小檗碱对行体外受精-胚胎移植的多囊卵巢综合征患者临床、内分泌、代谢指标及妊娠结局的影响  

Effect of berberine on clinical,metabolic and endocrine indexes and pregnancy outcome in women with polycystic ovary syndrome undergoing IVF treatment

作　　者：安媛[1] 张雅娟[1] 吕荟明[1] 李力男[1] 孙壮状[1] 

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001

出　　处：《现代中西医结合杂志》2016年第5期459-462,466,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：黑龙江省教育厅科学技术研究资助项目(12531344)

摘　　要：目的比较小檗碱和二甲双胍对多囊卵巢综合征(PCOS)患者的临床、内分泌、代谢指标及体外受精-胚胎移植(IVF-ET)结局的影响。方法将拟行IVF-ET的PCOS患者随机分为3组,小檗碱组给予盐酸小檗碱片口服,二甲双胍组给予二甲双胍口服,安慰剂组给予安慰剂口服,均治疗3个月。观察3组用药前后的临床、内分泌及代谢指标变化情况,统计3组不良反应发生情况及IVF或卵泡浆内单精子注射(ICSI)后临床结局。结果治疗后3组BMI、腰围、腰臀比均明显低于治疗前(P均<0.05),且小檗碱组BMI明显低于其他2组(P均<0.05);小檗碱组及二甲双胍组腰围、腰臀比均明显低于安慰剂组(P均<0.05),小檗碱组及二甲双胍组比较差异无统计学意义。小檗碱组和二甲双胍组治疗后血清T、FBG、FIN、HOMA-IR均明显低于治疗前(P均<0.05),SHBG水平均明显高于治疗前(P均<0.05),且与安慰剂组治疗后相比差异有统计学意义(P均<0.05),但小檗碱组和二甲双胍组间比较差异无统计学意义(P均>0.05)。3组治疗后TC、LDL-C水平均较治疗前明显降低(P均<0.05),且小檗碱组和二甲双胍组明显低于安慰剂组(P均<0.05),小檗碱组明显低于二甲双胍组(P均<0.05)。小檗碱组Gn总量显著低于二甲双胍组和安慰剂组(P均<0.05)。小檗碱组和二甲双胍组HCG日E2水平及重度OHSS发生率均显著低于安慰剂组(P均<0.05),小檗碱组和二甲双胍组比较差异无统计学意义(P均>0.05)。小檗碱组活产率显著高于二甲双胍组和安慰剂组(P均<0.05)。小檗碱组胃肠道不良反应发生率显著低于二甲双胍组(P<0.05)。结论 PCOS患者在IVF前应用小檗碱及二甲双胍均能够改善患者的临床、代谢及内分泌指标水平,从而提高IVF的临床妊娠率。且小檗碱作用优于二甲双胍,能够增加活产率,减少胃肠道不良反应。Objective It is to evaluate the clinical,metabolic and endocrine effects of berberine vs metformin in polycystic ovary syndrome（ PCOS） women scheduled for IVF treatment and to explore the potential benefits to the IVF process. Methods The patients with PCOS undergoing IVF treatment were randomly divided into 3 groups： berberine group,metformin group and placebo tablets group treated with berberine,metformin or placebo tablets respectively for 3 months before ovarian stimulation.The changes of clinical,endocrine,metabolic parameters before and after treatment and side effect,the outcome of IVF were observed and compared among the three groups. Results After treatment,BMI,waistline,WHR and the levels of TC,LDL-C decreased significantly compared with those before treatment in the three groups（ P all 〈 0. 05）,and BMI and the levels of TC,LDL- C in berberine group were the lowest（ P all 〈 0. 05）,waistline and WHR and the levels of TC,LDL- C in placebo group were the highest（ P all 〈 0. 05）. Compared with placebo group,greater reductions in total testosterone,fasting glucose,fasting insulin and HOMA- IR,and increases in SHBG were observed in the berberine and metformin groups. Three months of treatment with berberine or metformin before the IVF cycle increased the pregnancy rate and reduced the incidence of severe ovarian hyperstimulation syndrome. Furthermore,treatment with berberine,in comparison with metformin,was associated with decreases in BMI,lipid parameters and total FSH requirement,and an increase in live birth rate with fewer gastrointestinal adverse events. Conclusion Berberine and metformin treatments prior to IVF improved the pregnancy outcome by normalizing the clinical,endocrine and metabolic parameters in PCOS women. Berberine has a more pronounced therapeutic effect and achieved more live births with fewer side effects than metformin.

关 键 词：体外受精 胚胎移植 小檗碱 二甲双胍 多囊卵巢综合征 

分 类 号：R588[医药卫生—内分泌]