二甲双胍联合达英-35治疗多囊卵巢综合征及对辅助生殖技术结局的影响
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摘要
目的:探讨二甲双胍联合达英-35治疗对多囊卵巢综合征患者的临床体征、激素水平内分泌、代谢以及辅助生殖技术结局的影响,为多囊卵巢综合征的临床治疗提供参考。方法:选择100例多囊卵巢综合征患者作为研究对象,随机分为观察组和对照组两组,各50例,其中对照组患者给予达英-35治疗,观察组患者在对照组治疗的基础上外加二甲双胍联合治疗,治疗3个月以后,比较两组患者治疗前后的临床表现、临床体征、激素水平、血脂代谢以及胰岛素分泌情况的变化。同时给予上述患者体外受精-胚胎移植(IVF-ET)方法,分析药物治疗对辅助生殖技术结局的影响。结果:两组患者治疗前各临床体征、临床表现、性激素以及血脂内分泌指标差异无统计学意义(P> 0. 05);与治疗前相比,两组患者的临床表现和临床体征显著改善,而观察组改善更为显著(P <0. 05);治疗后两组患者的WHR、BMI、T、LH、FSH、TG、TC以及LDL-C值均明显降低,SHBG、HDL-C值明显升高,而观察组性激素以及血脂指标改善更为显著(P <0. 05);治疗后两组患者的FIN、FBS、Homaβ以及Homa IR值明显降低,而观察组患者降低更为显著(P <0. 05);治疗后观察组患者的优质胚胎数明显多于对照组,受精率、卵裂率以及妊娠率高于对照组(P <0. 05)。结论:二甲双胍和达英-35的联合应用可以更为显著的改善多囊卵巢综合征患者的临床表现、临床体征、性激素以及血脂、内分泌指标,更有助于改善多囊卵巢综合征患者辅助生殖技术结局。
Objective: To investigate the effect of metformin combined with Diane-35 on clinical signs,hormonal levels of endocrine,metabolism and assisted reproductive technology in patients with PCOS,and to provide reference for the clinical treatment of PCOS. Methods: A total of 100 patients with PCOS were randomly divided into observation group( 50 cases) and control group( 50 cases). The control group of patients given up Diane-35 treatment,the observation group patients in the control group based on the treatment plus metformin combination therapy,after 3 months of treatment,the changes of clinical manifestations,clinical signs,hormone levels,blood lipid metabolism and insulin secretion before and after treatment were compared between the two groups. At the same time,IVF-ET was used to analyze the effect of drug treatment on the outcome of assisted reproductive technology. Results: There was no significant difference in clinical signs,clinical manifestations,sex hormones,lipids and endocrine indexes between the two groups before treatment( P > 0. 05). Compared with before treatment,the clinical manifestations and clinical signs of both groups were significantly improved,while the observation group improved more significantly( P < 0. 05). After treatment,the WHR,BMI,T,LH,FSH,TG,TC and LDL-C in the two groups were significantly decreased,SHBG and HDL-C were significantly increased,while the observed hormones and blood lipid indicators improved more significantly( P < 0. 05). After treatment,the levels of FIN,FBS,Homa β and Homa IR in the two groups were significantly decreased,while those in the observation group were more significantly decreased( P < 0. 05). After treatment,the number of high quality embryos in the observation group was significantly more than that in the control group. The fertilization rate,cleavage rate and pregnancy rate were also significantly higher than those in the control group( P < 0. 05). Conclusion: The combination of metformin and Diane-35 can significantly improve the clinical manifestations,clinical signs,sex hormones,blood lipids and endocrine indexes,but also help to improve polycystic ovary syndrome patients assisted reproductive technology outcome.
