罗格列酮对多囊卵巢综合征的疗效观察

目的　探讨噻唑烷二酮类药物罗格列酮对多囊卵巢综合征 (PCOS)患者的代谢和性激素紊乱的作用。方法　48名PCOS患者按体重指数(BMI)分为非肥胖组和肥胖组。每位患者每天空腹口服 4mg罗格列酮,共 12周。测定治疗前后BMI、腰臀比(WHR)、胰岛素、胰岛素原 (PI)、血浆纤溶酶原激活物抑制物 1(PAI 1)、血脂、血压、肝功能、肾功能、稳态模型胰岛素抵抗指数 (HOMA IR)、FSH、LH、睾酮 (T),观察月经、卵泡发育情况(阴式或腹式B超 )。结果　罗格列酮治疗前,与非肥胖组相比,肥胖组收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、FPI、FINS、FPG、PAI 1、T均升高,差异有统计学意义 (均P<0. 05)。非肥胖组罗格列酮治疗后,FPI、FINS、HOMA IR、PAI 1、LH水平与治疗前相比均下降,差异有统计学意义(均P<0. 05)。肥胖组罗格列酮治疗后,SBP、TG、TC、FPI、FINS、HOMA IR、FPG、PAI 1、T、LH水平与治疗前相比均下降差异有统计学意义(均P<0. 05 )。结论　罗格列酮可降低PCOS患者的FINS、FPI、PAI 1、TG等水平,起到有效治疗及预防PCOS患者并发糖尿病,高血压,心血管疾病等代谢并发症的作用;罗格列酮可降低LH、T,调整生殖内分泌紊乱,调节月经周期,促进优势卵泡发育,治疗不孕症。

Therapeutic effects of rosiglitazone in patients with polycystic ovarian sydrome

Objective To evaluate the effect of rosiglitazone, one of the thiazolidinediones (TZD), on metabolism and reproductive hormone disturbance in patients with polycystic ovarian sydrome (PCOS). Methods Subjects were divided into 2 groups according to body mass index (BMI): the group of nonobese patients with PCOS (n=20) and the group of obese patients with PCOS (n=28). All patients with PCOS were administered rosiglitazone 4 mg/d for 12 weeks. BMI, waist hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL C), high density lipoprotein cholesterol (HDL C), triglyceride (TG), fasting proinsulin (FPI), fasting insulin (FINS), fasting plasma glucose (FPG), plasminogen activator inhibitor 1 (PAI 1), HOMA IR, FSH, T and LH were measured and/or calculated, and menstruation and development of ovarian follicles were obeserved. Results In basal state, SBP, DBP and levels of TG, FPI, FINS, FPG, PAI 1 and T in obese group were significantly higher than these in non obese group. Rosiglitazone treatment significantly reduced FPI, FINS, HOMA IR, PAI 1 and LH levels (all P<0.05) of non obese group. Similarly, reductions in SBP, TG, TC, FPI, FINS, HOMA IR, FPG, PAI 1, T and LH levels (all P<0.05) were also seen in obese group. Conclusion Rosiglitazone ameliorates insulin resistance, hyperinsulinemia, hyperproinsulinemia, dysfunction of pancreatic islets cell, sex hormone disturbance and anovulatory infertility in PCOS patients, which seems to be helpful in preventing the complications of diabetes mellitus as well as coronary heart disease.