Kriplani Alka, Agarwal Nutan
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi.
J Reprod Med. 2004 May;49(5):361-7.
To assess the effects of 6 months of metformin therapy on clinical and biochemical parameters in polycystic ovary syndrome (PCOS) and to evaluate those parameters in responders and nonresponders to identify the subjects who respond to an insulin sensitizer in PCOS.
Sixty-six diagnosed PCOS patients were recruited. Baseline characteristics (menstrual history, hirsutism scoring, acne grading, body mass index [BMI], serum luteinizing hormone and follicule-stimulating hormone [LH/FSH] ratio, testosterone,fasting insulin and glucose/insulin index) were assessed initially and 6 months after metformin therapy. Three groups were constructed on the basis of menstrual symptoms: oligomenorrhea (group I), amenorrhea (group II) and hypomenorrhea (group III). Responders were those who had improvements in menstrual pattern or conceived. Response was compared in 3 groups, and biochemical parameters were compared in responders and nonresponders.
There were 44 (66.6%) oligomenorrheic, 17 (25.7%) amenorrheic and 5 (7.5%) hypomenorrheic cases and 31 (46.5%) infertile women. In total, 85.7% responded to treatment; the rest (14.3%) were nonresponders. Among responders, 62.29% achieved regular periods, 22.95% experienced improvements in their menstrual abnormalities, and 13% conceived. Overall, a significant reduction occurred in BMI (P =.04), mean testosterone (P = .03) and mean fasting insulin levels (P = .01), but no significant improvement was observed in hirsutism, acne, LH/FSH ratio or glucose/insulin index. A total of 9.75%, 18.75% and 30% did not respond in the oligomenorrheic, amenorrheic and hypomenorrheic groups, respectively (P = .04). Testosterone and insulin were reduced significantly in responders (P = .05 and .01, respectively) but not in nonresponders (P = .26 and .73). An initial high LH/FSH ratio and lower testosterone levels were associated with a better response.
Six months of metformin therapy improved menstrual cyclicity and fertility in women with PCOS. It resulted in a decline in testosterone and insulin levels. Oligomenorrheic patients with an increased LH/FSH ratio and lower testosterone levels responded better.
评估6个月二甲双胍治疗对多囊卵巢综合征（PCOS）患者临床及生化指标的影响，并对有反应者和无反应者的这些指标进行评估，以识别PCOS中对胰岛素增敏剂有反应的患者。
招募66例确诊的PCOS患者。最初及二甲双胍治疗6个月后评估其基线特征（月经史、多毛评分、痤疮分级、体重指数[BMI]、血清黄体生成素和卵泡刺激素[LH/FSH]比值、睾酮、空腹胰岛素及血糖/胰岛素指数）。根据月经症状分为三组：月经过少（I组）、闭经（II组）和月经量过少（III组）。有反应者为月经模式改善或受孕者。比较三组的反应情况，并比较有反应者和无反应者的生化指标。
有44例（66.6%）月经过少、17例（25.7%）闭经和5例（7.5%）月经量过少患者，以及31例（46.5%）不孕女性。总体而言，85.7%的患者对治疗有反应；其余（14.3%）为无反应者。在有反应者中，62.29%月经周期恢复正常，22.95%月经异常情况改善，13%受孕。总体而言，BMI（P = 0.04）、平均睾酮水平（P = 0.03）和平均空腹胰岛素水平（P = 0.01）显著降低，但多毛、痤疮、LH/FSH比值或血糖/胰岛素指数未见显著改善。月经过少组、闭经组和月经量过少组分别有9.75%、18.75%和30%无反应（P = 0.04）。有反应者的睾酮和胰岛素水平显著降低（分别为P = 0.05和0.01），而无反应者则未降低（P = 0.26和0.73）。初始LH/FSH比值高和睾酮水平低与更好的反应相关。
6个月的二甲双胍治疗改善了PCOS女性的月经周期和生育能力。导致睾酮和胰岛素水平下降。LH/FSH比值升高且睾酮水平较低的月经过少患者反应更好。
