奥利司他联合二甲双胍治疗对肥胖型PCOS患者体质量、糖脂代谢及诱导排卵妊娠结局的影响  

Effect of Orlistat Combined with Metformin on Body Weight,Glycolipid Metabolism and Clinical Pregnancy Outcomes of Induced Ovulation in PCOS Patients with Obese

作　　者：郭丽娜[1] 王楠[1] 吕翠婷[1] 贾新转[1] 董翠[1] GUO Lina;WANG Nan;LV Cuiting(Department of Reproductive Medicine,The Fourth Hospital of Hebei Medical University,Shijiazhuang Hebei 050011,China)

机构地区：[1]河北医科大学第四医院生殖医学科,河北石家庄050011

出　　处：《实用妇产科杂志》2022年第3期218-222,共5页Journal of Practical Obstetrics and Gynecology

基　　金：河北省医学科学研究重点课题计划(编号:20110122)。

摘　　要：目的:探讨奥利司他联合二甲双胍治疗对肥胖型多囊卵巢综合征(PCOS)患者体质量、糖脂代谢及诱导排卵妊娠结局的影响。方法:对2018年6月至2019年12月于河北医科大学第四医院生殖医学科就诊的110例肥胖型[体质量指数(BMI)≥28 kg/m^(2)]PCOS不孕患者的临床资料进行回顾性分析,根据临床用药情况分为二甲双胍组60例,采用二甲双胍联合生活方式干预治疗;奥利司他+二甲双胍组50例,在二甲双胍组治疗基础上同时口服奥利司他。两组治疗3个月后行诱导排卵指导性生活或人工授精助孕。评估两组治疗前后体质量、糖脂代谢指标变化及诱导排卵妊娠结局。结果:①治疗后两组体质量及BMI均较治疗前明显降低,奥利司他+二甲双胍组下降幅度高于二甲双胍组,差异有统计学意义(P<0.05)。②治疗后两组卵泡刺激素(FSH)、性激素结合球蛋白(SHBG)较治疗前升高,黄体生成素(LH)、雌二醇(E_(2))、雄烯二酮(A_(2))、硫酸脱氢表雄酮(DHEAS)、睾酮(T)较治疗前降低,变化幅度组间比较差异均无统计学意义(P>0.05)。③治疗后空腹血糖、空腹胰岛素、口服75 g葡萄糖后2小时血糖、2小时胰岛素、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)均较治疗前降低,高密度脂蛋白(HDL-C)较治疗前升高,奥利司他+二甲双胍组TG、TC、HDL-C变化幅度高于二甲双胍组,差异有统计学意义(P<0.05)。④奥利司他+二甲双胍组诱导排卵3个周期累积妊娠率、活产率(58.0%、54.0%)高于二甲双胍组(45.0%、38.3%),但差异无统计学意义(P>0.05)。结论:奥利司他联合二甲双胍治疗可以更好改善肥胖型PCOS患者体质量、血脂代谢;但诱导排卵累积妊娠率与单用二甲双胍组差异不明显,尚需进一步研究。Objective:To investigate the effects of orlistat combined with metformin on body weight,glycolipid metabolism and clinical pregnancy outcomes of induced ovulation in polycystic ovary syndrome(PCOS)patients with obese.Methods:The clinical data of 110 infertile patients with PCOS and obese[body mass index(BMI)≥28 kg/m^(2)]treated in the reproductive medicine department of The Fourth Hospital of Hebei Medical University from June 2018 to December 2019 were retrospectively reviewed.They were divided into two groups according to different clinical treatment:metformin group including 60 patients treated with metformin combined with lifestyle intervention;orlistat+metformin group including 50 patients treated with oral orlistat simultaneously on the base of metformin group.After three months of treatment,the two groups were treated with ovulation induction to guide sexual life or artificial insemination.The changes of body weight,glucose and lipid metabolism and pregnancy outcome of ovulation induction were evaluated before and after treatment.Results:①After treatment,the body weight and BMI of the two groups were significantly decreased compared with those before treatment.The decreases rage were higher in orlistat+metformin group than in metformin group and the differences were statistically significant(P<0.05).②After treatment,the levels of follicle stimulating hormone(FSH)and sex hormone binding globulin(SHBG)in the two groups were higher than those before treatment,while the levels of luteinizing hormone(LH),estradiol(E_(2)),androstenedione(A_(2)),dehydroepiandrosterone sulfate(DHEAS)and testosterone(T)in the two groups were lower than those before treatment,but the differences were not statistically significant between groups(P>0.05).③After treatment,fasting blood glucose,fasting insulin,2 h blood glucose,2 h insulin,triglyceride(TG),total cholesterol(TC)and low density lipoprotein(LDL-C)were lower than those before treatment,while high density lipoprotein(HDL-C)was higher than that before treatment.The ch

关 键 词：多囊卵巢综合征 肥胖 奥利司他 二甲双胍 诱导排卵 

分 类 号：R711.76[医药卫生—妇产科学]