二甲双胍治疗青春期多囊卵巢综合征疗效分析

目的探讨青春期多囊卵巢综合征患者应用二甲双胍治疗的效果。方法35例青春期多囊卵巢综合征患者（其中有糖尿病家族史者7例）均测体质指数（BMI）、基础体温，进行毛发分度标准评分，抽血测定女性激素6项并行75g葡萄糖耐量试验（OGTT）和胰岛素释放试验。计算稳态模型的胰岛素抵抗指数（HOMA-IR）。确诊胰岛素抵抗者口服二甲双胍治疗，定期重复检测上述指标。结果有糖尿病家族史的患者均合并胰岛素抵抗，其与家族糖尿病史阴性者在糖耐量受损发病率分别为85％与19％；毛发分度标准评分为（9．71±3．44）分与（6．43±2．87）分；BMI为（33．78±2．77）kg／m2与（24．58±4．68）kg／m2；HOMA．IR为（14．35±4．95）与（4．87±0．79）；空腹胰岛素为（51．34±20．51）mU／L与（23．66±9．65）mU／L。负荷后2h胰岛素（241．55±40．09）mU／L及睾酮值（2．77±0．46）nmol／L均明显高于家族史阴性患者胰岛素（156．33±46．67）mU／L与睾酮值（1．73±0．33）nmol／L（均P〈0．01）。共7例胰岛素抵抗患者接受二甲双胍治疗，24个月后BMI、FG评分、空腹胰岛素、睾酮及促黄体生成素（LH）水平均比治疗前明显降低（均P〈0．05），并全部恢复排卵性月经。结论糖尿病家族中青春期多囊卵巢综合征患者可能存在较重胰岛素抵抗，坚持包括二甲双胍在内的长期治疗可明显改善胰岛素抵抗，并可恢复卵巢排卵功能。

Long-term effect of metformin on adolescent polycystic ovary syndrome

Objective To investigate the clinical effects of long-term mefformin treatment of adolescent polycystic ovary syndrome(PCOS).Methods Among 35 adolescent PCOS women,7 had diabetic family history.Body mass index (BMI),basal body temperature (BBT),sex hormone concentration,75 g oral glucose tolerance tests (OGTT) and insulin release tests (IRT) were tested in all cases.Homeostatic model assessment insulin resistance index(HOMA-IR) were calculated.Patients with insulin resistance(IR) received mefformin therapy.Most tests above-mentioned were repeated at certain time.Results Seven patients with diabetic family history all suffered from IR and had higher Ferriman-Gallway(FG) points,BMI,HOMA-IR,fasting insulin(I0),2 h insulin(I120),T level and incidence of Impaired glucose tolerance(IGT) than those without diabetic family history (P＜0.01).Among 7 cases receiving the mefformin therapy,their BMI,FG points,fasting insulin(I0) concentration,T and LH level decreased significantly after 24 months treatment(P＜0.05),and all cases resumed their ovulation.Conclusions Adolescent PCOS women may all have severe IR and can be treated the long-term mefformin therapy.