Objective: To investigate the effect of metformin combined with Diane-35 on clinical signs,hormonal levels of endocrine,metabolism and assisted reproductive technology in patients with PCOS,and to provide reference for the clinical treatment of PCOS. Methods: A total of 100 patients with PCOS were randomly divided into observation group( 50 cases) and control group( 50 cases). The control group of patients given up Diane-35 treatment,the observation group patients in the control group based on the treatment plus metformin combination therapy,after 3 months of treatment,the changes of clinical manifestations,clinical signs,hormone levels,blood lipid metabolism and insulin secretion before and after treatment were compared between the two groups. At the same time,IVF-ET was used to analyze the effect of drug treatment on the outcome of assisted reproductive technology. Results: There was no significant difference in clinical signs,clinical manifestations,sex hormones,lipids and endocrine indexes between the two groups before treatment( P > 0. 05). Compared with before treatment,the clinical manifestations and clinical signs of both groups were significantly improved,while the observation group improved more significantly( P < 0. 05). After treatment,the WHR,BMI,T,LH,FSH,TG,TC and LDL-C in the two groups were significantly decreased,SHBG and HDL-C were significantly increased,while the observed hormones and blood lipid indicators improved more significantly( P < 0. 05). After treatment,the levels of FIN,FBS,Homa β and Homa IR in the two groups were significantly decreased,while those in the observation group were more significantly decreased( P < 0. 05). After treatment,the number of high quality embryos in the observation group was significantly more than that in the control group. The fertilization rate,cleavage rate and pregnancy rate were also significantly higher than those in the control group( P < 0. 05). Conclusion: The combination of metformin and Diane-35 can significantly improve the clinical manifestations,clinical signs,sex hormones,blood lipids and endocrine indexes,but also help to improve polycystic ovary syndrome patients assisted reproductive technology outcome.
引文
[1]刘畅,张治芬.青春期多囊卵巢综合征胰岛素抵抗及其与生殖内分泌代谢异常的相关性分析[J].浙江医学,2014,36(2):108-111.
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[5]蔡华敏,金玉杰.二甲双胍联合炔雌醇环丙孕酮治疗多囊卵巢综合征合并不孕症的随机对照研究[J].白求恩医学杂志,2015,13(5):511-512.
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[7]邱锜敏,蔡良良,何苗.肺肾同治法联合西药对多囊卵巢综合征伴多毛症患者激素代谢及症状的影响[J].贵州医药,2017,41(4):383-385.
[8] Leonhardt H,Hellstr9m M,Gull B,et al. Ovarian morphology assessed by magnetic resonance imaging in women with and without polycystic ovary syndrome and associations with antimullerian hormone,free testosterone,and glucose disposal rate[J]. Fertility&Sterility,2014,101(6):1747-1756.
[9] Paul C,Lagan AS,Maniglio P,et al. Inositolas and other nutraceuticalsa synergistic actions counteract insulin resistance in polycystic ovarian syndrome and metabolic syndrome:state-of-the-art and future perspectives[J]. Gynecological Endocrinology,2016,32(6):431-438.
[10]梁逊莹,黄武炎,许慧芳,等.达英-35与二甲双胍联合治疗对多囊卵巢综合征患者内分泌系统的影响及其效果分析[J].中国医药导报,2014,11(9):104-106.
[11] Dursun F,Güven A,Yldz M. Assessment of Anti-Mullerian Hormone Level in Management of Adolescents with Polycystic Ovary Syndrome[J]. Revista Do Hospital Das Clínicas,2015,54(1):29-34.
[12]杨志平.达英-35联合二甲双胍治疗多囊卵巢综合征对激素、胰岛素抵抗的影响[J].中国妇幼保健,2016,31(5):1015-1017.
[13]厉玲芳,傅志泉.二甲双胍联合达英-35治疗多囊卵巢综合征的临床疗效研究[J].中国全科医学,2016,19(S1):187-189.
[14] Elsharkawy AA,Abdelmotaleb GS,Aly MK,et al. Effect of metformin on sleep disorders in adolescent girls with polycystic ovarian syndrome[J]. Journal of Pediatric&Adolescent Gynecology,2014,27(6):347-352.
[15]柯李琼.二甲双胍联合达英-35治疗多囊卵巢综合征患者的促排卵疗效及其对性激素、糖代谢的影响[J].实用临床医药杂志,2015,19(11):142-144.
