二甲双胍与复方醋酸环丙孕酮联合应用对多囊卵巢综合征患者内分泌及代谢的影响

目的　观察二甲双胍与复方醋酸环丙孕酮 (复方环丙孕酮 )联合应用 ,对多囊卵巢综合征 (PCOS)患者内分泌及代谢的影响。方法　对 4 5例患者进行前瞻性研究 ,为观察组 ;2 0例非PCOS不孕妇女为对照组。测定体重指数 (BMI)、腰臀围比值 (WHR)、多毛评分 (F G评分 )及生殖内分泌激素、糖、脂代谢指标等。观察组根据随机应用不同药物又分为复方环丙孕酮组、二甲双胍组及二甲双胍与复方环丙孕酮联合用药组 (联合用药组 ) ,每组各 15例。经 12周治疗后 ,比较上述各项指标的变化。结果　观察组治疗前BMI、WHR、F G评分、黄体生成激素 (LH)、睾酮 (T)、空腹胰岛素 (FI)、胰岛素抵抗 (IR)及甘油三酯等均较对照组增高 ;高密度脂蛋白胆固醇 (HDL C)较对照组降低 (P <0 0 1)。观察组 3组治疗前各项指标差异均无显著性 (P >0 0 5 )。治疗 12周后 ,联合用药组及二甲双胍组LH分别从 (13 9± 5 9)IU/L降低为 (5 8± 2 2 )IU/L ,从 (13 8± 7 6 )IU/L降低为 (11 8±6 5 )IU/L ;T分别从 (2 1± 0 8)nmol/L降低为 (1 2± 0 4 )nmol/L ,从 (2 2± 1 1)nmol/L降低为(1 8± 0 8)nmol/L ;游离睾酮 (FT)分别从 (2 8± 2 3)nmol/L降低为 (0 8± 0 5 )nmol/L ,从 (2 5±1 9)nmol/L降低为 (1     

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（1500mg／d），用药3个月后，观察洽疗前后临床表现、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、LH／FSH比值较治疗前明显降低，有显著性差异（P〈O．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〈O．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〉O．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。     

炔雌醇环丙孕酮联合二甲双胍治疗多囊卵巢综合征的临床效果观察

目的 观察炔雌醇环丙孕酮联合二甲双胍治疗多囊卵巢综合征（PCOS）的临床效果。方法 选取90例PCOS患者,按照随机数字表法分为研究组（采用炔雌醇环丙孕酮联合二甲双胍治疗）与对照组（采用炔雌醇环丙孕酮治疗）,每组45例。比较两组治疗前后激素水平、排卵率及妊娠率。结果 治疗前,两组卵泡刺激素（FSH）、促黄体生成素（LH）、睾酮（T）、胰岛素水平对比,差异均无统计学意义（P>0.05）;治疗后,两组LH、T及胰岛素水平均有所降低,FSH水平升高,其中研究组变化幅度大于对照组,差异有统计学意义（P<0.05）。研究组排卵率、妊娠率分别为84.44%、37.78%,均明显高于对照组的53.33%、17.78%,差异有统计学意义（P<0.05）。结论 炔雌醇环丙孕酮联合二甲双胍治疗POCS疗效更佳,可有效纠正患者内分泌紊乱,降低LH、T和胰岛素水平,提高FSH水平,促进卵泡发育,从而提高患者排卵率、妊娠率。     

二甲双胍联合炔雌醇环丙孕酮在多囊卵巢综合征治疗中的应用价值

目的 探讨多囊卵巢综合征患者采用二甲双胍联合炔雌醇环丙孕酮治疗的临床效果。方法 选取60例多囊卵巢综合征患者,根据信封法分为两组,每组30例。对照组给予炔雌醇环丙孕酮治疗,研究组在对照组基础上联合二甲双胍治疗。比较两组治疗前后的性激素水平、胰岛素水平、月经规律恢复及排卵恢复情况。结果 治疗后研究组睾酮(T)、卵泡刺激素(FSH)、雌二醇(E₂)、促黄体生成素(LH)水平均低于对照组(P<0.05)。治疗后研究组空腹胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR)低于对照组,胰岛素分泌指数(HOMA-β)高于对照组(P<0.05)。研究组月经规律恢复率93.33%高于对照组的73.33%,排卵恢复正常率96.67%高于对照组的80.00%(P<0.05)。结论 炔雌醇环丙孕酮联合二甲双胍能改善多囊卵巢综合征患者性激素、胰岛素水平,促进患者月经规律和排卵恢复,值得临床推广与应用。     

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.     

