肥胖型与非肥胖型多囊卵巢综合征的内分泌代谢特征及其治疗

①目的 探讨肥胖型和非肥胖型多囊卵巢综合征（PCOS）的内分泌代谢特征及分型治疗。②方法 选择30例PCOS不孕病人为观察组，30例非PCOS不孕病人为对照组，测定两组体质量指数（BMI）、腰臀围比值（WHR）、多毛评分（F-G评分）及生殖内分泌激素、糖代谢指标等。观察组根据BMl分为肥胖组和非肥胖组，比较上述各项指标的不同。同时观察组又根据胰岛素抵抗程度分为胰岛素抵抗组和非胰岛素抵抗组，分别应用二甲双胍和复方醋酸环丙孕酮治疗12周后，重复测定上述指标并比较其变化。③结果 观察组治疗前BMI、WHR、F-G评分、促黄体生成素（LH）、睾酮（T）、雄烯二酮（A）、空腹胰岛素（FI）、胰岛素抵抗指数（HomaIR）等较对照组增高，胰岛素样生长因子、性激素结合球蛋白（SHBG）较对照组降低，差异均有显著性（t=2．25～5．66，P〈0．05）。肥胖组FI、Homa IR高于非肥胖组，LH、SHBG低于非肥胖组，差异均有显著性（t=2．06～3．14，P〈0．05）。胰岛素抵抗组治疗后FI、HomaIR、胰岛素曲线下面积、A降低；而非胰岛素抵抗组治疗后LH、A降低，SHBG升高，差异均有显著性（t=2．16～3．19，P％0．05）。④结论 肥胖型PCOS主要表现为高胰岛素血症及胰岛素抵抗，而非肥胖型PCOS则以促黄体生成素异常为主。二甲双胍治疗胰岛素抵抗PCOS效果较好，复方醋酸环丙孕酮治疗非胰岛素抵抗PCOS有效。

ENDOCRINE AND METABOLIC CHARACTERISTICS AND TREATMENT OF POLYCYSTIC OVARIAN SYNDROME WITH AND WITHOUT OBESITY

Objective To study the endocrine and metabolic characteristics and treatment of polycystic ovarian syndrome(PCOS)with and without obesity. Methods Thirty PCOS infertile patients were selected into the observation group(Group A), and another non-PCOS infertile patients into the control group(Group B). Body mass index(BMI), waist/hip ratio(WHR), Ferryman-Gallway score(FGS), gonadotrophin, testosterone(T),4-androstenedione(A), sex hormone binding globulin(SHBG), fasting insulin(FI), glucose tolerance, insulin-like growth factor 1(IGF-1), insulin-like growth factor binding protein-1(IGFBP-1) were observed. Patients in Group A were subdivided into obesity and non-obesity groups on the basis of BMI, and insulin-resistant and non-insulin-resistant groups on the basis of insulin resistance(Homa IR). The women in the insulin-resistant and non-insulin-resistant groups were treated for 12 weeks with metformin and cyproterone acetate(CPA), respectively. Results BMI, WHR, FI, LH, A, T, and RF were significantly higher, while IGF-1,SHBG was lower, in Group A than in Group B ( t= 2.25- 5.66, P <0.05). Serum FI concentration and Homa IR in the obesity group were higher, while LH and SHBG were lower, than in non-obesity group ( t=2.06-3.14, P <0.05). FI, Homa IR, insulin AUC, and A deceased in the insulin-resistant group with metformin therapy. Serum LH, A, and SHBG concentration decreased, but SHBG increased in the non-insulin-resistant group after 12 weeks of CPA therapy ( t=2.16-3.19, P <0.05). Conclusion The patients of the obesity group showed high levels of insulin and insulin resistance, while those of the non-obesity group showed mainly high level of LH. Serum insulin concentration can be decreased and the insulin sensitivity increased with metformin therapy. Serum LH and T concentrations in the non-insulin-resistant group can be decreased by CPA therapy.