二甲双胍治疗耐克罗米芬的多囊卵巢综合征40例分析

目的：观察二甲双胍单用或联合高纯度卵泡刺激素（metrodin-HP即FSH－HP）治疗耐克罗米芬（CC)多囊卵巢综合征（PCOS）患者的疗效。方法：选择耐CC的PCOS患者40例，随机分成A组和B组。A组：20例患者从卵泡早期开始服二甲双胍，每天1500mg共12周，若未孕则加FSH－HP促排卵1个周期，B组；20例患者单独用FSH－HP促排卵1个周期。测定所有患者的性激素、空腹血糖（FG）及空腹胰岛素（FINS）。结果：服二甲双胍后，LH、T及FINS的水平明显下降（P＜0．05），A组有7例患者排卵且3例妊娠，妊娠率为15．0％，17例未孕者继续服二甲双胍联合FSH－HP促排卵，15例排卵和4例妊娠，妊娠率23．5％，B组单用FSH－HP促排卵，有14例排卵且3例妊娠，妊娠率15．0％，两者的妊娠率差异无显著性意义（P＞0．05）。A组的FSH－HP用量少于B组，差异有显著性意义（P＜0．05），中度以上OHSS发生率分别为0和10％，前者的发生率低于后者（P＜0．05）。结论：单用二甲双胍能使部分患者恢复排卵和妊娠。FSH－HP联合二甲双胍能减少FSH－HP的用量和OHSS的发生。二甲双胍单用或联合FSH－HP促排卵为耐CC的PCOS患者找到一种有效的治疗方法。     

二甲双胍/CC/HMG序贯用药治疗胰岛素抵抗PCOS患者的临床研究

目的 :探讨二甲双胍对胰岛素抵抗多囊卵巢综合征 (PCOS)患者的治疗效果及作用机理。方法 :随机将 69例胰岛素抵抗PCOS患者分为A、B两组。A组 34例用Diane 35治疗 3个周期后用CC +HMG促排卵 ;B组 35例用二甲双胍治疗 3个月后用CC +HMG促排卵。观察两组患者治疗前后的BMI、T、FINS、TNF α及排卵率。结果 :两组患者治疗后BMI及T差异无显著性(P >0 .0 5) ;FINS、TNF α及排卵率差异有显著性 (P <0 .0 5)。结论 :胰岛素抵抗PCOS患者治疗的关键是应用胰岛素增敏剂降低FINS ,二甲双胍对于PCOS合并不孕的治疗效果优于Diane 35。     

达英-35与胰岛素增敏剂治疗多囊卵巢综合征后促排卵药物的效果观察

目的:探讨比较单独应用达英-35以及达英-35分别与二甲双胍、罗格列酮联合治疗多囊卵巢综合征(PCOS)伴有胰岛素抵抗(IR)不孕患者效果及促排卵结局的差异.方法:97例PCOS伴有IR不孕患者随机分成3组.A组(单独应用达英-35)35例,B组(达英-35和二甲双胍)32例,C组(达英-35和罗格列酮)30例,3组患者治疗3个周期后均促排卵.比较用药后对体重、WHR、BMI、糖代谢、性激素及促排卵结局的影响.结果:3组患者治疗后血清睾酮较治疗前明显降低,B组、c组患者空腹胰岛素,胰岛素抵抗指数等显著下降;治疗后B组、C组妊娠率较A组增高,周期取消率、OHSS发生率较A组降低,差异均有统计学意义.结论:PCOS伴有IR不孕患者应用达英-35联合胰岛素增敏剂(二甲双胍及罗格列酮),可以明显改善内分泌、代谢紊乱,在此基础上促排卵,可以明显提高妊娠率.但因罗格列酮的用药安全性问题及价格较贵,所以此类患者应首选二甲双胍治疗.     

罗格列酮联合二甲双胍治疗多囊卵巢综合征的临床疗效观察

目的 :探讨罗格列酮联合二甲双胍治疗多囊卵巢综合征 (PCOS)的临床疗效。方法 :10 0例临床上有PCOS表现的肥胖不育患者通过口服葡萄糖耐量试验 (OGTT)、胰岛素及C肽释放试验 ,检出胰岛素抵抗 (IR)患者 80例 ,随机分为A、B、C 3组 ,分别给予促排卵药 ,促排卵药加二甲双胍 ,促排卵药加二甲双胍加罗格列酮 ,共治疗 2个月经周期 ,比较 3组用药前后及 3组间体重指数 (BMI)、胰岛素抵抗指数 (HomaIR)、游离脂肪酸(FFA)、肿瘤坏死因子α(TNFα)、纤溶酶原激活抑制物 1(PAI 1)和排卵率的变化。结果 :C组患者治疗后的BMI、HomaIR、FFA、TNFα、PAI 1较治疗前明显下降 (P <0 .0 5 )。C组的排卵率明显优于A组 (P <0 .0 1)和B组 (P <0 .0 5 )。结论 :罗格列酮联合二甲双胍治疗PCOS效果显著。     

