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  

Clinical effect of letrozole in combination with metformin in the treatment of infertile women with polycystic ovary syndrome and the effects of insulin resistance and sex hormone levels

作　　者：华彩红[1] 尹山兰[1] 郝尚辉 赵淑珍[1] 朱利红[1] 申素芳[1] HUA Cai-hong;YIN Shan-lan;HAO Shang-hui;ZHAO Shu-zhen;ZHU Li-hong;SHEN Su-fang(The First Affiliated Hospital of Xinxiang Medical University, Henan Xinxiang 453100, China)

机构地区：[1]新乡医学院第一附属医院,河南新乡453100

出　　处：《中国医院药学杂志》2018年第22期2343-2347,共5页Chinese Journal of Hospital Pharmacy

基　　金：河南省科技厅资助项目(编号:082102310084);河南省教育厅科技攻关项目(编号:16A320043)

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.

关 键 词：二甲双胍 多囊卵巢综合征 胰岛素抵抗 性激素水平 

分 类 号：R969[医药卫生—药理学]