炔雌醇环丙孕酮片联合绒毛膜促性腺激素治疗多囊卵巢综合征
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摘要
目的探讨炔雌醇环丙孕酮片(达英-35)联合人绒毛膜促性腺激素(HCG)治疗多囊卵巢综合征(PCOS)患者的效果及其对血清骨钙素(OC)、血清性激素结合球蛋白(SHBG)水平的影响。方法选择2015年2月至2017年4月接受治疗的136例PCOS患者作为研究对象,采用随机数字表法将其随机分为对照组(n=68)和联合组(n=68)。对照组患者给予达英-35口服治疗,联合组患者给予达英-35口服及HCG肌内注射治疗。治疗6个周期后,比较两组患者临床治疗效果及治疗前后体质指数(BMI)、腰臀比(WHR)、稳态模型的胰岛素抵抗指数(HOMA-IR)、性激素[卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(TT)]、OC、SHBG水平及治疗后两组患者排卵率和妊娠情况。结果 (1)联合组治疗总有效率95.59%,对照组75.00%,联合组显著高于对照组(χ~2=11.450,P<0.01);(2)治疗后两组患者BMI和HOMA-IR较治疗前均显著降低(P<0.05),且联合组治疗后BMI、HOMA-IR且均低于对照组(P<0.01),治疗第6个周期后的WHR也显著低于对照组(P<0.01);(3)治疗后两组FSH、LH和T较治疗前均明显降低(P<0.05),且联合组治疗后FSH、LH和T均明显低于对照组治疗后(P<0.01);(4)治疗后两组患者血清OC和SHBG较治疗前均显著升高(P<0.05),且联合组治疗后血清OC和SHBG均显著高于对照组(P<0.05或P<0.01);(5)治疗后两组患者排卵率较治疗前均显著升高,且治疗3周期后和6周期后联合组排卵率(82.35%,89.71%)及妊娠率(29.41%,52.94%)均显著高于对照组(41.18%,51.47%;11.76%,25.00%)(χ~2=24.410,23.942,6.476,11.161,P<0.05或P<0.01)。结论 PCOS患者存在血清OC和SHBG水平降低。达英-35口服联合HCG肌内注射治疗PCOS效果要明显优于单纯应用达英-35治疗,其可显著改善患者的高雄激素血症,调节内分泌紊乱和排卵障碍,促进患者血清OC和SHBG水平升高,提高患者的排卵率和妊娠率。
Objective To investigate the effect of ethylene estradiol cycloprogesterone tablets(Diane 35) combined with human chorionic gonadotropin(HCG) on the treatment of polycystic ovarian syndrome(PCOS) and its influence on the levels of serum osteocalcin(OC) and sex hormone-binding globulin(SHBG).Methods A total of 136 PCOS patients treated from February 2015 to April 2017 were randomly divided into control group and combined group(n=68,each).Oral Diane 35 was given in control group,and Diane 35 combined with HCG intramuscular injection was given in combined group.The therapeutic effects,body mass index(BMI),whist hip ratio(WHR),homeostasis model assessment of insulin resistance(HOMA-IR),and the levels of sex hormones[follicle stimulating hormone(FSH),luteotropic hormone(LH),total testosterone(TT)],OC,SHBG before and after treatment,ovulation induction and pregnancy status(follicle maturation time,single follicle ovulation rate,ovulation rate and pregnancy rate) after treatment were compared between two groups.Results(1) The total effective rate was 95.56% in combined group and 75.56% in control group,and there was a significant difference between two groups(χ~2=11.450,P<0.01).(2) After treatment,BMI and HOMA-IR were significantly lower than those before treatment in both groups(P<0.05) and were lower in combined group than those in control group(all P<0.01),After a six-cycle treatment,WHR was also significantly lower in combined group than that in control group(P<0.01).(3) After treatment,the levels of FSH,LH and TT were significantly lower than those before treatment in two groups(P<0.05) and were significantly lower in combined group than those in control group(all P<0.01).(4) After treatment,the serum OC and SHBG levels were significantly higher than those before treatment in both groups(P<0.05) and were significantly higher in combined group than those in control group(P<0.05 or P<0.01).(5) After treatment,the ovulation rate was significantly higher than that before treatment in two groups.After 3-,6-cycle treatment,the ovulation rates were 82.35%,89.71% respectively in combined group and 41.18%,51.47% respectively in control group,and the pregnancy rates were 29.41%,52.94%,respectively in combined group and 11.76%,25.00%,respectively in control group(χ~2= 24.410,23.942,6.476,11.161,P<0.05 or P<0.01).Conclusion Oral Diane 35 combined with intramuscular injection of HCG has more advantages in reducing hyperandrogenism,regulating endocrine disorders and ovulation disorders,promoting the increase of serum OC and SHBG levels and increasing the ovulation rate and pregnancy rate of patients.
