二甲双胍联合复方醋酸环丙孕酮对多囊卵巢综合征女性的内分泌和代谢影响

[Endocrine and metabolic effects of metformin in combination with compound cyproterone acetate in women with polycystic ovarian syndrome].

作者信息

Ye Bi-lü, Yang Hai-yan, Zhao Jun-zhao, Lin Jin-ju, Lin Wen-qin

机构信息

Department of Reproductive Medicine, First Affiliated Hospital, Wenzhou Medical College, Wenzhou, Zhejiang Province 325000, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2003 Dec;38(12):745-8.

PMID:14728846

Abstract

OBJECTIVE

To study the endocrinologic and metabolic effects of metformin in combination with compound cyproterone acetate (CPA) on patients with polycystic ovarian syndrome (PCOS).

METHODS

A prospective study involved total 45 PCOS patients as group A and 20 non-PCOS infertility patients as control (group B). Complete baseline work-up including body mass index (BMI), waist/hip ratio (WHR), ferriman-Gallwey score (FGS), gonadotrophin, testosterone (T), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (Ds), insulin (FI) and glucose tolerance test, were performed in all patients. Patients in group A were treated with CPA alone (group A1), metformin alone (group A2) or combination of CPA with metformin (group A3), respectively by randomization. At the end of 12-week therapy, subjects were re-evaluated and above parameters were measured.

RESULTS

Women in group A had significant increases in BMI, WHR, FGS, luteinizing hormone (LH), T, FI, insulin resistance, and significantly decrease in high-density lipoprotein (HDL)-C comparing with the control group (P < 0.01). No significant difference among A1, A2 and A3 was found at baseline. LH, T, free testosterone (FT) were significant decreased from (13.9 +/- 5.9) IU/L, (2.1 +/- 0.8) nmol/L and (2.8 +/- 2.3) nmol/L respectively to (5.8 +/- 2.2) IU/L, (1.2 +/- 0.4) nmol/L and (0.8 +/- 0.5) nmol/L respectively and SHBG was significant increased from (99 +/- 42) nmol/L to (187 +/- 64) nmol/L in group A3, when compared with LH, T and FT from (13.8 +/- 7.6) IU/L, (2.2 +/- 1.1) nmol/L and (2.5 +/- 1.9) nmol/L respectively to (11.8 +/- 6.5) IU/L, (1.8 +/- 0.8) nmol/L and (1.7 +/- 1.0) nmol/L respectively and SHBG from (99 +/- 40) nmol/L to (120 +/- 51) nmol/L in group A2 (P < 0.05 approximately 0.001). HDL-C were significantly increased from (1.5 +/- 0.3) mmol/L to (1.8 +/- 0.3) mmol/L in group A3 comparing with HDL-C from (1.5 +/- 0.4) mmol/L to (1.6 +/- 0.4) mmol/L in group A1 (P < 0.001).

CONCLUSIONS

The PCOS patients treated with metformin in combination with compound cyproterone acetate may be more effective in inhibiting hyperandrogen and hypersecretion of LH than metformin alone and more obvious in improving lipid profiles than CPA alone.

摘要

目的

研究二甲双胍联合复方醋酸环丙孕酮（CPA）对多囊卵巢综合征（PCOS）患者内分泌及代谢的影响。

方法

一项前瞻性研究，共纳入45例PCOS患者作为A组，20例非PCOS不孕患者作为对照组（B组）。对所有患者进行全面的基线检查，包括体重指数（BMI）、腰臀比（WHR）、费里曼-盖尔韦评分（FGS）、促性腺激素、睾酮（T）、性激素结合球蛋白（SHBG）、硫酸脱氢表雄酮（Ds）、胰岛素（FI）及葡萄糖耐量试验。A组患者随机分为单独使用CPA治疗（A1组）、单独使用二甲双胍治疗（A2组）或CPA与二甲双胍联合治疗（A3组）。在12周治疗结束时，对受试者进行重新评估并测量上述参数。

结果

与对照组相比，A组女性的BMI、WHR、FGS、黄体生成素（LH）、T、FI、胰岛素抵抗显著升高，高密度脂蛋白（HDL）-C显著降低（P<0.01）。A1、A2和A3组在基线时无显著差异。与A2组相比，A3组的LH、T、游离睾酮（FT）分别从（13.9±5.9）IU/L、（2.1±0.8）nmol/L和（2.8±2.3）nmol/L显著降至（5.8±2.2）IU/L、（1.2±0.4）nmol/L和（0.8±0.5）nmol/L，SHBG从（99±42）nmol/L显著升至（187±64）nmol/L；而A2组的LH、T、FT分别从（13.8±7.6）IU/L、（2.2±1.1）nmol/L和（2.5±1.9）nmol/L降至（11.8±6.5）IU/L、（1.8±0.8）nmol/L和（1.7±1.0）nmol/L，SHBG从（99±精确到小数点后一位数40）nmol/L升至（120±51）nmol/L（P<0.05至0.001）。与A1组HDL-C从（1.5±0.4）mmol/L升至（1.6±0.4）mmol/L相比，A3组HDL-C从（1.5±0.3）mmol/L显著升至（1.8±0.3）mmol/L（P<0.001）。