罗格列酮对多囊卵巢综合征胰岛素抵抗及高雄激素血症的治疗研究

目的　探讨胰岛素增敏剂罗格列酮对多囊卵巢综合征 (PCOS)的胰岛素抵抗及高雄激素血症的治疗效果。方法　对 30例PCOS患者给予每天早餐前口服 4mg罗格列酮 ,共 1 2周 ,比较治疗前后体重指数、胰岛素、血糖和血脂、瘦素和神经肽Y以及生殖激素水平与排卵率的变化。结果治疗 1 2周后 ,基础胰岛素水平从 (1 8± 8)mIU/L降至 (1 2± 7)mIU/L(P <0 0 1 ) ,胰岛素抵抗指数从4 3± 1 2降至 2 6± 0 7(P <0 0 1 )。黄体生成素从 (1 5 4± 4 4)U/L降至 (7 9± 2 1 )U/L ,游离睾酮从(1 2 5± 1 9)pmol/L降至 (8 9± 1 4)pmol/L ,雄烯二酮从 (9 8± 1 7)nmol/L降至 (7 4± 1 2 )nmol/L ,差异均有极显著性 (P均 <0 0 1 ) ;硫酸脱氢表雄酮从 (8 7± 3 5) μmol/L降至 (6 9± 2 1 ) μmol/L(P<0 0 5) ;性激素结合球蛋白从 (39± 3)nmol/L升至 (58± 5)nmol/L(P <0 0 1 )。血浆瘦素水平从 (1 8±4) μg/L降至 (1 3± 3) μg/L(P <0 0 1 )。 30例月经稀发的患者 ,2 5例恢复排卵 ,排卵率 50 %。 结论　罗格列酮可降低PCOS患者血浆瘦素水平 ,改善胰岛素敏感性 ,进而改善高雄激素血症等内分泌紊乱 ,恢复有排卵月经

Effect of rosiglitazone on insulin resistance and hyperandrogenism in polycystic ovary syndrome

OBJECTIVE: To evaluate the effect of rosiglitazone on insulin resistance and hyperandrogenism in polycystic ovary syndrome (PCOS). METHODS: Rosiglitazone was given 4 mg daily to 30 patients with PCOS for 12 weeks. Before and after treatment, body mass index (BMI), plasma glucose, insulin, levels insulin resistance index (HOMA IR), blood lipid spectrum, leptin, neuropeptide Y, and sex hormone concentrations and ovulation rate were determined and compared. RESULTS: After 12 weeks of treatment, basal insulin level decreased from (18 +/- 8) to (12 +/- 7) mIU/L (P < 0.01), HOMA IR decreased from 4.3 +/- 1.2 to 2.6 +/- 0.7 (P < 0.01). Luteinizing hormone, free testosterone and androstenedione levels decreased [(15.4 +/- 4.4) versus (7.9 +/- 2.1) U/L, (12.5 +/- 1.9) versus (8.9 +/- 1.4) pmol/L, (9.8 +/- 1.7) versus (7.4 +/- 1.2) nmol/L respectively, P < 0.01]; Dehydroepiandrosterone sulfate level also decreased [(8.7 +/- 3.5) versus (6.9 +/- 2.1) micromol/L, P < 0.05]; Sex hormone binding globulin level increased [(39 +/- 3) versus (58 +/- 5) nmol/L, P < 0.01]. Plasma leptin level was decreased [(18 +/- 4) versus (13 +/- 3) microg/L, P < 0.01]. Ovulation rate increased to 50%. CONCLUSION: Rosiglitazone might decrease plasma leptin level and improve insulin sensitivity, which led to alleviation of hyperandrogenism and resumption of ovulation and menses in patients with PCOS.