Objective To investigate the effect of ethylene estradiol cycloprogesterone tablets(Diane 35) combined with human chorionic gonadotropin(HCG) on the treatment of polycystic ovarian syndrome(PCOS) and its influence on the levels of serum osteocalcin(OC) and sex hormone-binding globulin(SHBG).Methods A total of 136 PCOS patients treated from February 2015 to April 2017 were randomly divided into control group and combined group(n=68,each).Oral Diane 35 was given in control group,and Diane 35 combined with HCG intramuscular injection was given in combined group.The therapeutic effects,body mass index(BMI),whist hip ratio(WHR),homeostasis model assessment of insulin resistance(HOMA-IR),and the levels of sex hormones[follicle stimulating hormone(FSH),luteotropic hormone(LH),total testosterone(TT)],OC,SHBG before and after treatment,ovulation induction and pregnancy status(follicle maturation time,single follicle ovulation rate,ovulation rate and pregnancy rate) after treatment were compared between two groups.Results(1) The total effective rate was 95.56% in combined group and 75.56% in control group,and there was a significant difference between two groups(χ~2=11.450,P<0.01).(2) After treatment,BMI and HOMA-IR were significantly lower than those before treatment in both groups(P<0.05) and were lower in combined group than those in control group(all P<0.01),After a six-cycle treatment,WHR was also significantly lower in combined group than that in control group(P<0.01).(3) After treatment,the levels of FSH,LH and TT were significantly lower than those before treatment in two groups(P<0.05) and were significantly lower in combined group than those in control group(all P<0.01).(4) After treatment,the serum OC and SHBG levels were significantly higher than those before treatment in both groups(P<0.05) and were significantly higher in combined group than those in control group(P<0.05 or P<0.01).(5) After treatment,the ovulation rate was significantly higher than that before treatment in two groups.After 3-,6-cycle treatment,the ovulation rates were 82.35%,89.71% respectively in combined group and 41.18%,51.47% respectively in control group,and the pregnancy rates were 29.41%,52.94%,respectively in combined group and 11.76%,25.00%,respectively in control group(χ~2= 24.410,23.942,6.476,11.161,P<0.05 or P<0.01).Conclusion Oral Diane 35 combined with intramuscular injection of HCG has more advantages in reducing hyperandrogenism,regulating endocrine disorders and ovulation disorders,promoting the increase of serum OC and SHBG levels and increasing the ovulation rate and pregnancy rate of patients.
引文
[1] 齐新宇,庞艳莉,乔杰.多囊卵巢综合征代谢异常的研究进展[J].中华医学杂志,2016,96(9):747-749.
[2] 李扬璐,阮祥燕,Alfred O.Mueck.多囊卵巢综合征对妊娠结局的影响研究进展[J].首都医科大学学报,2016,37(4):449-453.
[3] 李小成,史丽,任卫东,等.骨钙素通过抑制脂肪组织炎症改善肥胖小鼠胰岛素敏感性[J].中国病理生理杂志,2017,33(2):302-307.
[4] 华飞,吕欣,项守奎,等.多囊卵巢综合征患者血清骨钙素水平的变化[J].医学研究生学报,2016,29(6):625-628.
[5] 刘颖华,侯丽辉,徐芳,等.不同性激素结合球蛋白水平对多囊卵巢综合征患者的影响[J].实用医学杂志,2016,32(12):1969-1971.
[6] 王靖雯,蒋凤艳,覃钰芹,等.炔雌醇环丙孕酮与屈螺酮炔雌醇对多囊卵巢综合征高雄激素血症的治疗作用[J].山东医药,2016,56(5):75-76.
[7] 何丽,王蔼明.四种促排卵药物在多囊卵巢综合征促排卵治疗中的应用进展[J].山东医药,2016,56(35):101-104.
[8] 乐杰.妇产科学[M].7版.北京:人民卫生出版社,2008:351.
[9] 中华医学会妇产科学分会内分泌学组.多囊卵巢综合征的诊断和治疗专家共识[J].中华妇产科杂志 2008,43(7):553-555.
[10] 田勍,王海宁,王海燕,等.多囊卵巢综合征患者不同表型之间代谢异常的特点分析[J].中国糖尿病杂志,2017,25(1):14-18.
[11] 余红英,熊燕.年龄及 BMI 对多囊卵巢综合征患者胰岛素抵抗和糖脂代谢的影响[J].山东医药,2016,56(1):66-68.
[12] 王全先,刘军杰,孙鑫涛,等.多囊卵巢综合征患者血清雄烯二酮水平与其代谢特征的关系[J].热带医学杂志,2018,18(3):371-376.
[13] 梁燕,聂石婵,陈沛林.PCOS患者炎症反应因子表达水平与糖脂代谢紊乱的相关性[J].热带医学杂志,2018,18(12):1569-1572.
[14] 李晓荷.不同治疗方案对多囊卵巢综合征患者胰岛素抵抗及性激素、排卵的影响[J].中国妇幼保健,2016,31(6):1327-1328.
[15] Krishna D,Dhoble S,Praneesh G,et al.Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic:A Randomized control trial[J].J Hum Reprod Sci,2016,9(3):164-172.
[16] 邱晴,都健,杨晶,等.血清性激素结合球蛋白水平对2型糖尿病患者合并代谢综合征的影响研究[J].中国全科医学,2016,19(10):1151-1155.