探讨二甲双胍联合炔雌醇环丙孕酮对多囊卵巢综合征PCOS不孕症治疗的效果

目的探讨二甲双胍联合炔雌醇环丙孕酮对多囊卵巢综合征PCOS不孕症治疗的效果。方法选取2016年5月~2018年5月我院收治92例多囊卵巢综合征PCOS不孕症门诊患者为研究对象,将92例患者随机分为治疗组与常规组,每组46例,对常规组使用炔雌醇环丙孕酮进行门诊促排卵治疗,治疗组患者采用二甲双胍联合炔雌醇环丙孕酮进行门诊促排卵治疗,治疗后对两组患者的诱导排卵率、妊娠率与激素水平指标进行观察对比。结果治疗后,治疗组患者的诱导排卵率与妊娠率均高于常规组,P<0.05,与常规组相比,治疗组患者的激素水平指标有明显改善,P<0.05。结论对多囊卵巢综合征PCOS不孕症患者采用二甲双胍联合炔雌醇环丙孕酮进行治疗,可以提高患者的排卵率与妊娠率,调节患者体内的激素水平。     

复方醋酸环丙孕酮治疗多囊卵巢综合征47例

多囊卵巢综合征（ＰＣＯＳ）引起的内分泌紊乱是导致不排卵的首位原因。对于无生育要求的ＰＣＯＳ患者,持续高水平的黄体生成素（ＬＨ）及睾酮（Ｔ）所致的排卵异常、月经紊乱及高雄激素征候群使治疗颇为棘手。现将我们应用复方醋酸环丙孕酮（复方ＣＰＡ）治疗的结果报道...     

复方醋酸环丙孕酮与螺内酯干预对非肥胖型多囊卵巢综合征(PCOS)内分泌代谢的影响

目的:比较复方醋酸环丙孕酮和螺内酯治疗以高雄激素血症为主要表现的非肥胖型多囊卵巢综合征(PCOS)的临床疗效和对内分泌代谢的影响。方法:按前瞻性随机对照研究方法选择以高雄激素血症为主要表现的非肥胖型PCOS患者80例,按随机化分组方案分为复方醋酸环丙孕酮(EE-CA)组和螺内酯(Sp)组,每组40例,分别口服相应的药物6个月,比较治疗前、后的体质量指数(BMI)、腰臀比(WHR)、多毛体征、痤疮程度以及卵巢体积,并测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、泌乳素(PRL)、总睾酮(T)、性激素结合球蛋白(SHBG)、硫酸脱氢表雄酮(DHEAS)、空腹血糖(FPG)、空腹胰岛素(FINS)和血脂的水平,记录服药后不良反应。结果:治疗多毛EE-CA和Sp疗效接近(P>0.05);EE-CA组治疗6个月后痤疮评分下降较Sp组作用明显(P<0.05),在缩小卵巢体积方面显著优于Sp(P<0.05),降低血LH、LH/FSH、T、游离雄激素指数(FAI)、DHEAS和升高SHBG的作用较Sp组显著(P<0.05,P<0.01);EE-CA组FINS、甘油三酯(TG)和高密度脂蛋白(HDL)高于Sp组(P<0.05)。结论:本研究用于治疗以高雄激素血症为主要表现的非肥胖型PCOS的药物都是有效的;EE-CA降低高雄激素血症的效果优于Sp,但对高甘油三酯的患者使用要慎重;Sp亦有较好的降雄激素作用,且对糖、脂代谢没有显著影响。     

