达英-35联合二甲双胍治疗多囊卵巢综合征伴不孕27例临床效果观察

目的探讨多囊卵巢综合征（PCOS）伴不孕患者达英-35（炔雌醇环丙孕酮）联合二甲双胍预治疗前后内分泌的改变、随后的促排卵效果及妊娠率的变化。方法将47例确诊为PCOS伴不孕的患者随机分为实验组和对照组。实验组给予达英-35联合二甲双胍预治疗3～6个周期后再促排卵治疗。对照组完善各项检查后直接促排卵治疗。对比实验组治疗前后基础卵泡刺激素（FSH）、黄体生成素（LH）、睾酮（T）、LH／FSH值、稳态模型的胰岛素抵抗指数（HOMA-IR）、B超下窦卵泡计数（AFC）变化情况，并统计其排卵率及妊娠率；对比实验组和对照组的排卵率和妊娠率。结果实验组治疗后临床症状明显改善，经量较前增多，痤疮不同程度改善，激素水平LH、T、LH／FSH，以及HOMA-IR、AFC治疗前后比较差异有统计学意义（P〈0．05），均降到接近正常范围。实验组周期排卵率、妊娠率均显著高于对照组。差异有统计学意义（P〈0．05）。结论达英-35联合二甲双胍治疗PCOS能明显改善症状，调整激素水平，提高对促排卵药物的敏感性，增加妊娠率，是治疗多囊卵巢综合征较为理想的方法。

Clinical effects of Diane-35 plus Metformin on 27 cases of Infertile Patients with Polycystic Ovary Syndrome

Objective To observe the effects of Diane-35 （ cyproterone acetate, CPA） in combination with mefformin on the metabolic changes,the outcomes of ovulation induction and the pregnant rate in the infertility women with Polycystie ovarian syndrome（ PCOS）. Methods 47 infertile patients suffering PCOS randomly assigned into two groups. Study group firstly took Diane-35 cyclically plus metformin for three to six cycles before induced ovulation. Control group was induced ovulation without any pre-treatment. Before and after pre-treatment, all subjects including serum follicle stimulating hormone （ FSH ） . luteinzinghormone （ LH ） , LH/FSH, tes- tosterone（T） ,HOMA-IR,average follicle number（AFC） were measured in study group. The same method of induced ovulation was performed in the two groups. Compared the results of the different groups before and after treatment in study group. Results After CPA in combination with Metformin therapy in study group,significant decreases in concentration of LH,T, as well as the value of LH/FSH, AFC were observed （ P 〈 0. 05 ） ; All clinic symptoms like acne,hirsutism,cyclic menses,ovulation rate and pregnant rate were improved obviously in study group. Compared to control group, ovulatory rate per cycle and pregnant rate of study group were increased significantly（P 〈 0. 05）. Conclusion CPA in combination with Metformin therapy may normalize the endocrine level, and improve the ovarian response to ovulation drugs and increase the pregnancy rate of infertility patients with PCOS.