征(polycystic ovary syndrome,PCOS)治疗中的临床疗效.方法:收集首都医科大学附属北京妇产医院2014年6月至2016年6月门诊就诊的PCOS患者共120例,随机进入二甲双胍联合辛伐他汀治疗组和二甲双胍治疗组,用药治疗3个月.对两组患者治疗前后的性激素、血糖参数、血脂参数进行检测.结果:两组患者治疗前后相比,性激素、血糖参数、血脂参数均显著改善,差异具有统计学意义(P＜0.05);两组之间相比,联合治疗组疗效显著优于二甲双胍治疗组,差异具有统计学意义(P＜0.05).结论:二甲双胍联合辛伐他汀治疗PCOS的疗效优于二甲双胍单用,对改善患者性激素水平、血糖和血脂指标具有优势.