[16] Das M,Son WY,Buckett W,et al. In-vitro maturation versus IVF with GnRH antagonist for women with polycystic ovary syndrome:treatment outcome and rates of ovarian hyperstimulation syndrome[J]. Reproductive Biomedicine Online,2014,29(5):545-551.
[2] Barry JA,Azizia MM,Hardiman PJ. Risk of endometrial,ovarian and breast cancer in women with polycystic ovary syndrome:a systematic review and meta-analysis[J]. Human Reproduction Update,2014,20(5):748-758.
[3] Shafiee MN,Khan G,Ariffin R,et al. Preventing endometrial cancer risk in polycystic ovarian syndrome(PCOS)women:could metformin help[J]. Gynecologic Oncology,2014,132(1):248-253.
[4] Ruan X,Kubba A,Aguilar A,et al. Use of cyproterone acetate/ethinylestradiol in polycystic ovary syndrome:rationale and practical aspects[J]. European Journal of Contraception&Reproductive Health Care the Official Journal of the European Society of Contraception,2017,22(3):183-190.
[5]蔡华敏,金玉杰.二甲双胍联合炔雌醇环丙孕酮治疗多囊卵巢综合征合并不孕症的随机对照研究[J].白求恩医学杂志,2015,13(5):511-512.
[6] Tandulwadkar SR,Lodha PA,Mangeshikar NT. Obstetric complications in women with IVF conceived pregnancies and polycystic ovarian syndrome.[J]. Journal of Human Reproductive Sciences,2014,7(1):13-18.
[7]邱锜敏,蔡良良,何苗.肺肾同治法联合西药对多囊卵巢综合征伴多毛症患者激素代谢及症状的影响[J].贵州医药,2017,41(4):383-385.
[8] Leonhardt H,Hellstr9m M,Gull B,et al. Ovarian morphology assessed by magnetic resonance imaging in women with and without polycystic ovary syndrome and associations with antimullerian hormone,free testosterone,and glucose disposal rate[J]. Fertility&Sterility,2014,101(6):1747-1756.
[9] Paul C,Lagan AS,Maniglio P,et al. Inositolas and other nutraceuticalsa synergistic actions counteract insulin resistance in polycystic ovarian syndrome and metabolic syndrome:state-of-the-art and future perspectives[J]. Gynecological Endocrinology,2016,32(6):431-438.
[10]梁逊莹,黄武炎,许慧芳,等.达英-35与二甲双胍联合治疗对多囊卵巢综合征患者内分泌系统的影响及其效果分析[J].中国医药导报,2014,11(9):104-106.
[11] Dursun F,Güven A,Yldz M. Assessment of Anti-Mullerian Hormone Level in Management of Adolescents with Polycystic Ovary Syndrome[J]. Revista Do Hospital Das Clínicas,2015,54(1):29-34.
[12]杨志平.达英-35联合二甲双胍治疗多囊卵巢综合征对激素、胰岛素抵抗的影响[J].中国妇幼保健,2016,31(5):1015-1017.
[13]厉玲芳,傅志泉.二甲双胍联合达英-35治疗多囊卵巢综合征的临床疗效研究[J].中国全科医学,2016,19(S1):187-189.
[14] Elsharkawy AA,Abdelmotaleb GS,Aly MK,et al. Effect of metformin on sleep disorders in adolescent girls with polycystic ovarian syndrome[J]. Journal of Pediatric&Adolescent Gynecology,2014,27(6):347-352.
[15]柯李琼.二甲双胍联合达英-35治疗多囊卵巢综合征患者的促排卵疗效及其对性激素、糖代谢的影响[J].实用临床医药杂志,2015,19(11):142-144.
[16] Das M,Son WY,Buckett W,et al. In-vitro maturation versus IVF with GnRH antagonist for women with polycystic ovary syndrome:treatment outcome and rates of ovarian hyperstimulation syndrome[J]. Reproductive Biomedicine Online,2014,29(5):545-551.