摘要
目的观察营养治疗并艾塞那肽联合穴位埋线治疗肥胖型多囊卵巢综合征(polycystic ovary syndrome,PCOS)的临床效果。方法选择2013年5月—2016年5月收治的肥胖型PCOS 120例,剔除临床资料不完整者,最终入选90例,随机分为对照组与观察组,每组各45例。两组均予营养治疗+二甲双胍+艾塞那肽,观察组在此基础上予穴位埋线。两组均连续治疗3个月,比较治疗前后体重指数(body mass index,BMI)、腰臀比(waist-to-hipratio,WHR)、血脂[甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)]、血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]、激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌激素(E2)、睾酮(T)]水平变化,记录排卵、妊娠及不良反应情况。结果与本组治疗前比较,两组治疗后FPG、2 h PBG、FINS、HOMA-IR、TG、LDL-C、TC、BMI、WHR、LH、LH/FSH、E2、T均降低,HDL-C、FSH均升高,差异有统计学意义(P <0. 05);与对照组比较,观察组治疗后FPG、2 h PBG、FINS、HOMA-IR、TG、LDL-C、TC、BMI、WHR、LH、LH/FSH、E2、T均显著下降,HDL-C、FSH均显著升高,差异有统计学意义(P <0. 05)。对照组、观察组排卵率分别为68. 89%(31/45)、82. 22%(37/45);随访1年,对照组、观察组妊娠率分别为42. 22%(19/45)、62. 22%(28/45),比较差异均有统计学意义(P <0. 05)。两组不良反应发生率比较差异无统计学意义(P=0. 267)。结论营养治疗并艾塞那肽联合穴位埋线治疗通过改善肥胖型PCOS患者的糖脂代谢与外周激素水平,以提高排卵率与妊娠率。
Objective To observe the clinical effect of nutritional therapy and exenatide combined with acupoint catgut embedding(ACE) in the treatment of obese polycystic ovary syndrome(PCOS). Methods A total of120 cases of obese PCOS infertility admitted to our hospital from May 2013 to May 2016 were selected,and 90 cases were selected after excluding incomplete clinical data. They were randomly divided into control group and observation group,with 45 cases in each group. Both groups were given nutrition therapy + metformin + exenatide therapy,while the observation group was given catgut embedding at acupoints on this basis. Both groups were treated continuously for 3 months. The changes of body mass index(BMI),waist-to-hip ratio(WHR),blood lipid [triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),and total cholesterol(TC) ],blood glucose [fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPBG),fasting plasma insulin(FINS),and homeostasis model-insulin resistance(HOMA-IR) ],and hormone [follicle-stimulating hormone(FSH),luteinizing hormone(LH),estrogen(E2),and testosterone(T) ]were compared before and after treatment,and ovulation,pregnancy(followed up for 1 year) and adverse reactions were recorded. Results Compared with those before treatment,FPG,2 hPBG,FINS,HOMA-IR,TG,LDL-C,TC,BMI,WHR,LH,LH/FSH,E2,and T were decreased,whereas HDL-C and FSH were increased after treatment,and the difference was statistically significant(P < 0. 05). Compared with the control group,FPG,2 hPBG,FINS,HOMA-IR,TG,LDL-C,TC,BMI,WHR,LH,LH/FSH,E2,and T in the observation group were decreased significantly after treatment,while HDL-C and FSH were increased significantly,and the difference was statistically significant(P < 0. 05). The ovulation rate was 68. 89 %(31/45) in the control group and 82. 22 %(37/45) in the observation group. They were followed up for one year. and the pregnancy rate of control group and observation group was 42. 22 %(19/45)and 62. 22 %(28/45) respectively,suggesting significant difference(P < 0. 05). There was no significant difference in the incidence of adverse reactions between the two groups(P = 0. 267). Conclusion Nutrition therapy and exenatide combined with catgut embedding at acupoints can improve ovulation rate and pregnancy rate by improving glucose and lipid metabolism and peripheral hormone levels in obese PCOS patients.
引文
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