屈螺酮炔雌醇片联合二甲双胍对多囊卵巢综合征患者胰岛素抵抗的影响

目的观察屈螺酮炔雌醇片联合二甲双胍对多囊卵巢综合征（PCOS）患者胰岛素抵抗的影响。方法将62例PCOS患者采用随机数字表法分为观察组和对照组，每组31例。对照组给予屈螺酮炔雌醇片治疗，1片/d，21 d为1个疗程，停药后月经来潮的第5天开始下一个疗程，连续服药6个疗程。观察组给予屈螺酮炔雌醇片联合二甲双胍治疗，前药用法相同，二甲双胍0.5 g/次，3 次/d。治疗前后分别检测2组患者性激素水平和胰岛素抵抗指数，并比较2组排卵率和妊娠率。结果治疗6个疗程后，2组患者黄体生成素、黄体生成素/卵泡刺激素比值、睾酮、雌二醇和胰岛素抵抗指数水平均较明显低于治疗前［观察组：（8.8±2.7）U/L比（14.2±3.6）U/L，（0.9±0.3） 比（2.0±0.5），（1.8±0.6）mmol/L比（2.7±0.8）mmol/L，（96±20）pmol/L 比（139±24）pmol/L，（1.6±0.6）比（3.7±0.9）；对照组：（11.2±3.1）U/L比（14.3±3.3）U/L，（0.9±0.3） 比（1.3±0.5），（2.1±0.6）mmol/L比（2.7±0.8） mmol/L，（115±22）pmol/L比（136±26） pmol/L，（2.8±0.7）比（3.7±0.9），均P＜0.01］；卵泡刺激素明显高于治疗前［观察组：（10.2±2.4）U/L比（6.9±1.5）U/L；对照组：（8.8±1.7）U/L比（7.0±1.5）U/L，均P＜0.01］；观察组治疗后各指标与对照组治疗后比较，差异均有统计学意义（均P＜0.01）；观察组患者排卵率和妊娠率均明显高于对照组，差异有统计学意义［64.5%（20/31）比38.7%（12/31），38.7%（12/31）比16.1%（5/31）］（P＜0.05）。结论屈螺酮炔雌醇片联合二甲双胍能改善PCOS患者高雄激素状态和胰岛素抵抗，从而提高患者排卵率及妊娠率。

Influence of drospirenone and ethinylestradiol tablets combined with metformin on insulin resistance in patients with polycystic ovary syndrome

ObjectiveTo observe the influence of drospirenone and ethinylestradiol tablets combined with metformin on insulin resistance in patients with polycystic ovary syndrome. MethodsSixty two patients with polycystic ovary syndrome were selected and randomly divided into control group and observation group, with 31 cases in each group. Patients of the control group were given drospirenone and ethinylestradiol tablets from the 5th day of the menstrual cycle for a total of 21 days with 6 menstrual cycles. Patients of the observation group were given metformin in addition. Sex hormone level and insulin resistance index were measured before and after treatment. The ovulation and pregnancy rates were evaluated in two groups. Results After 6 courses treatment,luteinizing hormone, luteinizing hormone/follicle stimulating hormone ratio, testosterone, estradiol and insulin resistance showed a significantly reduction compared with those before treatment [observation group（14.2±3.6）U/L,（2.0±0.5）,（2.7±0.8）mmol/L,（139±24）pmol/L,（3.7±0.9）; control group（14.3±3.3）U/L,（2.1±0.5）,（2.7±0.8） mmol/L,（136±26） pmol/L,（3.7±0.9）]; follicle stimulating hormone was significantly higher than before treatment [observation group （6.9±1.5） U/L,control group （7.0±1.5） U/L]（P〈0.01）. There were significant differences between the observation group and control group after treatment [luteinizing hormone （8.8±2.7） U/L vs （11.2±3.1） U/L, follicle stimulating hormone （10.2±2.4） U/L vs （8.8±1.7） U/L, luteinizing hormone/follicle stimulating hormone （0.9±0.3） vs （1.3±0.5）, testosterone （1.8±0.6） mmol/L vs （2.1±0.6）mmol/L, estradiol （96±20）pmol/L vs （115±22）pmol/L, insulin resistance （1.6±0.6） vs （2.8±0.7）]（P〈0.01）. The ovulation and pregnancy rates were significantly higher in the observation group compared with those in control group[64.5%（20/31） vs 38.7%（12/31）, 38.7%（12/31） vs 16.1%（5/31）]（P〈0.05）. ConclusionsDrospirenone and ethinylestradiol tablets combined with metformin can improve the elevated androgen levels and insulin resistance in patients with polycystic ovary syndrome. The ovulation and pregnancy rates are significantly improved with drospirenone and ethinylestradiol tablets combined with metformin.