来曲唑联合二甲双胍治疗耐克罗米芬多囊卵巢综合征不孕患者的临床疗效及胰岛素抵抗、性激素水平的影响
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摘要
目的:探讨耐克罗米芬多囊卵巢综合征不孕患者采用来曲唑、二甲双胍联合治疗的疗效及对其胰岛素抵抗、性激素水平的影响。方法:90例耐克罗米芬多囊卵巢综合征(PCOS)不孕患者,随机数字表法分组,对照组45例口服来曲唑治疗,观察组45例联合来曲唑、二甲双胍口服治疗,均连续服用3个月经周期。治疗后检测对比2组胰岛素抵抗指标[胰岛素抵抗指标(HomaIR)、胰岛素曲线下面积(AUCINS)、胰岛素分泌指数(Homaβ)]、糖代谢指标[空腹胰岛素(FIN)、空腹血糖(FPG)]及性激素水平变化情况,并统计比较2组周期取消率、排卵率、妊娠率及卵巢过度刺激综合征(OHSS)发生情况。结果:治疗后2组体质量均较治疗前显著改善,且观察组BMI、体质量均小于对照组(P<0.05);治疗后观察组周期取消发生率、OHSS发生率小于对照组,排卵率、妊娠率均显著高于对照组(P<0.05);治疗后观察组E2水平与对照组比较明显升高,FSH、T及LH水平均明显降低(P<0.05);治疗后观察组FPG、FIN、AUCINS、HomaIR、Homaβ等胰岛素水平指标与对照组比较均明显降低(P<0.05)。2组患者治疗过程中均未产生明显不良反应。结论:耐克罗米芬多囊卵巢综合征不孕患者采用来曲唑、二甲双胍联合治疗能有效改善胰岛素抵抗、性激素水平,促进排卵,提高患者妊娠率,且安全可靠。
OBJECTIVE To investigate the clinical effect of letrozole in combination with metformin in the treatment of infertile women with clomiphene resistant polycystic ovary syndrome and the effects of insulin resistance and sex hormone levels.METHODS Ninety clomiphene resistant polycystic ovary syndrome(PCOS)patients with infertility were divided into two groups according to the random number table method in our hospital from May 2013 to June 2015.Patients in the control group(45 cases)were treated with oral administration of oral therapy,and patients in the observation group(45 cases)were treated with letrozole in combination with metformin.All patients were treated for 3 menstrual cycles.After treatment,the two groups were compared for insulin resistance indicators[insulin resistance index(HomaIR),area under the insulin curve(AUCINS),insulin secretion index(Homa)],glucose metabolism index [fasting insulin(FIN),fasting blood glucose(FPG)]and sex hormone levels.RESULTS The quality of the two groups after treatment was significantly improved than before treatment,and the observation group had smaller BMI and body mass than the control group(P<0.05).After treatment,the menstrual cycle cancellation rate and the incidence rate of OHSS in the observation group were lower,and the ovulation rate and the pregnancy rate were significantly higher than those in the control group(P<0.05).After treatment,the level of E2 in the observation group was significantly higher than that in the control group,and the levels of FSH,T and LH were significantly lower(P<0.05).After treatment,the levels of FPG,FIN,AUCINS,HomaIR,Homa of the observation group were significantly lower than those of the control group(P<0.05).CONCLUSION Letrozole in combination with metformin can effectively improve the level of insulin resistance and sex hormone in infertile patients with clomiphene resistant polycystic ovary syndrome,and the ovulation and improve the pregnancy rate of patients.
OBJECTIVE To investigate the clinical effect of letrozole in combination with metformin in the treatment of infertile women with clomiphene resistant polycystic ovary syndrome and the effects of insulin resistance and sex hormone levels.METHODS Ninety clomiphene resistant polycystic ovary syndrome(PCOS)patients with infertility were divided into two groups according to the random number table method in our hospital from May 2013 to June 2015.Patients in the control group(45 cases)were treated with oral administration of oral therapy,and patients in the observation group(45 cases)were treated with letrozole in combination with metformin.All patients were treated for 3 menstrual cycles.After treatment,the two groups were compared for insulin resistance indicators[insulin resistance index(HomaIR),area under the insulin curve(AUCINS),insulin secretion index(Homa)],glucose metabolism index [fasting insulin(FIN),fasting blood glucose(FPG)]and sex hormone levels.RESULTS The quality of the two groups after treatment was significantly improved than before treatment,and the observation group had smaller BMI and body mass than the control group(P<0.05).After treatment,the menstrual cycle cancellation rate and the incidence rate of OHSS in the observation group were lower,and the ovulation rate and the pregnancy rate were significantly higher than those in the control group(P<0.05).After treatment,the level of E2 in the observation group was significantly higher than that in the control group,and the levels of FSH,T and LH were significantly lower(P<0.05).After treatment,the levels of FPG,FIN,AUCINS,HomaIR,Homa of the observation group were significantly lower than those of the control group(P<0.05).CONCLUSION Letrozole in combination with metformin can effectively improve the level of insulin resistance and sex hormone in infertile patients with clomiphene resistant polycystic ovary syndrome,and the ovulation and improve the pregnancy rate of patients.