二甲双胍联合复方醋酸环丙孕酮治疗青春期PCOS疗效分析

目的:探讨二甲双胍联合复方醋酸环丙孕酮(CPA)对青春期多囊卵巢综合征(PCOS)患者的临床疗效.方法:将23例青春期PCOS患者随机分为两组,A组(n=13)给予复方CPA,B组(n=10)联合给予复方CPA和二甲双胍(1 500mg/d),用药3个月后,观察治疗前后临床表现、血浆性激素水平、空腹血糖、空腹胰岛素水平的变化,以及短期对氯米芬(CC)促排卵的反应和黄体生成激素(LH)反跳率.结果:治疗3个月后,两组患者卵泡刺激素(FSH)、LH水平、IH/FSH 比值较治疗前明显降低,有显著性差异(P＞0.05),多毛、痤疮症状改善,雄激素水平无明显变化.在A组稳态模型胰岛素抵抗指数(HOMA-IR)较治疗前升高,差异有统计学意义(P＜0.05).A组8例患者(61.55%)和B组6例患者(60.00%)对CC无反应,在3个周期CC后,A组有8例患者(61.55%)和B组3例患者(30.00%)出现LH反跳,B组的LH反跳比例低于A组,但无统计学差异(P＞0.05).结论:复方CPA联合二甲双胍治疗青春期PCOS可以改善患者的临床症状,降低LH水平,降低LH反跳率,可作为青春期PCOS治疗的选择.     

二甲双胍辅助克罗米芬用于多囊卵巢综合征促卵泡发育的效果观察

目的:探讨二甲双胍辅助克罗米芬对多囊卵巢综合征(PCOS)患者促卵泡发育的效果。方法:选择PCOS患者150例,随机分为A、B、C3组,A组(50例)口服克罗米芬;B组(50例)口服二甲双胍;C组(50例)口服克罗米芬和二甲双胍。3组用药时间均为12周,比较用药前后空腹血胰岛素和血睾酮及卵泡发育率的变化。结果:B组和C组患者治疗后血胰岛素及睾酮均下降,治疗前后比较,差异有显著性(P <0.05),C组治疗后卵泡发育率为89%,明显高于A组的59%和B组的34%,差异也有显著性(P <0.05)。结论:二甲双胍能有效降低PCOS患者的胰岛素抵抗,与克罗米芬合用能提高卵泡发育率。     

二甲双胍、达因-35联合来曲唑治疗多囊卵巢综合征疗效观察

目的：观察二甲双胍、达因-35和来曲唑治疗PCOS的疗效。方法：PCOS患者60例,随机分成3组,A组服用二甲双胍和达因-35治疗3个月后,用来曲唑促排卵;B组服用二甲双胍和达因-35一个月后,用来曲唑促排卵;C组直接用来曲唑促排卵。观察三组优势卵泡数目、子宫内膜厚度、血清雌二醇水平、排卵率、妊娠率。结果：三组有排卵的周期中HCG日子宫内膜的厚度、优势卵泡数目及血雌二醇水平差异无显著性（P〉0．05）,三组排卵率、妊娠率比较,A组和B组差异无显著性（P〉0．05）,c组和A组及B组差异有显著性（P〈0．05）。结论：PCOS患者经二甲双胍和达因-35预处理1到3个月后,可以提高排卵率和妊娠率。     

不同胰岛素增敏剂对多囊卵巢综合征代谢异常的疗效比较

目的:比较二甲双胍与罗格列酮治疗多囊卵巢综合征(PCOS)内分泌、代谢异常的疗效。方法:将89例PCOS患者分成A、B两组,A组予二甲双胍,B组予罗格列酮,均连用6个月。观察患者用药前后的体重、生殖激素、血糖和胰岛素水平的变化。结果:用药6月A组患者体重下降,B组体重上升,两组LH、LH/FSH、T均下降,治疗前后比较差异有显著性(P<0.05);B组T的下降幅度比A组明显(P<0.05)。A、B组空腹胰岛素(FINS)、餐后2小时胰岛素、胰岛素抵抗指数(Homa IR)均下降,治疗前后比较差异有显著性(P<0.05)。FINS、2小时INS以及Homa IR下降程度均表现为:罗格列酮>二甲双胍(P<0.05)。结论:罗格列酮比二甲双胍更能改善PCOS患者的胰岛素抵抗,而且无胃肠副反应,但价格较贵、起效较慢和引起体重增加,而二甲双胍有减轻体重的作用。     