二甲双胍联合辛伐他汀治疗多囊卵巢综合征疗效的Meta分析

目的:评价二甲双胍联合辛伐他汀治疗多囊卵巢综合征(PCOS)的疗效,进而指导临床治疗。方法:计算机检索Pub Med、EMbase、Cochrane Library、中国知网、万方、维普及中国生物医学文献数据库,纳入关于二甲双胍联合辛伐他汀治疗PCOS的随机对照试验(RCT)。用Rev Man 5. 1软件进行Meta分析,发表偏倚采用Stata 12. 1软件进行分析。结果:共纳入9篇RCT文献。Meta分析结果显示:二甲双胍联合辛伐他汀可明显提高患者的临床总有效率(OR=6. 56,95%CI 2. 95～14. 60,P 0. 00001);显著降低患者血浆总胆固醇(TC)(SMD=-2. 66,95%CI-3. 65～-1. 66,P 0. 00001),甘油三酯(TG)(SMD=-1. 25,95%CI-2. 02～-0. 49,P=0. 001),低密度脂蛋白(LDL)(SMD=-2. 91,95%CI-3. 98～-1. 84,P 0. 00001),睾酮(T)(SMD=-0. 64,95%CI-1. 13～-0. 15,P=0. 01),空腹胰岛素(FIN)(SMD=-1. 17,95%CI-2. 09～-0. 26,P=0. 01)。但是对血浆高密度脂蛋白(HDL)(P=0. 84)、黄体生成素(LH)(P=0. 29)、卵泡刺激素(FSH)(P=0. 50)、催乳素(PRL)(P=0. 08)、空腹血糖(FBS)(P=0. 55)、C反应蛋白(CRP)(P=0. 44),体质量指数(BMI)(P=0. 91)以及胰岛素敏感指数(ISI)(P=0. 30)和多毛症得分(P=0. 87)差异无统计学意义。结论:二甲双胍联合辛伐他汀治疗PCOS患者的疗效优于二甲双胍单用,对改善患者性激素、血脂、血糖水平更具优势,提高临床总有效率,疗效显著,值得临床推广使用。     

炔雌醇环丙孕酮联合二甲双胍治疗多囊卵巢综合征合并胰岛素抵抗的临床疗效

目的 探讨炔雌醇环丙孕酮联合二甲双胍治疗多囊卵巢综合征合并胰岛素抵抗患者的效果。方法 选择多囊卵巢综合征合并胰岛素抵抗患者60例为研究对象,根据随机抽签法分为对照组和研究组,每组30例。对照组给予炔雌醇环丙孕酮治疗,研究组给予炔雌醇环丙孕酮联合二甲双胍治疗,统计患者治疗效果以及治疗后的激素水平及糖、脂代谢情况。结果 研究组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,研究组促黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E₂)水平均高于对照组,睾酮(T)水平低于对照组,差异均有统计学意义(P<0.05)。治疗后,脂代谢指标中,研究组甘油三酯(TG)、低密度脂蛋白(LDL)、血清总胆固醇(TC)水平低于对照组,高密度脂蛋白(HDL)水平高于对照组,差异均有统计学意义(P<0.05);糖代谢指标中,研究组空腹胰岛素(FINS)水平低于对照组,空腹血糖(FPG)水平高于对照组,差异均有统计学意义(P<0.05)。结论 炔雌醇环丙孕酮联合二甲双胍治疗多囊卵巢综合征合并胰岛素抵抗临床治疗效果较好,可改善患者的糖、脂代谢功能,提...     

The effects of Diane-35 and metformin in treatment of polycystic ovary syndrome: An updated systematic review

Objectives. To systematically evaluate the efficacy and safety of Diane-35 for treating polycystic ovary syndrome (PCOS) and compare it with metformin, either in combination or alone.

Study design. A systematic review and meta-analysis were conducted. Randomized controlled studies applying Diane-35 and metformin for treating PCOS were included. The primary outcome was hirsutism. Authors of primary articles were contacted and methodological quality was evaluated. Subgroups were drawn based on treatment duration and sensitivity analysis was conducted; heterogeneity and bias are discussed.

Results. Twelve studies were included. The effect on improving hirsutism was not different between Diane-35 and metformin. Compared with Diane-35, metformin appeared to protect patients against glucose metabolic abnormality with treatment of at least 6 months. Except for triglycerides, no difference in lipid profile existed between Diane-35 and metformin. The evidence that Diane-35 deteriorates lipid and glucose metabolism was insufficient. Diane-35 could result in hypertension and headache. Methodological quality was still the key problem for studies.

Conclusions. Diane-35 is superior to metformin in reducing androgens, but inferior to metformin in reducing insulin. Whether Diane-35 deteriorates lipid metabolism and insulin resistance is still unclear.     

The association between the environmental endocrine disruptor bisphenol A and polycystic ovary syndrome: a systematic review and meta-analysis

Objective: To investigate the association between bisphenol A (BPA) and polycystic ovary syndrome (PCOS).

Methods: A systematic review and meta-analysis using STATA software for observational studies.

Results: Nine studies involving 493 PCOS patients and 440 controls were included in this review. The meta-analysis demonstrated that PCOS patients had significantly higher BPA levels compared with control groups (standardized mean difference (SMD): 2.437, 95% confidence interval (CI): (1.265, 3.609), p?p?p?=?.002), high quality (SMD: 0.624, 95% CI: (0.391, 0.856), p?p?=?.008).

