二甲双胍与炔雌醇环丙孕酮对肥胖及非肥胖多囊卵巢综合征女性血脂水平的影响。
Effects of metformin and ethinyl estradiol-cyproterone acetate on lipid levels in obese and non-obese women with polycystic ovary syndrome.
作者信息
Rautio K, Tapanainen J S, Ruokonen A, Morin-Papunen L C
机构信息
Department of Obstetrics and Gynecology, University Hospital of Oulu, PO Box 5000, FIN-90 014, Finland.
出版信息
Eur J Endocrinol. 2005 Feb;152(2):269-75. doi: 10.1530/eje.1.01840.
OBJECTIVE
Women with polycystic ovary syndrome (PCOS) exhibit risk factors for cardiovascular diseases such as abdominal obesity, insulin resistance and dyslipidemia. Insulin sensitizers, especially metformin, have been shown to improve these metabolic disturbances, but there are only a few studies on their effects on serum lipids in polycystic ovary syndrome.
METHODS
Thirty-five women with PCOS (18 obese and 17 non-obese) were randomized to 6-month treatments with metformin or ethinyl estradiol-cyproterone acetate oral contraceptive pills.
RESULTS
In the whole-study population (non-obese and obese women) serum levels of high-density lipoprotein cholesterol increased from 1.4+/-0.2 to 1.6+/-0.1 mmol/l (means +/-S.E. throughout) at 3 and 6 months (P < 0.001), the total cholesterol:high-density lipoprotein cholesterol ratio decreased significantly from 3.8+/-0.3 to 3.3+/-0.2 at 6 months (P < 0.001) and a similar trend was observed in serum triglyceride levels during metformin treatment. In the oral contraceptive group, serum levels of total cholesterol increased from 4.9+/-0.3 to 5.4+/-0.3 mmol/l (P < 0.05), high-density lipoprotein cholesterol increased from 1.2+/-0.1 to 1.5+/-0.1 mmol/l (P < 0.001), the total cholesterol:high-density lipoprotein cholesterol ratio decreased from 4.6+/-0.4 to 3.7+/-0.2 (P < 0.001) and triglycerides increased from 1.3+/-0.1 to 1.9+/-0.2 mmol/l at 6 months of treatment (P < 0.001). Serum low-density lipoprotein cholesterol levels remained unchanged during both treatments. Milder but similar changes in the subgroups of obese and non-obese women were observed during both treatments. Moreover, in the whole-study population both systolic (P = 0.02) and diastolic (P = 0.05) blood pressures decreased over the 6 months of metformin treatment.
CONCLUSION
In women with PCOS, metformin treatment had beneficial effects on lipid profile and blood pressure, and therefore it could be useful in the prevention of cardiovascular complications in these women.
目的
多囊卵巢综合征（PCOS）女性存在心血管疾病的危险因素，如腹部肥胖、胰岛素抵抗和血脂异常。胰岛素增敏剂，尤其是二甲双胍，已被证明可改善这些代谢紊乱，但关于其对多囊卵巢综合征患者血脂影响的研究较少。
方法
35例PCOS女性（18例肥胖，17例非肥胖）被随机分为两组，分别接受为期6个月的二甲双胍治疗或炔雌醇环丙孕酮口服避孕药治疗。
结果
在整个研究人群（包括非肥胖和肥胖女性）中，3个月和6个月时血清高密度脂蛋白胆固醇水平从1.4±0.2 mmol/l升至1.6±0.1 mmol/l（均值±标准误，下同）（P<0.001），6个月时总胆固醇与高密度脂蛋白胆固醇比值从3.8±0.3显著降至3.3±0.2（P<0.001），二甲双胍治疗期间血清甘油三酯水平也呈现类似趋势。在口服避孕药组，治疗6个月时血清总胆固醇水平从4.9±0.3 mmol/l升至5.4±0.3 mmol/l（P<0.05），高密度脂蛋白胆固醇从1.2±0.1 mmol/l升至1.5±0.1 mmol/l（P<0.001），总胆固醇与高密度脂蛋白胆固醇比值从4.6±0.4降至3.7±0.2（P<0.001），甘油三酯从1.3±0.1 mmol/l升至1.9±0.2 mmol/l（P<0.001）。两种治疗期间血清低密度脂蛋白胆固醇水平均无变化。在肥胖和非肥胖女性亚组中，两种治疗期间均观察到轻微但类似的变化。此外，在整个研究人群中，二甲双胍治疗6个月期间收缩压（P=0.02）和舒张压（P=0.05）均下降。
结论
对于PCOS女性，二甲双胍治疗对血脂谱和血压有有益影响，因此可能有助于预防这些女性的心血管并发症。
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