二甲双胍联合枸橼酸氯米芬治疗多囊卵巢综合征伴胰岛素抵抗患者的疗效观察

目的　探讨二甲双胍联合枸橼酸氯米芬治疗多囊卵巢综合征 (PCOS)胰岛素抵抗性不孕症的疗效及二甲双胍对PCOS胰岛素抵抗伴假性黑棘皮病的治疗效果。方法　将 70例PCOS胰岛素抵抗性不孕症患者 (A组 ) ,按治疗方法不同分为Aa组、Ab组各 2 0例 ,Ac组 30例。Ac组口服二甲双胍 ,每日 3次 ,每次 5 0 0mg ,连用 3个月 ,从月经周期或撤退性出血第 5天开始口服枸橼酸氯米芬片 ,每日 1次 ,每次 5 0mg,连服 5d ,共用 3个周期 ;Aa组单用二甲双胍 ,Ab组单用枸橼酸氯米芬 ,Aa及Ab两组的用药方法分别同Ac组中二甲双胍和枸橼酸氯米芬的用法。 30例PCOS伴假性黑棘皮病和胰岛素抵抗的患者为B组 ,口服二甲双胍片治疗 3个月 ,用法同Aa组 ,观察各组患者治疗前后体重指数、腰臀比例、空腹胰岛素、空腹血糖、血浆胆固醇、甘油三酯、性激素 (卵泡刺激素、黄体生成素、催乳素、雌二醇、孕酮、睾酮 )水平的变化及B组的皮损变化。结果　 (1)Ac组治疗后胰岛素抵抗状态明显改善 ,妊娠率达 5 7% ,明显高于Aa组 (2 0 % )和Ab组 (15 % ) ,差异有极显著性 (P <0 0 1) ;Ac组治疗前 ,空腹胰岛素、体重指数、睾酮、血浆胆固醇、甘油三酯分别为 (4 9 7± 6 4 )mU/L、2 9 4± 2 2、(6 4± 2 2 )nmol/L、(6 3± 0 5 )mmol/L、(4 1± 1 0     

二甲双胍对PCOS合并高胰岛素血症患者血清胰岛素及性激素的影响

目的:探讨二甲双胍对多囊卵巢综合征(PCOS)合并高胰岛素血症患者血清胰岛素、性激素及性激素结合球蛋白(SHBG)水平的影响及其作用机制,了解二甲双胍治疗的临床效果。方法:给予2 4例PCOS合并高胰岛素血症患者二甲双胍5 0 0mg ,每日3次,8周治疗,对治疗前后血清空腹胰岛素(FINS)、胰岛素敏感性指数、性激素及性激素结合球蛋白水平进行检测。结果:二甲双胍可降低血清空腹胰岛素及睾酮水平(P <0 .0 1) ,提高胰岛素敏感性指数(P <0 .0 1) ,治疗前后血清SHBG水平差异无显著性(P >0 .0 5 )。结论:二甲双胍是治疗PCOS的重要手段。     

Effects of metformin on insulin resistance, androgen concentration, ovulation and pregnancy rates in women with polycystic ovary syndrome following laparoscopic ovarian drilling

AIM: To evaluate the effects of metformin on insulin resistance, androgen concentration, ovulation rates and pregnancy rates in infertile women with polycystic ovary syndrome (PCOS). METHODS: Forty-two infertile women with PCOS were selected in this randomized clinical study. Basal steroid and gonadotropin levels were measured, and oral glucose tolerance test (OGTT) was performed. The patients were randomly divided into group 1 (n = 21) and group 2 (n = 21). Group 1 patients were treated with laparoscopic ovarian drilling (LOD). Group 2 patients underwent laparoscopic ovarian drilling (LOD) and received 1700 mg per day of metformin for 6 months. LOD was performed in women with PCOS using a unipolar electrode. Serum progesterone (P) level > 5 ng/mL was considered as a confirmation of ovulation. Ovulation and pregnancy rates were determined after six cycles. RESULTS: Serum androgens and insulin response to OGTT decreased significantly after metformin therapy. Mean serum P levels and endometrial thickness were significantly higher in cycles treated with metformin plus LOD (34.6 +/- 25.4 ng/mL, 8.4 +/- 1.1 mm) than in those treated with LOD alone (26.2 +/- 24.7 ng/mL, 7.9 +/- 2.8 mm) (P < 0.05). The ovulation (56 of 65 cycles, 86.1% vs 29 of 65 cycles, 44.6%) and pregnancy rates (nine of 21 women, 47.6% vs four of 21 women, 19.1%) were significantly higher in group 2 than in group I. CONCLUSIONS: Metformin improves insulin resistance, reduces androgen levels and significantly increases the ovulation and pregnancy rates in infertile women, following LOD.     

