多囊卵巢综合征胰岛素抵抗性不孕症药物治疗临床研究

目的:探讨胰岛素抵抗(IR)及其代偿性高胰岛素血症对排卵功能和性激素水平尤其是睾酮(T)、促黄体生成素(LH)水平及血脂(TG、TC)水平的影响,观察用二甲双胍改善多囊卵巢综合征(PCOS)IR状态的同时,加用克罗米芬促排卵治疗PCOS IR性不孕症的疗效。方法:选择PCOS IR性不孕患者65例随机分为3组,平均年龄26.72±2.72岁,平均不孕年限2.82±1.52年。A组:20例患者单用二甲双胍治疗,每次500mg,每日3次,连服3个月;B组:单用克罗米芬治疗,连用3个周期;C组:二甲双胍加克罗米芬治疗3个周期。测量治疗前后身高、体重、腰围、臀围,计算体重指数(BMI)和腰臀比例(WHR),空腹抽血测定胰岛素(FINS)、血糖(FBG)、血浆胆固醇(TC)、甘油三酯(TG)、性激素(FSH、LH、PRL、E_2、P、T)。结果:三组治疗后的妊娠率分别为15％,20％,56％。C组与A组和B组之间有显著性差异(P<0.01)。A组与B组之间无显著性差异(P>0.05)。C组IR状态也明显改善,FINS、BMI、T、TG、TC值较治疗前明显下降(P<0.01)。结论:二甲双胍能明显地改善IR和提高PCOS对克罗米芬的敏感性,加强克罗米芬促排卵治疗的疗效,两者合用治疗PCOS IR性不孕症有较好的疗效。

Clinical Study of Infertility Medication Caused by Polycystic Ovary Syndrome (PCOS) along with Insulin-resist-ance (IR)

Objective: To observe the effects of IR and hyperinsulinism on ovulation function and levels of sex hormones and blood lipid. To investigate the effects of Metformin and Colomiphene on treating infertility caused by IR of PCOS. Methods: 65 infertility patients were randomly divided into three groups. The average age of them was 26.72±2.72 years old, and the av-erage infertility time was 2.82±1.52 years. Patients in group A ( n = 20) took Metformin 1500mg only, three times daily for 3 months. Patients in group B (n =20) took Colomiphene only for 3 cycles. Patients, in group C were treated by Metformin and Clomiphene for 3 cycles. Measured the following indexes before and after three cycles treatment: height, weight, waist-line, hipline, body mass index(BMI) , waist hip ratio(WHR) , FINS, FBG, TC, TG, sex hormone ( FSH,LH,PRL,E2 ,P, T) . Results: The pregnancy rate were 15% (group A) , 20% (group B) , 56% (group C) respectively. There was significant difference between group C and group A, group B(P<0.01). There was significant difference between group A and B(P> 0.05). In group C the IR condition also had great improved and the serum levels of T, TG, TC, FINS and BMI posttreatment were lower significantly than those of pretreatment(P <0. 01). Conclusion: Metformin can increase the sensibility of PCOS on Clomiphene and improve ovulation function of Clomiphene. Metformin plus Clomiphene is a very effective way of treating infertility caused by IR of PCOS.