[17] Abu-Hijleh TM,Gammoh E,Al-Busaidi AS,et al.Common variants in the sex hormone-binding globulin (SHBG) gene influence SHBG levels in women with polycystic ovary syndrome[J].Ann Nutr Metab,2016,68(1):66-74.
[18] 王双,李军,李思源,等.骨钙素在2型糖尿病合并骨质疏松中意义的研究[J].中国骨质疏松杂志,2017,23(4):469-472.
[19] 吕欣,华飞.骨钙素与多囊卵巢综合征相关性的研究进展[J].中国医药生物技术,2016,11(2):167-169.
[20] 俞颖.绝经后2型糖尿病肾病患者骨密度与骨代谢的关系研究[J].中华全科医学,2017,15(11):1938-1940.
[21] Erkan G,Tayyar AT,A?maz G,et al.Role of osteocalcin,tumor necrosis factor-alpha and adiponectin in polycystic ovary syndrome patients with insulin resistance[J].Turk J Obstet Gynecol,2017,14(2):89-93.
[22] 皇甫金荣,胡玲.骨钙素与糖代谢关系的研究进展[J].中国药物与临床,2016,16(12):1783-1784.
[2] 李扬璐,阮祥燕,Alfred O.Mueck.多囊卵巢综合征对妊娠结局的影响研究进展[J].首都医科大学学报,2016,37(4):449-453.
[3] 李小成,史丽,任卫东,等.骨钙素通过抑制脂肪组织炎症改善肥胖小鼠胰岛素敏感性[J].中国病理生理杂志,2017,33(2):302-307.
[4] 华飞,吕欣,项守奎,等.多囊卵巢综合征患者血清骨钙素水平的变化[J].医学研究生学报,2016,29(6):625-628.
[5] 刘颖华,侯丽辉,徐芳,等.不同性激素结合球蛋白水平对多囊卵巢综合征患者的影响[J].实用医学杂志,2016,32(12):1969-1971.
[6] 王靖雯,蒋凤艳,覃钰芹,等.炔雌醇环丙孕酮与屈螺酮炔雌醇对多囊卵巢综合征高雄激素血症的治疗作用[J].山东医药,2016,56(5):75-76.
[7] 何丽,王蔼明.四种促排卵药物在多囊卵巢综合征促排卵治疗中的应用进展[J].山东医药,2016,56(35):101-104.
[8] 乐杰.妇产科学[M].7版.北京:人民卫生出版社,2008:351.
[9] 中华医学会妇产科学分会内分泌学组.多囊卵巢综合征的诊断和治疗专家共识[J].中华妇产科杂志 2008,43(7):553-555.
[10] 田勍,王海宁,王海燕,等.多囊卵巢综合征患者不同表型之间代谢异常的特点分析[J].中国糖尿病杂志,2017,25(1):14-18.
[11] 余红英,熊燕.年龄及 BMI 对多囊卵巢综合征患者胰岛素抵抗和糖脂代谢的影响[J].山东医药,2016,56(1):66-68.
[12] 王全先,刘军杰,孙鑫涛,等.多囊卵巢综合征患者血清雄烯二酮水平与其代谢特征的关系[J].热带医学杂志,2018,18(3):371-376.
[13] 梁燕,聂石婵,陈沛林.PCOS患者炎症反应因子表达水平与糖脂代谢紊乱的相关性[J].热带医学杂志,2018,18(12):1569-1572.
[14] 李晓荷.不同治疗方案对多囊卵巢综合征患者胰岛素抵抗及性激素、排卵的影响[J].中国妇幼保健,2016,31(6):1327-1328.
[15] Krishna D,Dhoble S,Praneesh G,et al.Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic:A Randomized control trial[J].J Hum Reprod Sci,2016,9(3):164-172.
[16] 邱晴,都健,杨晶,等.血清性激素结合球蛋白水平对2型糖尿病患者合并代谢综合征的影响研究[J].中国全科医学,2016,19(10):1151-1155.
[17] Abu-Hijleh TM,Gammoh E,Al-Busaidi AS,et al.Common variants in the sex hormone-binding globulin (SHBG) gene influence SHBG levels in women with polycystic ovary syndrome[J].Ann Nutr Metab,2016,68(1):66-74.
[18] 王双,李军,李思源,等.骨钙素在2型糖尿病合并骨质疏松中意义的研究[J].中国骨质疏松杂志,2017,23(4):469-472.
[19] 吕欣,华飞.骨钙素与多囊卵巢综合征相关性的研究进展[J].中国医药生物技术,2016,11(2):167-169.
[20] 俞颖.绝经后2型糖尿病肾病患者骨密度与骨代谢的关系研究[J].中华全科医学,2017,15(11):1938-1940.
[21] Erkan G,Tayyar AT,A?maz G,et al.Role of osteocalcin,tumor necrosis factor-alpha and adiponectin in polycystic ovary syndrome patients with insulin resistance[J].Turk J Obstet Gynecol,2017,14(2):89-93.
[22] 皇甫金荣,胡玲.骨钙素与糖代谢关系的研究进展[J].中国药物与临床,2016,16(12):1783-1784.