Conclusions: Serum BPA may be positively associated with women with PCOS and BPA might be involved in the insulin-resistance and hyperandrogenism of PCOS. More evidence from high quality studies, advanced detection methods, and larger cohorts for observational trials are needed to further confirm the association between BPA and PCOS.     

复方醋酸环丙孕酮和罗格列酮序贯用药对氯米芬抵抗的多囊卵巢综合征患者内分泌及生育功能的影响

目的探讨复方醋酸环丙孕酮和罗格列酮序贯用药对改善多囊卵巢综合征（PCOS）患者生育功能的临床疗效。方法30例氯米芬抵抗的PCOS胰岛素抵抗患者，口服复方醋酸环丙孕酮3个月后，罗格列酮联合氯米芬用药6个月，比较用药前后体重指数、月经周期、生殖激素水平、排卵率、妊娠率、血糖和胰岛素水平的变化。结果与用药前相比，服用复方醋酸环丙孕酮后，雄激素水平和LH／FSH值明显降低（P〈0．05），服用罗格列酮后，胰岛素抵抗指数（Homa IR）、胰岛素分泌指数（Homa β）以及β细胞功能评定指数（MBCI）均较用药前降低（P〈0．05）。结论复方醋酸环丙孕酮和罗格列酮序贯用药可有效地抑制氯米芬抵抗的PCOS患者的高雄激素血症，改善胰岛素抵抗及生育功能。     

二甲双胍对体外受精/卵胞质内单精子显微注射中多囊卵巢综合征患者妊娠结局有效性的系统评价

目的:系统性评价二甲双胍对常规体外受精/卵胞质内单精子显微注射(IVF/ICSI)中多囊卵巢综合征(PCOS)患者妊娠结局的有效性,旨在为助孕前的干预措施提供理论依据。方法:计算机检索中国学术期刊全文数据库(CNKI)、万方数据库、维普数据库、Pub Med、Medline、Embase有关二甲双胍对IVF/ICSI中PCOS患者妊娠结局的临床随机对照试验(RCT)。按Cochrane系统评价方法,首先对纳入的文献进行质量评价和资料提取后,采用Rev Man5.2软件进行Meta分析。结果:纳入11个RCT研究,共1 310例患者,其中二甲双胍组713例,对照组597例。Meta分析结果显示:与对照组相比较,二甲双胍组的临床妊娠率(OR=1.60,95%CI:1.26~2.04,P=0.000 2)较高,卵巢过度刺激综合征(OHSS)发生率较低(OR=0.45,95%CI:0.31~0.64,P=0.000 1)。而活产率(OR=1.38,95%CI:0.98~1.94,P=0.06)和流产率(OR=0.72,95%CI:0.51~1.02,P=0.07)组间无统计学差异。结论:二甲双胍可提高IVF/ICSI中PCOS患者的妊娠率、降低OHSS发生率,但不能提高活产率及降低流产率。     

Use of cyproterone acetate/ethinylestradiol in polycystic ovary syndrome: rationale and practical aspects

Introduction: Polycystic ovary syndrome (PCOS) is a common, heterogeneous disorder characterised by hyperandrogenic skin symptoms, irregular menstruation and subfertility, increased risk of endometrial malignancy, and increased risk of preventable diseases associated with metabolic syndrome. Cyproterone acetate (CPA) 2?mg, combined with ethinylestradiol (EE) 35?μg, is indicated for the treatment of moderate to severe acne related to androgen-sensitivity (with or without seborrhea) and/or hirsutism, in women of reproductive age.

Objectives: To review the present knowledge about PCOS and summarize the role of CPA/EE in the care of patients suffering from this condition for the practitioner.

Methods: Experts with clinical interest and experience in treating symptoms of androgen excess performed a non-systematic review to provide updated information regarding the use of CPA/EE in patients with PCOS.

Results: Polycystic ovary-related hyperandrogenic skin symptoms are effectively treated by CPA/EE, reducing not only the symptoms but also their negative impact on quality of life and mental health. Proven additional benefits for these patients include the treatment of menstrual irregularities and reduction in endometrial cancer risk. Possible benefits include preservation of fertility. Treatment increases the risk for venous thromboembolic complications. The nature of other metabolic and cardiovascular long-term effects i.e., whether positive or negative, are still to be investigated.

