二甲双胍治疗肥胖型和非肥胖型多囊卵巢综合征的疗效观察

目的 探讨二甲双胍改善肥胖型和非肥胖型多囊卵巢综合征（PCOS）患者内分泌和生殖功能的效果.方法 84例PCOS患者给予二甲双胍1 500 mg/d,治疗3个月经周期；肥胖组48例,非肥胖组36例.比较治疗前后临床变化和内分泌变化.记录排卵率和妊娠率,与用克罗米芬促排卵治疗的35例PCOS患者（18例肥胖患者和17例非肥胖患者）比较.结果 二甲双胍治疗3个月经周期肥胖组患者体质指数（BMI）、腰臀比（WHR）、总睾酮、空腹胰岛素和黄体生成素/卵泡刺激素均较治疗前下降,差异均有统计学意义（P＜0.05,P＜0.01）；而非肥胖组治疗前后比较,各项指标虽有改变,但差异均无统计学意义（P＞0.05）.3个月经周期后,不论是肥胖组还是非肥胖组患者,用二甲双胍治疗后累积排卵率高于用克罗米芬,但差异无统计学意义（P＞0.05）.肥胖组用二甲双胍和克罗米芬治疗后累积妊娠率分别是54.17％ （26/48）和27.78％（5/18）;非肥胖组用二甲双胍和克罗米芬治疗后累积妊娠率分别是58.33％（21/36）和29.41％（5/17）,二甲双胍累积妊娠率高于克罗米芬,差异有统计学意义（P＜0.05）.结论 二甲双胍能改善PCOS患者内分泌状态,促进排卵,提高妊娠率.

The curative effects of metformin in polycystic ovary syndrome patients with obese and without obese

Objective To explore the efficacy of metformin for improving the endocrine and reproductive function in polycystic ovary syndrome （PCOS） patients with obese and without obese. Methods Eighty four infertility patients with PCOS （48 cases with obese and 36 cases without obese） were treated with mefformin at a dose of 1 500 mg daily for 3 menstrual cycles. The clinical and endocrine changes were compared before and after treatment. The ovulation rate and pregnancy rate of subjects treated by metformin were recorded, and compared with the ovulation rate and pregnancy rate of 35 PCOS cases （18 cases with obese and 17 cases without obese） treated by clomiphene citrate （CC）. Results After treatment of metformin for three menstrual cycles, the BMI, WHP, total testosterone and fast insulin and luteinizing hormone （LH）/folliclestimulatehonnone （FSH）inPCOSpatientswithobese decreased significantly （P〈0.05 or P〈0.01 ）, but the decreases of those indexes in PCOS patients without obese were not obvious （P〉0.05）. After treatment for three menstrual cycles, although the cumulative ovulation rate in metformin group was higher than that in CC group, there was no significant difference （P〉0.05）. The cumulative pregnancy rates in metformin group with obese and CC group with obese were 54.17% （26/48） and 27.78% （5/18）, respectively; the cumulative pregnancy rates in metformin group without obese and CC group without obese were 58.33% （21/36） and 29.41% （5/17）, respectively. The cumulative pregnancy rate in mefformin group was significantly higher than that in CC group （P〈0.05）. Conclusion Metformin could improve the endocrine condition, boost the ovulation and increase the pregnancy rates in PCOS patients.