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。     

二甲双胍治疗耐克罗米酚多囊卵巢综合征23例临床分析

目的探讨二甲双胍在多囊卵巢综合征(PCOS)治疗中的作用.方法对23例耐克罗米酚PCOS患者的临床资料进行回顾性分析,比较二甲双胍治疗前后各项内分泌代谢指标的变化及其对恢复月经、促排结局及妊娠的影响.结果二甲双胍治疗前后比较,血清睾酮、空腹胰岛素水平下降,胰岛素敏感性指数上升(P<0.01).6例(26.09%)的患者恢复月经,4例(17.39%)恢复自然排卵,2例妊娠. 二甲双胍加促排治疗共26个周期,排卵周期率为61.54%(16/26),妊娠周期率为23.08%(6/26). 结论二甲双胍可以降低雄激素水平及胰岛素水平,改善PCOS妇女对克罗米酚促排的反应.     

Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the effect of metformin therapy on hyperandrogenism, insulin resistance, cervical scores, ovulation, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS). DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Infertility clinic of a tertiary referral center. PATIENT(S): Fifty-six women with clomiphene citrate-resistant PCOS. INTERVENTION(S): Two cycles of oral metformin therapy (850 mg, twice daily) in group I and placebo therapy (twice daily) in group II. Clomiphene citrate (100 mg/day) on cycle days 3-7 of the second cycle in both groups. MAIN OUTCOME MEASURE(S): Insulin, T, DHEAS, FSH, LH, body mass index (BMI), waist-to-hip ratio, endometrial thickness, cervical score, ovulation, and pregnancy rates in clomiphene-induced cycles after metformin therapy. Result(s): Metformin therapy resulted in a significant decrease in total T, LH level, LH/FSH ratio, insulin resistance, and mean BMI. No difference in waist-to-hip ratio, DHEAS level, and fasting insulin level was observed. Clomiphene citrate induction resulted in higher ovulation rates and thicker endometrium in the metformin group than in the placebo group. There was higher cumulative pregnancy rate in the metformin group; however, there was no significant difference in the pregnancy rate between the two groups. CONCLUSION(S): Metformin therapy not only decreases hyperandrogenism and insulin resistance but also improves ovulation rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with PCOS.     

达英-35联合不同胰岛素增敏剂对PCOS伴IR患者的临床疗效比较

目的:比较吡格列酮和二甲双胍分别配伍达英-35治疗多囊卵巢综合征(P-COS)的内分泌异常以及对卵巢生殖功能恢复的疗效。方法:随机将91例PCOS合并胰岛素抵抗(IR)患者分为两组,吡格列酮配伍组47例口服达英-35和盐酸吡格列酮,二甲双胍配伍组44例口服达英-35和盐酸二甲双胍,两组均于治疗3个月后进行诱导排卵治疗3个周期。检测治疗前后性激素、IR程度、血脂水平以及观察诱导排卵的效果。结果:二甲双胍配伍组治疗后BM I明显降低(P<0.05)。两组治疗后F-G评分均显著降低(P<0.05),卵泡总数及卵巢体积均显著降低(P<0.01),LH、LH/FSH、A2均显著降低(P<0.01)。两组治疗后IR明显改善(P<0.01),吡格列酮配伍组FIN水平降低的更为显著(P<0.05)。吡格列酮配伍组治疗后TC显著下降(P<0.05),TG、LDL-C显著下降(P<0.01),HDL-C显著升高(P<0.05),二甲双胍配伍组治疗前后血脂无明显改变(P>0.05)。两组的周期排卵率、单卵泡发育率、妊娠结局无明显差异(P>0.05)。结论:达英-35与吡格列酮配伍或与二甲双胍联合应用,均能改善PCOS患者的IR和高雄激素症状,对于异常的糖脂代谢,吡格列酮的疗效要优于二甲双胍。     

