复方孕二烯酮与二甲双胍联合应用对PCOS患者IGF-1、IGFBP-1、 肾素-血管紧张素系统及促排卵结局的影响

目的:研究二甲双胍与复方孕二烯酮(复方GES)对多囊卵巢综合征(PCOS)患者卵巢肾素-血管紧张素系统(RAS)、血清胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-1(IGFBP-1)、性激素水平及促排卵结局的影响并探讨其可能的作用机制。方法:选择PCOS患者40例,随机分为两组,实验组接受二甲双胍及复方GES治疗,连续3个月。治疗前后分别测定血浆肾素原(PRA)、血管紧张素Ⅱ(ATⅡ)及血清IGF-1、IGFBP-1、空腹胰岛素(INS)、空腹血糖(GLU)、黄体生成素(LH)、促卵泡素(FSH)、雄烯二酮(A2)、雌二醇(E2)、睾酮(T),测量每侧卵巢内卵泡数目、卵巢体积并观察临床症状的改善及服药期间的副反应。停药后开始促排卵治疗。对照组直接进行促排卵治疗。结果:实验组服药3个周期后,FSH(P<0.05)、LH、A2、E2、T水平及LH/FSH比值(P<0.01)均显著下降,血浆PRA、ATⅡ与空腹INS、BMI、INS/GLU比值显著降低(P<0.01)。IGFBP-1水平明显上升(P<0.05)。超声监测双侧卵巢体积显著缩小,卵泡数目明显减少(P<0.01)。促排卵治疗过程中,实验组HMG(或FSH)用量显著低于对照组(P<0.01),单卵泡生长率和HCG日A型内膜出现率均高于对照组(P<0.01),周期排卵率显著高于对照组(P<0.05)。结论:二甲双胍与复方GES合并用于PCOS患者,能改善PCOS患者内分泌水平,调节PCOS患者IR状态,显著提高PCOS患者CC+HMG方案促排卵治疗的效果,并减少促排卵并发症的发生。

Influence of compound gestodene and metformin on IGF-1,IGFBP-1,rennin-anootensin system and induced ovulation of polycystic ovary syndrome patients

Objective:To elucidate the effect of GES Co.and metformin on PCOS patient's rennin-angiotensin system(RAS),serme IGF-1,IGFBP-1,sex hormone level and the effect of GES Co.and metformin on PCOS patient's induced ovulation.The mechanism of GES Co.and metformin treatment on PCOS patients was also discussed.Methods:Forty proven PCOS patients were enrolledand separated into two groups at random.The studied groups were all treated daily with GES Co.and metformin for three cycles.Fasting blood samples of all patients were obtained to assess serum levels of PRA,ATⅡ,IGF-1,IGFBP-1,LH,FSH,T,A2,E2,fasting INS and fasting GLU.The evaluation was repeated after three cycles of treatment.Side effects were evaluated and the changes of clinical symptoms were observed.Bilateral ovarian volume and follicle numbers were measured with vaginal ultrasound before and after treatment.After stopping the drugs,they all accepted treatment of induced ovulation.The patients of the control group accepted the treatment of induced ovulation directly after completing all examinations and excepting other infertile factors.Results:In the studied group,the mean serum FSH(P<0.05),LH,A2,E2,T levels and LH/FSH ratioafter three cycles of treatment were significantly lower than those before treatment(P<0.01).The mean levels of serum PRA,ATⅡ,fasting INS,BMI,INS/GLU were also significantly lower than those before treatment(P<0.01).The serum IGFBP-1 levels was significantly higer than that before treatment(P<0.05).The patients' bilateral volumes and follicle numbers decreased significantly after 3 cycles of treatment(P<0.01).The symptoms were lightened significantly.The result of induced ovulation: During the treatment of induced ovulation,the mean dose of HMG(or FSH) of the studied group was significantly lower than that in the control group(P<0.01).The rate of single follicle growth and the rate of endometrium shape of A on the day of HCG injection were higer than those in the control group(P<0.01).The ovulation rate per cycle of the studied group was significantly higer than that of the control group(P<0.05).Conclusion:GES Co.can decrease the mean serum PRA and ATⅡ levels,enhance the serum level of IGFBP-1,decrease the serum levels of LH,T,A2 and LH/FSH ratio,decrease bilateral ovarian volumes and follicle numbers,alleviate the clinical symptoms of PCOS patients,and has no effect on the level of serum INS.GES Co.can increase the ovulation rate and pregnancy rate of induced ovulation significantly,and the complications are reduced significantly.