胰岛素增敏剂治疗多囊卵巢综合征伴胰岛素抵抗的前瞻性研究

目的 观察在多囊卵巢综合征(PCOS)并胰岛素抵抗(IR)患者中,二甲双胍与吡格列酮联合应用及吡格列酮单独应用的临床疗效.方法 对40例PCOS并IR患者进行前瞻性研究,并选取20例非PCOS不孕妇女为对照组.PCOS组根据BMI分为A、B两组,测定糖、脂代谢指标、生殖激素及C反应蛋白(CRP)等.A组20例(吡格列酮),B组20例(二甲双胍与吡格列酮).经12周治疗后,再比较上述各指标的变化.结果 PCOS组治疗前胰岛素水平、生殖激素及CRP等均较对照组增高.2组患者治疗后胰岛素抵抗指数、甘油三脂及血清睾酮(T)等均较治疗前明显降低(P＜0.05),B组BMI较治疗前明显下降(P＜0.05).应用协方差分析治疗后2组的各指标,2hINS、T在B组下降较A组更明显(P＜0.05).结论 二甲双胍与吡格列酮联用治疗PCOS并IR,较单用吡格列酮更有效；慢性炎症反应可能参与PCOS的发生及发展过程,慢性炎症的发生可能是胰岛素敏感性降低的原因之一.

Prospective study of insulin-sensitizer in treating of polycystic ovary syndrome with insulin resistance

【Objective】 To investigate the clinical theraputic effects of pioglitazone and pioglitazone plus metformin in patients of polycystic ovary syndrome(PCOS) with insulin resistance(IR).【Methods】 A prospective study involved total 40 PCOS patients as the examination group and 20 non-PCOS infertility patients as control.PCOS patients were divided into two groups according to BMI: group A(pioglitazone) and group B(pioglitazone plus metformin).Levels of sex hormone,C-reactive protein(CRP) were performed in all patients.After the end of 12-week therapy,above-mentioned parameters were re-evaluate-d.【Results】 PCOS patients had significant increases in levels of blood insulin,sex hormone,CRP comparing with the control group;after the treatment,levels of insulin,IR,triglyceride,testosterone(T) decreased significantly than before in both groups(P <0.05).BMI decreased significantly than before in group B(P <0.05).The levels of BMI,2hINS,T in group B were decreased significantly than group A by the covariance analysis.【Conclusion】 Pioglitazone plus metformin has better effects than pioglitazone mono-therapy;the chronic inflammation may participate in the pathogenesis of PCOS.Chronic inflammation may be one of the reasons to reducing insulin sensitivity.