来曲唑对多囊卵巢综合征患者性激素结合球蛋白水平及糖脂代谢指标的影响

目的探究来曲唑(LE)对多囊卵巢综合征(PCOS)患者性激素结合球蛋白(SHBG)水平及糖脂代谢指标的影响。方法选取2016年6月至2019年6月本院诊治的80例PCOS患者为研究对象。根据非随机临床同期对照研究及患者自愿原则分为观察组、对照组,每组40例,对照组患者口服枸橼酸氯米芬片(初始剂量50 mg/d,无排卵反应后增至100mg/d)治疗,观察组给予LE(月经第5天口服LE,5 mg/d)治疗,两组均持续给药5 d,比较治疗前、疗程结束后两组糖脂代谢指标[总胆固醇(TC)、低密度脂蛋白(LDLC)、三酰甘油(TG)及空腹胰岛素(INS)、胰岛素抵抗指数(HOMA-IR)]、SHBG水平、性激素[卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)]水平、排卵、妊娠情况及药物安全性。结果与同组治疗前比较,疗程结束后两组TC、LDLC、TG、INS、HOMA-IR明显降低(P<0.05),且观察组INS、HOMA-IR明显低于对照组(P<0.05),与同组治疗前比较,疗程结束后两组SHBG、FSH明显升高、LH、E2、T明显降低,且观察组SHBG、FSH相较于对照组显著升高、LH、E2、T显著降低(P<0.05),观察组周期排卵率、临床妊娠率明显高于对照组(χ^2=4.228、4.073,P<0.05),观察组不良反应总发生率与对照组比较差异无统计学意义(P>0.05)。结论LE治疗PCOS患者的促排卵效果显著,可明显降低SHBG水平、调节性激素水平并提高临床妊娠率,而促排卵治疗前需指导应用抗雄激素药物、胰岛素增敏剂以有效调节患者的糖脂代谢指标。

Effects of Letrozole on Sex Hormone-binding Globulin Level and Glucose-lipid Metabolism Indexes in Patients with Polycystic Ovary Syndrome

Objective To explore effects of letrozole(LE)on sex hormone-binding globulin(SHBG)level and glucose-lipid metabolism indexes in patients with polycystic ovary syndrome(PCOS).Methods 80 patients with PCOS who were treated in the hospital from June,2016 to June,2019 were selected as the study subjects.They were divided into the observation group and control group according to the principles of non-randomized clinical concurrent controlled trial and patient’s voluntariness,with 40 cases in each group.The control group orally took clomifene citrate tablets(the initial dose was 50mg/day which was increased to 100mg/day if there was no ovulation reaction),while the observation group were treated with LE(patients took LE orally from the 5th day of menstruation,5mg/day).Both groups were given 5 days of medication.The levels of glucose-lipid metabolism indexes[total cholesterol(TC),low density lipoprotein cholesterol(LDLC),triglyceride(TG),fasting insulin(INS),homeostasis model assessment of insulin resistance(HOMA-IR)],levels of SHBG and sex hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),testosterone(T)],ovulation,pregnancy and drug safety before the treatment and after the end of course were compared between the two groups.Results After the treatment,TC,LDLC,TG,INS and HOMA-IR in both groups were significantly decreased(P<0.05).INS and HOMA-IR of the observation group were significantly lower than those of the control group(P<0.05).After the end of course,SHBG and FSH in both groups were significantly increased,while LH,E2 and T were significantly decreased.SHBG and FSH in the observation group were significantly higher than those in the control group,while LH,E2 and T were significantly lower(P<0.05).The cycle ovulation rate and clinical pregnancy rate in the observation group were significantly higher than those in the control group(χ^2=4.228,4.073,P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The ovulation induction effect of LE is significant on PCOS patients,which can significantly reduce SHBG level,regulate sex hormones levels and improve clinical pregnancy rate.Before the ovulation induction therapy,usage of anti-androgen drugs and insulin sensitizers should be guided to effectively regulate glucose-lipid metabolism indexes of patients.