药物治疗多囊卵巢综合征性不孕30例临床分析

目的探讨联合应用复方醋酸环丙孕酮(即达英-35)和二甲双胍治疗多囊卵巢综合征(PCOS)的临床疗效。方法30例PCOS合并高雄激素和胰岛素抵抗患者于自然月经或撤退性出血第5天服用达英-353个周期和二甲双胍3个月。服药前后观察临床表现、阴道超声卵巢体积及卵泡个数、血清生殖激素、血脂分析、空腹及餐后2小时血糖及胰岛素水平。在上述观察指标接近正常后,再用克罗米酚促排卵,待B超监测卵泡成熟,肌注绒毛膜促性腺素5000-10000U,并指导受孕。结果服药前后对比,30例患者血清黄体生成素(LH)、睾酮(T)水平均显著下降(P<0.01);空腹及餐后血清胰岛素(INS)水平显著下降(P<0.01);双侧卵巢体积和卵泡数目显著减少(P<0.01)。HDL-C上升,LDL-C下降(P<0.01),治疗后随访,20例患者恢复排卵性月经,并有17例妊娠。结论联合应用达英-35和二甲双胍治疗PCOS,可减轻临床症状,降低胰岛素水平,降低血脂,恢复正常的血激素相,卵巢大小、形态从卵泡数目均得到有效改善,有助于恢复排卵性月经,并获得妊娠。药物治疗能成功地为多囊卵巢综合征性不孕的患者解决生育问题并改善患者血脂及血糖的代谢。

Clinical analysis on 30 cases of infertile patients with polycystic ovarian syndrome by drug therapy

Objective To explore the clinical effect on infertile patients with polycystic ovarian syndrome (PCOS) by Diane-35 (ethinyl estmdiol and cyproterone acetate) plus metformin hydrochloride. Methods 30 PCOS patients who were combined with high androgen and insulin resistance were taken Diane-35 for 3 weeks and metformin hydrochloride for 3 months at the fifth day of the natural menses or withdrawal bleeding. The clinical symptom, ovarian volume and follicular amount by vagina ultrasonic, serum genital hormone, lipids in the blood, FPG, 2HPG and insulin were recorded. After above indexes were close to normal, the patients who were taken clomiphene to stimulate ovulation were given human chorionic gonadotrophin 5000-10000U by intramascular injection and were coached pregnancy. Results There was significant difference in LH, T, FINS, 2HINS, ovarian volume, follicular amount, HDL-C and LDL-C before and after treatment(p<0.01). The LH, T, FINS, 2HINS, ovarian volume, follicular amount, LDL-C reduced, And the HDL-C ascended in the 30 PCOS patients. 20 patients resumed menstrual ovulation and 17 patients got pregnancy. Conclusion It can alleviate clinical symptom, reduce insulin level and lipids in the blood and resume normal hormone, it can also improve the size of the ovary, shape and follicular amount, whatmore, it is helpful to resume menstrual ovulation and make patients get pregnancy by taking Diane-35 plus metformin hydrochloride in the PCOS patients. Drug therapy can successfully solve the PCOS patients infertile problem.