引文
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[6] Xu L,Xiong Y.Effects of Ethinylestradiol and Cyproterone Acetate Combined with Metformin on Ovulation Induction of Pa-tients with Polycystic Ovarian Syndrome[J].Chin Pharm(中国药房),2016,27(24):3368-3370.
[7] Lin H,Li SY,Feng WQ.Efficacy of metformin combined with ethinyl estradiol cyproterone tablets in the treatment of polycystic ovary syndrome and its effect on related hormone secretion[J].Guangdong Med J(广东医学),2014,35(5):763-764.
[8] Wu XC.Curative effect of different ovulation simulation scheme for patients with polycystic ovary syndrome[J].Chin J Hum Sex(中国性科学),2014,23(5):35-37.
[9] Moran LJ,Misso ML,Wild RA,et al.Impaired glucose tolerance,type 2diabetes and metabolic syndrome in polycystic ovary syndrome:a systematic review and meta-analysis[J].Hum Reprod Update,2010,16(1):347-363.
[10]Zheng Y.Analysis of clinical features of obese patients with polycystic ovary syndrome[J].Chin J Mod Drug Appl(中国现代药物应用),2015,9(3):57-58.
[11]Yao Y,Fan J,Xia BG,et al.Research on the Polymorphism of Exon 17of Insulin Receptor in the Women with Polycystic Ovary Syndrome[J].Pro Mod Biomed(现代生物医学进展),2014,14(6):1113-1116.
[12]Trikudanathan S.Polycystic ovarian syndrome[J].Med Clin North Am,2015,99(1):221-235.
[13]Liu XH.Therapeutic effect of letrozole combined with metformin on patients with polycystic ovary syndrome infertility[J].Med Front(医药前沿),2014(11):29-30.
[14]Wu YY.Effect of letrozole combined with progesterone on infertility and ovarian function in patients with polycystic ovary syndrome[J].Mod Diag Treat(现代诊断与治疗),2016,27(8):1456-1457.
[15]Li LN,He Y,Liu XJ,et al.Effect of subclinical hypothyroidism on metabolic disorders in patients with polycystic ovary syndrome[J].Guangdong Med J(广东医学),2014,35(21):3361-3362.
[16]Chen JL.Analysis of the effect of Da Ying-35and insulin sensitizer on ovulation induction drugs after polycystic ovary syndrome[J].Mater Child Health Care Chin(中国妇幼保健),2015,30(35):6289-6290.
[17]Huang JL.Effect of Da Ying-35and metformin on sex hormone levels and insulin resistance in patients with polycystic ovary syndrome[J].Mod J Integ Trad Chin West Med(现代中西医结合杂志),2013,22(25):2775-2777.
[18]Hou DF,Ding X,Zhao SX.Efficacy of clomiphene citrate combined with metformin in the treatment of polycystic ovary syndrome and its influence on sex hormone and insulin resistance[J].Hainan Med J(海南医学),2017,28(17):2799-2801.
[19]Bensalem A,Ajina M,Suissi M,et al.Polymorphisms of transcription factor-7-like 2(TCF7L2)gene in Tunisian women with polycystic ovary syndrome(PCOS)[J].Gene,2014,533(2):554-557.
[20]Huang X,Ji L,Xie HM,et al.Progress in the treatment of polycystic ovary syndrome with metformin[J].Chin Pharm(中国药房),2014,25(12):1143-1145.
[21]Fauser BC,Tarlatzis B C,Rebar R W,et al.Consensus on women’s health aspects of polycystic ovary syndrome(PCOS):the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group[J].Fertil Steril,2012,97(1):28-38;e25.
[22]Liu HM,Zhang XP,Liu DY,et al.Correlation between polycystic ovary syndrome and insulin function and sex hormone levels[J].Chin J Lab Diag(中国实验诊断学),2014,18(1):125-127.
[23]Wu J,Hou LH,Wang Y,et al.Effect of Obesity and Insulin Resistance Factor on Lipid Metabolism in Women with Polycystic Ovary Syndrome[J].J Med Res(医学研究杂志),2015,44(8):35-37.
[24]Pei HL.The impact of Diane-35and Metformin on sex hormone levels and insulin resistance for the patients with polycystic ovary syndrome[J].Chin Med Hera(中国医药导报),2013,10(1):73-75.
[2] Zhang XF.Therapeutic effect of metformin combined with Da Ying-35on polycystic ovary syndrome[J].Mode J Integ Trad Chinese West Med(现代中西医结合杂志),2014,23(20):2243-2244.