Conclusions: Cyproterone acetate/ethinylestradiol provides effective treatment for PCO-related hyperandrogenic skin symptoms. This efficacy and additional benefits related to menstrual irregularities and endometrial cancer risk, have to be weighed against the risk of venous thromboembolic complications based on an individual benefit/risk evaluation.     

Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives

OBJECTIVE: To compare the effects of cyproterone acetate and desogestrel, as part of combined oral contraceptives, on lipid metabolism and hirsutism of adolescents with polycystic ovary syndrome (PCOS). DESIGN: Prospective randomized clinical trial. SETTING: Outpatient gynecology clinic (referral center) of a university. PATIENT(S): Twenty-eight adolescent girls with clinical and biological hyperandrogenism and six or less menses during the past 12 months. INTERVENTION(S): Group A (n = 14) received 0.15 mg of desogestrel plus 0.030 mg of ethinyl estradiol daily. Group B (n = 14) received 2 mg of cyproterone acetate plus 0.035 mg of ethinyl estradiol daily. Treatment was given for 21 days followed by a 7-day rest for a period of 12 months. MAIN OUTCOME MEASURE(S): Hirsutism and lipid profile were evaluated before initiation and at 3, 6, 9, and 12 months of treatment. Androgen profile was evaluated before and at 12 months of treatment. RESULT(S): A significant decline of the Ferriman-Gallway hirsutism score was observed from the sixth month of therapy in both groups. During therapy, the levels of testosterone, free testosterone, Delta(4)-androstenedione, and 17OH-progesterone decreased significantly, whereas sex hormone-binding globulin (SHBG) increased significantly in both groups. The level of total cholesterol and low density lipoprotein (LDL) cholesterol increased significantly, whereas high density lipoprotein (HDL) cholesterol and apolipoprotein A-I increased significantly from the third month of therapy in both groups. Total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios remained unchanged. The levels of triglycerides increased significantly in the cyproterone acetate-treated group after the third month. CONCLUSION(S): Treatment of adolescent girls with PCOS with the two studied formulations is comparably effective in decreasing hirsutism and androgen levels. Both combined oral contraceptives are associated with an increase of total cholesterol, LDL cholesterol, and HDL cholesterol levels and no change of the total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios. Treatment with the cyproterone acetate combined oral contraceptive is associated with a tendency toward increasing the levels of triglycerides.     

The effectiveness of metformin ovulation induction treatment in patients with PCOS: a systematic review and meta-analysis

Objective: To evaluate of metformin effectiveness of ovulation induction treatment in polycystic ovary syndrome (PCOS) women. Methods: Eight databases and nine related journals were searched for randomized controlled trails (RCTs) on the comparison between metformin and clomiphene citrate used for PCOS women. Meta analysis was performed after quality assessment. Results: Ovulation rate in metformin group compared with clomiphene citrate group was lower with a significant difference [OR = 0.48 (0.26–0.87), p = 0.01]; no significant difference was found for pregnancy rate [OR = 0.94 (0.26–3.43)], miscarriage rate [OR = 0.63 (0.06–6.47)] between two groups. Compared with the combination of metformin and clomiphene citrate group, pregnancy rate in metformin group was significantly lower [Peto OR = 1.56 (1.16–2.08), p = 0.003], but there was no significant difference in the two groups about ovulation rate [OR = 1.52 (0.95–2.45)], miscarriage rate [Peto OR = 1.40 (0.79–2.48)]. Conclusions: Compared with clomiphene citrate, metformin used for ovulation induction treatment in PCOS women, can promote ovulation induction and pregnancy rate, the effect of the combination treatment is better than that of a single drug use.     

No more surrogate end-points in randomised trials: the PCOSMIC trial protocol for women with polycystic ovary syndrome using metformin for infertility with clomiphene

Current data supporting the effectiveness of metformin as a fertility treatment for women with polycystic ovary syndrome have been misinterpreted. Still unproven for women with polycystic ovary syndrome is, first, whether metformin adds to the standard first-line fertility management in all women, second, whether metformin is an effective fertility treatment for overweight women, and third, the relative fertility efficacy of metformin and clomiphene citrate as a first-line treatment in women with a lower body weight. The PCOSMIC (polycystic ovary syndrome: metformin for infertility with clomiphene) trial is an ongoing New Zealand multicentre double-blind placebo-controlled parallel randomised trial assessing these questions.