罗格列酮和二甲双胍治疗多囊卵巢综合征胰岛素抵抗的临床研究

目的:比较罗格列酮和二甲双胍对胰岛素抵抗的多囊卵巢综合征(PCOS)患者内分泌、生殖功能的临床疗效。方法:将60例多囊卵巢综合征(PCOS)的胰岛素抵抗患者随机分为罗格列酮组和二甲双胍组各30例,罗格列酮组口服罗格列酮联合克罗米芬,二甲双胍组口服二甲双胍联合克罗米芬,两组的用药时间均为12周,分别比较两组用药前后的体重指数(BMI)、血糖、胰岛素、胰岛素抵抗指数(Homa-IR)、血脂、血清卵泡刺激素(FSH)、黄体生成素(LH)、游离睾酮(T);通过B超检查评估排卵率。结果:①治疗后二甲双胍组患者BMI降低(P<0.05),罗格列酮组患者BMI轻微上升(P>0.05),两组治疗后BMI比较差异有统计学意义(P<0.05)。②两组治疗后空腹胰岛素(FINS)、胰岛素抵抗指数(Homa-IR)、2h胰岛素(INS2h)均降低,罗格列酮组FINS、Homa-IR及INS2h的下降幅度大于二甲双胍组(P<0.05)。③两组治疗后LH、LH/FSH、T均下降,罗格列酮组T的下降幅度比二甲双胍明显。④两组治疗后卵巢的排卵功能有改善,妊娠率提高,但两组比较差异无统计学意义。结论:罗格列酮和二甲双胍均可增强克罗米芬的促排卵疗效,提高妊娠率。罗格列酮改善PCOS患者的胰岛素抵抗、纠正高雄激素血症优于二甲双胍,适用于胰岛素抵抗较严重的PCOS患者;二甲双胍有降低体重的作用,无潜在致畸作用,治疗费用低廉,适合临床首先选用。

Clinical research of rosiglitazone and metformin in treatment of the patients with polycystic ovary syndrome combined with insulin resistance

Objective: To compare the clinical effects of rosiglitazone and metformin on endocrine function and reproductive function of the patients with polycystic ovary syndrome(PCOS) combined with insulin resistance. Methods: Sixty PCOS patients with insulin resistance were randomly divided into rosiglitazone group and metformin group,30 patients in each group,the patients in rosiglitazone group were treated with oral administration of rosiglitazone combined with clomiphene,while the patients in metformin group were treated with oral administration of metformin combined with clomiphene,all the women in the two group were treated for 12 weeks;body mass index(BMI),blood glucose,insulin,insulin resistance index,blood lipids,serum follicle stimulating hormone(FSH),luteinizing hormone(LH),free testosterone before and after treatment were compared between the two groups;the ovulation rate was evaluated by B ultrasound. Results: After treatment,BMI in metformin group decreased significantly(P<0.05),BMI in rosiglitazone group increased slightly(P>0.05),there was statistically significant difference in BMI after treatment between the two groups(P<0.05).After treatment,fasting insulin(FINS) levels,insulin resistance indexes,and two-hour insulin levels in the two groups decreased,the decrease amplitudes of the three parameters in rosiglitazone group were larger than those in metformin group(P<0.05).After treatment,LH levels,the ratios of LH/FSH,and testosterone levels in the two groups decreased,the decrease amplitude of testosterone in rosiglitazone group was larger than that in metformin group.After treatment,the ovarian ovulation functions in the two groups were improved,the pregnancy rates in the two groups increased,but there was no statistically significant difference between the two groups. Conclusion: Both rosiglitazone and metformin can enhance the efficacy of clomiphene for ovulation and increase pregnancy rate.Rosiglitazone can improve insulin resistance and correct hyperandrogenemia of PCOS patients,and the effect is superior to that of metformin,rosiglitazone is suitable for PCOS patients with severe insulin resistance;metformin can reduce the body weight of the patients,which has no potential teratogenic effect,and the cost of treatment is low,so it should be used in clinic at first.