二甲双胍治疗青春期多囊卵巢综合征患者的疗效研究  

Efficacy of metformin in the treatment of polycystic ovary syndrome in adolescents

作　　者：徐晶晶[1] 赵赟[1] 林金芳[1] 

机构地区：[1]复旦大学附属妇产科医院妇科,上海200011

出　　处：《中华内分泌代谢杂志》2012年第8期631-634,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：国家“十一五”课题基金（2007BA104804）;上海市科委课题基金（08411952900）;上海市女性生殖内分泌相关疾病重点实验室

摘　　要：目的研究二甲双胍治疗青春期多囊卵巢综合征的疗效。方法采用非随机同期对照试验，所有患者治疗期为6个月。研究共纳入180例研究对象，其中A组（治疗组，二甲双胍＋醋酸甲羟孕酮组）为135例青春期PCOS患者（15～19岁）连续服用二甲双胍，若无自发排卵月经则每2个月予醋酸甲羟孕酮保护子宫内膜；B组（对照组，单纯醋酸甲羟孕酮组）为45例同年龄段PCOS患者仅每2个月服用醋酸甲羟孕酮保护子宫内膜。统计治疗前后所有患者内分泌激素、代谢指标变化及排卵恢复的情况。结果（1）入组患者治疗前均无排卵，2组患者各项指标无统计学差异；（2）治疗6个月后，A组共74．81％（101／135例）患者恢复排卵；B组无自发排卵恢复患者；（3）A组患者空腹胰岛素、稳态模型评估的胰岛素抵抗指数（HOMA—IR）、睾酮及LH较治疗前下降（均P〈0．05），B组患者无显著改变；（4）回归分析结果显示：排卵恢复与空腹胰岛素、HOMA—IR呈负相关（偏回归系数：空腹胰岛素，-0．257，95％CI：-0．446— -0．017：HOMA—IR：-1．251，95％CI：-2．491～0．036，P〈0．05）。结论（1）二甲双胍能有效改善青春期PCOS患者的排卯功能障碍及生殖内分泌功能紊乱；（2）患者排卵的恢复与胰岛素水平的下降相关。Objective To evaluate the effect of metformin in treating adolescent polycystic ovary syndrome （PCOS）. Methods Group A [ the metformin and medroxyprogesterone acetate （MPA） group ] was made of 135 adolescents with PCOS taking metformin, and MPA if no menstruation came, while group B （ the control group ） consisted of 45 patients taking MPA every two months. Endocrinologic profiles and ovulation were evaluated before and after six months treatment. Results （ 1 ） All patients suffered from anovulation before treatment. （ 2 ） Ovulation failure was successfully improved in 74.81% （ 101/135 ）of patients in group A after 6 months, which was significantly higher than that before treatment. In group B, no case recovered ovulation. （3） In group A, fasting serum insulin, homeostasis model assay for insulin resistance （HOMA-IR） , total testosterone, LH were significantly decreased. （4） The retrieval of ovulation was negatively correlated with fasting insulin and HOMA-IR （ both P〈0.05 ）. Conclusions （ 1 ） Metformin effectively improves ovulation function and reproductive endocrine parameters in adolescent girls with PCOS. （ 2 ） Recovery of ovulation is associated with the decrease of serum insulin.

关 键 词：青春期 多囊卵巢综合征 胰岛素抵抗 二甲双胍 

分 类 号：R711.75[医药卫生—妇产科学]