比索洛尔联合胰岛素增敏剂治疗对PCOS患者内分泌功能的影响

目的：探讨比索洛尔联合胰岛素增敏剂治疗对多囊卵巢综合征(PCOS)患者内分泌功能的影响。方法选择2011年8月至2014年8月我院内分泌科收治的60例PCOS患者，根据随机数表法将60例患者分为观察组(n=30)和对照组(n=30)，对照组接受胰岛素增敏剂吡格列酮治疗，观察组患者接受比索洛尔联合吡格列酮治疗，比较两组患者治疗前后的空腹胰岛素(FIN)、空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、雌二醇(E2)、睾酮(T)、孕酮(PRGE)、垂体泌乳素(PRL)、性激素结合蛋白(SHBG)、皮质酮(Cor)、促肾上腺皮质激素(ACTH)、肾上腺皮质激素释放激素(CRH)、促性腺激素释放激素(CnRH)、环磷酸腺苷和环磷酸鸟苷的变化，并对疗效进行评价。结果治疗后，观察组患者的FIN (18.5±3.9) mIU/L vs (26.3±4.7) mIU/L]、FPG (7.13±1.4) mmol/L vs (4.72±1.7) mmol/L]、HOMA-IR (0.65±0.13) vs (0.42±0.19)]、HOMA-β(2.45±0.47) vs (1.69±0.14)]、E2(56.9±8.7) pg/mL vs (46.9±10.5) pg/mL]、T (58.5±4.2) ng/dL vs (39.6±6.7) ng/dL]、PRGE (0.69±0.21) pg/mL vs (0.52±0.17) pg/mL]、PRL (17.5±5.3) pg/mL vs (13.2±4.7) pg/mL]和环磷酸腺苷水平(26.9±3.5) pmol/L vs (21.2±2.4) pmol/L]较治疗前均明显降低(P<0.05)，SHBG (18.5±3.9) nmol/L vs (26.3±4.7) nmol/L]、Cor (18.5±3.9) ng/mL vs (26.3±4.7) ng/mL]、ACTH (18.5±3.9) ng/mL vs (26.3±4.7) ng/mL]、CRH (53.7±6.4) pg/mL vs (61.3±7.2) pg/mL]和环磷酸鸟苷的水平(25.6±4.9) pmol/L vs (27.1±1.8) pmol/L]较治疗前均明显升高，差异均有统计学意义(P<0.05)；治疗后，对照组患者的FIN (25.9±3.7) mIU/L vs (18.5±3.9) mIU/L]、FPG (7.09±0.93) mmol/L vs (5.52±1.86) mmol/L]、HOMA-IR (0.67±0.14) vs (0.45±0.11)]、HOMA-β(2.39±0.96) vs (2.08±0.33)]、E2(57.8±6.4) pg/mL vs (46.9±10.5) pg/mL]、T (59.6±5.5) ng/dL vs (45.8±9.1) ng/dL]、PRGE (0.67±0.19) pg/mL vs (0.53±0.15) pg/mL]和PRL (17.4±3.3) pg/mL vs (14.2±5.6) pg/mL]较治疗前均明显降低，SHBG (84.3±15.8) nmol/L vs (131.9±30.1) nmol/L]水平较治疗前明显升高，差异均有统计学意义(P<0.05)，而Cor、ACTH、CRH、环磷酸腺苷水平和环磷酸鸟苷水平较治疗前均无明显变化(P>0.05)；观察组患者的治疗总有效率为93.33%，明显高于对照组的66.67%，差异有统计学意义(P<0.05)。结论比索洛尔联合胰岛素增敏剂吡格列酮治疗PCOS可明显改善患者机体的内分泌环境，提高患者的治疗效果。

Effect of bisoprolol combined with insulin sensitizer on endocrine function of patients with polycystic ovary syndrome

Objective To explore the influence of bisoprolol combined with insulin-sensitizing agent on endo-crine function of patients with polycystic ovary syndrome (PCOS). Methods Sixty patients of PCOS treated in Depart-ment of Endocrinology in our hospital during August 2011 to August 2014 were randomly divided into observation group (n=30) and control group (n=30) according to the random number table method. The control group received insulin sensitiz-er pioglitazone treatment, and observation group received bisoprolol combined with pioglitazone treatment. Endocrine-relat-ed indicators in two groups before and after treatment were compared, including fasting insulin (FIN), fasting plasma glucose (FPG), homeostasis model assessment of insulin resistance (HOMA-IR), HOMA-β, estradiol (E2), testosterone (T), proges-terone (PRGE), pituitary prolactin (PRL), sex hormone-binding protein (SHBG), corticosterone (Cor), adrenocorticotropic hormone (ACTH), corticotrophin-releasing hormone (CRH), stimulating gonadotropin-releasing hormone (CnRH), cyclic ad-enosine monophosphate, cyclic guanosine monophosphate. Also, the efficacy of treatment was evaluated. Results After treatment, FIN (18.5 ± 3.9) mIU/L vs (26.3 ± 4.7) mIU/L], FPG (7.13 ± 1.4) mmol/L vs (4.72 ± 1.7) mmol/L, HOMA-IR (0.65±0.13) vs (0.42±0.19)], HOMA-β(2.45±0.47) vs (1.69±0.14)], E2 (56.9±8.7) pg/mL vs (46.9±10.5) pg/mL], T (58.5±4.2) ng/dL vs (39.6±6.7) ng/dL, PRGE (0.69±0.21) pg/mL vs (0.52±0.17) pg/mL], PRL (17.5±5.3) pg/mL vs (13.2±4.7) pg/mL], and cyclic adenosine monophosphate (cAMP) levels (26.9±3.5) pmol/L vs (21.2±2.4) pmol/L] in the observation group were significantly lower than those before treatment (P<0.05), while SHBG (18.5 ± 3.9) nmol/L vs (26.3±4.7) nmol/L], Cor (18.5±3.9) ng/mL vs (26.3±4.7) ng/mL], ACTH (18.5±3.9) ng/mL vs (26.3±4.7) ng/mL, CRH (53.7 ± 6.4) pg/mL vs (61.3 ± 7.2) pg/mL and cyclic guanosine monophosphate (cGMP) levels (25.6 ± 4.9) pmol/L vs (27.1±1.8) pmol/L] were significantly higher than that before treatment (P<0.05). After treatment, FIN (25.9±3.7) mIU/L vs (18.5±3.9) mIU/L], FPG (7.09±0.93) mmol/L vs (5.52±1.86) mmol/L], HOMA-IR (0.67±0.14) vs (0.45±0.11)], HOMA-β(2.39±0.96) vs (2.08±0.33)], E2 (57.8±6.4) pg/mL vs (46.9±10.5) pg/mL], T (59.6±5.5) ng/dL vs (45.8±9.1) ng/dL], PRGE (0.67 ± 0.19) pg/mL vs (0.53 ± 0.15) pg/mL] and PRL (17.4 ± 3.3) pg/mL vs (14.2 ± 5.6) pg/mL] were significantly lower than before treatment, while SHBG (84.3±15.8) nmol/L vs (131.9±30.1) nmol/L] in the control group were significantly higher than those before treatment (P<0.05), with no statistically significant change in Cor, ACTH, CRH, cAMP and cGMP levels (P>0.05). The total effective rate was 93.33%in the observation group, which was significantly higher than 66.67%in the control group (P<0.05). Conclusion Bisoprolol combined with insulin sensitizing agents can significant-ly improve the body's endocrine environment in PCOS patients and the patient's treatment effect.