医学营养指导联合运动疗法对肥胖型多囊卵巢综合征患者糖脂代谢和胰岛素抵抗水平的影响

目的基于限能量平衡膳食的医学营养指导联合运动疗法对肥胖型多囊卵巢综合征(PCOS)患者糖脂代谢和胰岛素抵抗水平的影响。方法选取2017年4月至2018年4月北京市垂杨柳医院诊治的90例肥胖型PCOS患者作为研究对象。按照数字随机原则分成两组,对照组(n=45)采用盐酸二甲双胍缓释片和艾塞那肽注射液治疗3个月,观察组(n=45)在上述基础上实施医学营养指导联合运动疗法3个月。比较两组治疗前后人体成分指标、生殖血清学指标、糖脂代谢指标及胰岛素抵抗水平变化情况,记录两组治疗后排卵率和临床妊娠率。结果治疗3个月后观察组脂肪量、体脂率显著低于对照组,差异具有统计学意义(P<0.05)。观察组空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)显著低于对照组,差异具有统计学意义(P<0.05)。治疗后观察组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)显著低于对照组,高密度脂蛋白胆固醇(HDL-C)显著高于对照组,差异具有统计学意义(P<0.05)。治疗后观察组游离睾酮(T)、黄体生成素(LH)水平显著低于对照组,促卵泡激素(FSH)水平显著高于对照组,差异具有统计学意义(P<0.05)。治疗后两组排卵率和临床妊娠率比较差异无统计学意义(P>0.05)。结论医学营养指导联合运动疗法治疗肥胖型PCOS患者可更好地降低体重,改善糖脂代谢功能,调节机体生殖激素水平。

Effect of medical nutrition guidance combined with exercise therapy on lipid metabolism and insulin resistance in obese polycystic ovary syndrome

Objective To study the effects of dietary energy-limited nutritional therapy combined with exercise therapy on glucose and lipid metabolism and insulin resistance in obese patients with polycystic ovary syndrome(PCOS).Methods From April 2017 to April 2018,90 obese PCOS patients treated in Beijing Chuiyangliu Hospital were selected as research objects.The control group(n=45)was treated with metformin hydrochloride sustained-release tablets and exenatide injection for 3 months,while the observation group(n=45)was given medical nutrition guidance combined with exercise therapy for 3 months on the basis of the above.The changes of body composition index,reproductive serological index,glucose and lipid metabolism index and insulin resistance were compared between the two groups before and after treatment,and the ovulation rate and clinical pregnancy rate were recorded.Results After 3 months of treatment,the fat volume and body fat rate of the observation group were significantly lower than those of the control group(P<0.05).Fasting blood glucose(FPG),fasting insulin(FINS)and insulin resistance index(HOMA-IR)in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)of the observation group were significantly lower than those of the control group,and the high-density lipoprotein cholesterol(HDL-C)was significantly higher than that of the control group(P<0.05).After treatment,the levels of free testosterone(T)and luteinizing hormone(LH)in the observation group were significantly lower than those in the control group,while the level of follicle stimulating hormone(FSH)in the observation group was significantly higher than that in the control group(P<0.05).There was no significant difference in ovulation rate and clinical pregnancy rate between the two groups after treatment(P>0.05).Conclusions Nutritional guidance combined with exercise therapy for obesity PCOS can better control body weight,improve glycolipid metabolism,and regulate body reproductive hormone levels.