二甲双胍和噻唑烷二酮类分别与达因-35联用治疗多囊卵巢综合征的疗效比较

目的:比较二甲双胍和噻唑烷二酮类(TZDs)分别与达因-35联用治疗多囊卵巢综合征(PCOS)的临床疗效。方法:随机将53例患者分成两组,A组予以二甲双胍治疗3个月后与达因-35共用3个月,B组予以TZDs治疗3个月后和达因-35共用3个月,总治疗期6个月,比较治疗前后内分泌激素、体重指数、血糖、排卵率等的改变。结果:两组治疗后胰岛素(INS)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、睾酮(T)及黄体生成素(LH)均明显降低(P<0.05,P<0.01)。A组降低体重优于B组,B组改善胰岛素抵抗优于A组。两组在排卵率和妊娠率方面无显著差异(P>0.05),双胍组4例自发性妊娠,TZDs组也有4例自发性妊娠。随访1年,8例婴儿发育均无异常。结论:二甲双胍和TZDs分别与达因-35联用,均能改善PCOS患者的胰岛素抵抗及内分泌紊乱,肥胖的PCOS患者推荐首选二甲双胍+达因-35,体重正常者或胰岛素抵抗严重者选用TZDs+达因-35。

The therapeutic effect of metformin and thiazolidinediones combined with Diane-35 in polycystic ovary syndrome

Objective:To compare the therapeutic effect of metformin and thiazolidinediones(TZDs) combined with Diane-35 in polycystic ovary syndrome(PCOS).Methods:53 cases of PCOS were randomly divided into two groups(group A was given metformin for 3 months and then plus Diane-35 for another 3 months;group B given TZDs for 3 months and then plus Diane-35 for another 3 months).The changes of endocrine hormone,body mass index,blood glucose and ovulation rate were compared before and after treatment.Results:After treatment,there were obvious decreases in insulin(INS),insulin resistance index(HOMA-IR),triglyceride(TG),low density lipoprotein(LDL-C),testosterone(T) and luteinizing hormone(LH) in both groups(P<0.05 or P<0.01).Cases in group A losed more weight than that in group B.Cases in group B had a better improvement in insulin resistance than that in group A.There were no significant differences in the rate of ovulation and the result of pregnancy between two groups(P>0.05).There were four spontaneous pregnancies in metformin combined with Diane-35 and four in TZDs combined with Diane-35 group.All eight babies developed normally at one year's follow-up.Conclusion:Both metformin plus Diane-35 and TZDs plus Diane-35 can improve the insulin resistance and imbalance of other endocrine hormones of PCOS cases.The first choice of PCOS cases with obese is metformin and Diane-35.While for the PCOS cases with normal weight or with severe insulin resistance,TZDs and Diane-35 is a better choice.