二甲双胍联合枸橼酸氯米芬治疗多囊卵巢综合征伴胰岛素抵抗患者的疗效观察

目的　探讨二甲双胍联合枸橼酸氯米芬治疗多囊卵巢综合征 (PCOS)胰岛素抵抗性不孕症的疗效及二甲双胍对PCOS胰岛素抵抗伴假性黑棘皮病的治疗效果。方法　将 70例PCOS胰岛素抵抗性不孕症患者 (A组 ) ,按治疗方法不同分为Aa组、Ab组各 2 0例 ,Ac组 30例。Ac组口服二甲双胍 ,每日 3次 ,每次 5 0 0mg ,连用 3个月 ,从月经周期或撤退性出血第 5天开始口服枸橼酸氯米芬片 ,每日 1次 ,每次 5 0mg,连服 5d ,共用 3个周期 ;Aa组单用二甲双胍 ,Ab组单用枸橼酸氯米芬 ,Aa及Ab两组的用药方法分别同Ac组中二甲双胍和枸橼酸氯米芬的用法。 30例PCOS伴假性黑棘皮病和胰岛素抵抗的患者为B组 ,口服二甲双胍片治疗 3个月 ,用法同Aa组 ,观察各组患者治疗前后体重指数、腰臀比例、空腹胰岛素、空腹血糖、血浆胆固醇、甘油三酯、性激素 (卵泡刺激素、黄体生成素、催乳素、雌二醇、孕酮、睾酮 )水平的变化及B组的皮损变化。结果　 (1)Ac组治疗后胰岛素抵抗状态明显改善 ,妊娠率达 5 7% ,明显高于Aa组 (2 0 % )和Ab组 (15 % ) ,差异有极显著性 (P <0 0 1) ;Ac组治疗前 ,空腹胰岛素、体重指数、睾酮、血浆胆固醇、甘油三酯分别为 (4 9 7± 6 4 )mU/L、2 9 4± 2 2、(6 4± 2 2 )nmol/L、(6 3± 0 5 )mmol/L、(4 1± 1 0

Clinical study on treating insulin resistance and promoting ovulation in polycystic ovary syndrome

OBJECTIVE: To investigate the effects of metformin and clomiphene on infertility caused by polycystic ovary syndrome (PCOS) with insulin-resistance (IR) and to observe the effects of metformin on PCOS with pseudoacanthosis nigricans (AN) and IR. METHODS: Seventy infertility patients caused by PCOS with IR were randomly divided into three groups : patients in group Aa (n = 20) took metformin 500 mg only, three times daily for 3 months; patients in group Ab (n = 20) took clomiphene 50 mg only, once daily from the 5th day of menstrual cycle or withdrawal bleeding for 5 days and 3 cycles, and patients in group Ac (n = 30) were treated by metformin and clomiphene for 3 cycles, with the same dosages as groups Aa and Ab. Thirty patients who suffered from PCOS with AN and IR were served as group B, They took metformin only, the same as group Aa. The following indexes were measured before and after three months or cycles of treatment in all the patients: body height, weight, waistline, hipline, body mass index (BMI), waist hip ratio (WHR), fasting insulin (FINS), fasting blood-glucose (FBG), total cholesterol (TC), triglyceride (TG), and sex hormones [follicle-stimulating hormone (FSH), luteotropic hormone (LH), prolactin (PRL), estradiol (E(2)), progestin (P), testosterone (T)]. RESULTS: The pregnant rate was 15% (group Aa), 20% (group Ab), and 57% (group Ac) respectively. It was significantly higher in group Ac than in groups Aa and Ab, (P < 0.01), while there was no significant difference between the latter two groups (P > 0.05). In group Ac the pretreatment levels of FINS, BMI, T, TG, and TC were (49.7 +/- 6.4) mU/L, 29.4 +/- 2.2, (6.4 +/- 2.2) nmol/L, (4.1 +/- 1.0) mmol/L, (6.3 +/- 0.5) mmol/L, and posttreatment levels were (27.7 +/- 1.8) mU/L, 23.6 +/- 5.2, (3.8 +/- 2.0) nmol/L, (2.2 +/- 0.7) mmol/L, (4.6 +/- 0.5) mmol/L. In group Aa pretreatment levels of FINS, BMI, T, TG, and TC were (50.0 +/- 8.2) mU/L, 28.7 +/- 1.2, (6.4 +/- 2.0) nmol/L, (4.3 +/- 1.2) mmol/L, (6.6 +/- 0.3) mmol/L, and posttreatment levels were (29.9 +/- 8.2) mU/L, 22.4 +/- 9.3, (4.3 +/- 0.9) nmol/L, (2.3 +/- 0.3) mmol/L, (4.8 +/- 0.6) mmol/L. In group B pretreatment levels of FINS, BMI, T, TG, and TC were (51.0 +/- 8.1) mU/L, 29.8 +/- 3.1, (6.3 +/- 3.5) nmol/L, (4.5 +/- 1.2) mmol/L, (6.8 +/- 0.2) mmol/L, and posttreatment levels were (28.5 +/- 2.8) mU/L, 23.4 +/- 6.1, (3.0 +/- 0.9) nmol/L, (2.3 +/- 0.9) mmol/L, (5.0 +/- 0.6) mmol/L. In groups Ac, Aa and B, the IR condition was obviously improved and posttreatment serum levels of T, TG, TC, FINS and BMI were significantly lower than those of pretreatment (all P < 0.01). In group Ab pretreatment levels of FINS, BMI, T, TG, and TC were (48.8 +/- 7.4) mU/L, 27.3 +/- 2.8, (6.0 +/- 2.0) nmol/L, (3.9 +/- 1.4) mmol/L, (6.4 +/- 0.6) mmol/L, and posttreatment levels were (42.9 +/- 7.0) mU/L, 27.5 +/- 3.1, (4.0 +/- 2.4) nmol/L, (3.9 +/- 0.3) mmol/L, (5.9 +/- 0.3) mmol/L, (all P > 0.05). Among patients in group B, 90% (27/30) menstrual condition and ovulation function were improved and AN was reduced in different degree after three months' treatment. CONCLUSION: Metformin can increase the sensitivity of PCOS to clomiphene and improve ovulation function of clomiphene. Metformin plus clomiphene is an effective way of treating infertility caused by PCOS with IR.