二甲双胍治疗耐克罗米芬的多囊卵巢综合征40例分析

目的：观察二甲双胍单用或联合高纯度卵泡刺激素（metrodin-HP即FSH－HP）治疗耐克罗米芬（CC)多囊卵巢综合征（PCOS）患者的疗效。方法：选择耐CC的PCOS患者40例，随机分成A组和B组。A组：20例患者从卵泡早期开始服二甲双胍，每天1500mg共12周，若未孕则加FSH－HP促排卵1个周期，B组；20例患者单独用FSH－HP促排卵1个周期。测定所有患者的性激素、空腹血糖（FG）及空腹胰岛素（FINS）。结果：服二甲双胍后，LH、T及FINS的水平明显下降（P＜0．05），A组有7例患者排卵且3例妊娠，妊娠率为15．0％，17例未孕者继续服二甲双胍联合FSH－HP促排卵，15例排卵和4例妊娠，妊娠率23．5％，B组单用FSH－HP促排卵，有14例排卵且3例妊娠，妊娠率15．0％，两者的妊娠率差异无显著性意义（P＞0．05）。A组的FSH－HP用量少于B组，差异有显著性意义（P＜0．05），中度以上OHSS发生率分别为0和10％，前者的发生率低于后者（P＜0．05）。结论：单用二甲双胍能使部分患者恢复排卵和妊娠。FSH－HP联合二甲双胍能减少FSH－HP的用量和OHSS的发生。二甲双胍单用或联合FSH－HP促排卵为耐CC的PCOS患者找到一种有效的治疗方法。

Analysis of 40 cases of clomiphene-resistant polycystic ovary syndrome treated by metformin

Objective To observe the effects of metformin alone and metformin plus FSH-HP in the treatment of patients with polycystic ovary syndrome (PCOS) who are resistant to clomiphene citrate (CC). Methods Forty PCOS patients with CC-resistant were randomly assigned into two groups. Patients in group A ( n =20) were given metformin, 1 500mg daily for 12 weeks from early follicular phase ,if no pregnancy was obtained, plus FSH-HP 1 cycle for induction of ovulation. Patients in group B were induced ovulation with FSH-HP alone for 1 cycle. The levels of serum FSH,LH,T, glucose and insulin at fasting (FG and FINS) were measured in all patients. Results In group A,the levels of serum LH, T and FINS were significantly decreased when compared with those of pre-treatment levels ( P < 0. 05 ) , and 3 of 7 o-vulated women conceived after the treatment of metformin alone,with the pregnancy rate of 15%. In 17 failed pregnancy patients, there were 15 patients ovulated and among them,4 conceived after add FSH-HP with pregnancy rate of 23. 5%. In group B,fourteen patients ovulated,and three of them conceived by using FSH-HP only with pregnancy rate of 15. 0%. The rates of pregnancy showed no significant differences (23. 5% vs 15. 0% , P > 0. 05). The ampoules of FSH-HP used was much more in group B than in group A ( P <0. 05). Ovarian hyperstimulation syndrome (OHSS) in middle or higher grade developed in 2 cases (10% ) in group B and none in group A ( P < 0. 05). Conclusion Metformin therapy in women with PCOS can induce ovulation and pregnancy. FSH-HP combined with metformin may reduce the ampoules of FSH-HP and the risk of OHSS. Metformin alone or plus FSH-HP is a very effective way in the treatment of CC-resistant P-COS.