[3] Asemi Z,Samimi M,Taghizadeh M,et al.Effects of Ramadan Fasting on Glucose Homeostasis,Lipid Profiles,Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome in Kashan,Iran[J].Arch Iran Med,2015,18(12):806-810.
[4] Liang XY,Huang WY,Xu HF,et al.Influence and effect analysis of Diane-35and Metformin combination therapy in the endocrine system of patients with polycystic ovary syndrome[J].Chin Med Hera(中国医药导报),2014,11(9):104-106.
[5] Zhang YZ,He WN.Effect of ethinyl estradiol cyproterone combined with metformin on pregnancy and childbirth in patients with polycystic ovary syndrome[J].Chin J Clin Res(中国临床研究),2016,29(4):544-545.
[6] Xu L,Xiong Y.Effects of Ethinylestradiol and Cyproterone Acetate Combined with Metformin on Ovulation Induction of Pa-tients with Polycystic Ovarian Syndrome[J].Chin Pharm(中国药房),2016,27(24):3368-3370.
[7] Lin H,Li SY,Feng WQ.Efficacy of metformin combined with ethinyl estradiol cyproterone tablets in the treatment of polycystic ovary syndrome and its effect on related hormone secretion[J].Guangdong Med J(广东医学),2014,35(5):763-764.
[8] Wu XC.Curative effect of different ovulation simulation scheme for patients with polycystic ovary syndrome[J].Chin J Hum Sex(中国性科学),2014,23(5):35-37.
[9] Moran LJ,Misso ML,Wild RA,et al.Impaired glucose tolerance,type 2diabetes and metabolic syndrome in polycystic ovary syndrome:a systematic review and meta-analysis[J].Hum Reprod Update,2010,16(1):347-363.
[10]Zheng Y.Analysis of clinical features of obese patients with polycystic ovary syndrome[J].Chin J Mod Drug Appl(中国现代药物应用),2015,9(3):57-58.
[11]Yao Y,Fan J,Xia BG,et al.Research on the Polymorphism of Exon 17of Insulin Receptor in the Women with Polycystic Ovary Syndrome[J].Pro Mod Biomed(现代生物医学进展),2014,14(6):1113-1116.
[12]Trikudanathan S.Polycystic ovarian syndrome[J].Med Clin North Am,2015,99(1):221-235.
[13]Liu XH.Therapeutic effect of letrozole combined with metformin on patients with polycystic ovary syndrome infertility[J].Med Front(医药前沿),2014(11):29-30.
[14]Wu YY.Effect of letrozole combined with progesterone on infertility and ovarian function in patients with polycystic ovary syndrome[J].Mod Diag Treat(现代诊断与治疗),2016,27(8):1456-1457.
[15]Li LN,He Y,Liu XJ,et al.Effect of subclinical hypothyroidism on metabolic disorders in patients with polycystic ovary syndrome[J].Guangdong Med J(广东医学),2014,35(21):3361-3362.
[16]Chen JL.Analysis of the effect of Da Ying-35and insulin sensitizer on ovulation induction drugs after polycystic ovary syndrome[J].Mater Child Health Care Chin(中国妇幼保健),2015,30(35):6289-6290.
[17]Huang JL.Effect of Da Ying-35and metformin on sex hormone levels and insulin resistance in patients with polycystic ovary syndrome[J].Mod J Integ Trad Chin West Med(现代中西医结合杂志),2013,22(25):2775-2777.
[18]Hou DF,Ding X,Zhao SX.Efficacy of clomiphene citrate combined with metformin in the treatment of polycystic ovary syndrome and its influence on sex hormone and insulin resistance[J].Hainan Med J(海南医学),2017,28(17):2799-2801.
[19]Bensalem A,Ajina M,Suissi M,et al.Polymorphisms of transcription factor-7-like 2(TCF7L2)gene in Tunisian women with polycystic ovary syndrome(PCOS)[J].Gene,2014,533(2):554-557.
[20]Huang X,Ji L,Xie HM,et al.Progress in the treatment of polycystic ovary syndrome with metformin[J].Chin Pharm(中国药房),2014,25(12):1143-1145.
[21]Fauser BC,Tarlatzis B C,Rebar R W,et al.Consensus on women’s health aspects of polycystic ovary syndrome(PCOS):the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group[J].Fertil Steril,2012,97(1):28-38;e25.
[22]Liu HM,Zhang XP,Liu DY,et al.Correlation between polycystic ovary syndrome and insulin function and sex hormone levels[J].Chin J Lab Diag(中国实验诊断学),2014,18(1):125-127.
[23]Wu J,Hou LH,Wang Y,et al.Effect of Obesity and Insulin Resistance Factor on Lipid Metabolism in Women with Polycystic Ovary Syndrome[J].J Med Res(医学研究杂志),2015,44(8):35-37.
[24]Pei HL.The impact of Diane-35and Metformin on sex hormone levels and insulin resistance for the patients with polycystic ovary syndrome[J].Chin Med Hera(中国医药导报),2013,10(1):73-75.