Laparoscopic ovarian drilling in polycystic ovary syndrome

BACKGROUND AND OBJECTIVE: Patients with polycystic ovary syndrome (PCOS) treated with gonadotrophins often have a polyfollicular response and are exposed to the risks of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. The aim of the present study was to evaluate the efficacy of laparoscopic ovarian drilling (LOD) on the endocrinologic, clinical parameters and reproductive outcome of clomiphene-resistant anovulatory infertile patients with PCOS using monopolar diathermy. MATERIAL AND METHODS: Forty-five clomiphene-resistant anovulatory women with PCOS have participated in the study. Serum testosterone (T), follicle stimulating hormone (FSH) and luteinizing hormone (LH), fasting insulin and glucose levels, body mass indexes, modified Ferriman Gallwey (FG) hirsutism scores of the subjects are recorded before and after the procedure. Endocrinologic and clinical profile and reproductive outcome of the patients were analysed. RESULTS: Ovarian drilling was successfully employed without any surgical complications and mean +/- S.D. duration of follow-up time was 29.73 +/- 10.64 months. In the follow-up period 93.3% of the subjects were recorded to have regular cycles and 64.4% pregnancy rate was achieved, spontaneously. The serum levels of T, free T, LH, LH:FSH ratio, insulin and FG scores were significantly reduced after LOD, although glucose levels and glucose/insulin ratio remained unchanged. CONCLUSION: In choosing ovulation induction method in clomiphene resistant PCOS patients, LOD may avoid or reduce the risk of OHSS and multiple pregnancy than gonadotrophins with the same success rate of conception. The high pregnancy rate, and economic aspect of the procedure offer an attractive management for patients with PCOS.     

Combined metformin and clomiphene citrate versus highly purified FSH for ovulation induction in clomiphene-resistant PCOS women: a randomised controlled trial

Aim.?To compare the effect of combined metformin–clomiphene citrate (CC) with highly purified urinary FSH (HP-uFSH) for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS).

Methods.?One-hundred fifty-three anovulatory women with CC-resistant PCOS were selected in this randomised controlled trial. Patients received combined metformin–CC (n?=?75, 205 cycles) or HP-uFSH (n?=?78, 186 cycles) for three cycles. Outcome measures were; Ovulation rate, number of growing and mature follicles, serum E2, serum P, endometrial thickness, pregnancy and miscarriage rates.

Results.?The ovulation rate per cycle was significantly higher in the HP-uFSH group (83.8% vs. 62%, p?=?0.01). The number of follicles ≥12?mm ≥14?mm and ≥18?mm on the hCG day was significantly greater in the HP-uFSH group (p?=?0.01, p?=?0.02 and p?=?0.03, respectively). Pregnancy occurred in 23/205 cycles (11.2%) in combined metformin–CC group and 40/186 cycles (21.5%) in the HP-uFSH group; the difference was statistically significant (p?=?0.02). Two patients in the HP-uFSH group suffered mild OHSS.

Conclusions.?Combined metformin–CC resulted in modest ovulation and pregnancy rates without side effects. It is logical to offer this first for CC-resistant PCOS women before resorting to more expensive alternatives especially in developing communities where economic aspects of therapy are important.     

The effect of age on the ovarian response to gonadotropin and on pregnancy rate in polycystic ovary syndrome.

Recent studies have proposed that, in women affected by the polycystic ovary syndrome (PCOS), aging is able to regularize the menstrual cyclicity. To evaluate the ovarian response in PCOS patients according to their age, we studied 33 PCOS patients, 20 of whom with an age ranging from 28 to 34 years (younger PCOS) and 13 ranging from 35 to 45 years (older PCOS). All patients underwent an ovulation induction therapeutic protocol with low-dose recombinant follicle stimulating hormone, for a total of 80 cycles (44 cycles for the younger PCOS group and 36 cycles for the older PCOS group). No significant difference was found between the days of therapy (12.3 +/- 5.4 vs. 13.5 +/- 5.6 days), total amount of drugs (980.7 +/- 568.9 IU vs. 1063.9 +/- 469.5 IU) or ovulation rate (93% vs. 89%) in the two groups. The two groups showed a significant difference in the maximum estradiol level (2053.5 +/- 1497.2 vs. 1269.0 +/- 911.5 pmol/l, p < 0.01), the number of the recruited and preovulatory follicles (1.7 +/- 2.5 vs. 0.64 +/- 0.9, p < 0.05 and 1.7 +/- 1.1 vs. 1.2 +/- 0.5, p < 0.01, respectively) and the pregnancy rate (36% vs. 14%, p < 0.05). In conclusion, our data clearly showed that, also in PCOS, advanced age is a negative prognostic factor in the ovarian response to ovulation induction therapies.