Cagnacci Angelo, Tirelli Alessandra, Cannoletta Marianna, Pirillo Debora, Volpe Annibale
Department of Obstetrics, Gynaecology and Pediatrics Sciences, University of Modena, 41100 Modena, Italy.
Contraception. 2005 Dec;72(6):443-6. doi: 10.1016/j.contraception.2005.05.021. Epub 2005 Aug 22.
To evaluate the influence of two medical treatments for endometriosis on insulin sensitivity.
After surgery, 26 women with endometriosis were randomly allocated to a 6-month treatment with a GnRH agonist (Leuprorelin 3.75 mg/28 days) or a subdermal progestin implant (etonogestrel 68 mg). Insulin sensitivity (SI) and glucose utilization independent of insulin (Sg) were investigated at baseline and after 6 months by a frequently sampled intravenous glucose tolerance test (FSIGT) associated with the minimal model method.
Both therapies tended to decrease SI, but the effect did not reach statistical significance in the GnRH agonist group (5.43+/-1.29 vs. 3.99+/-0.8) and was significant in the etonogestrel group (5.74+/-1.12 vs. 3.95+/-0,78; p=.046). Sg, fasting glucose, insulin, C-peptide and C-peptide/insulin were not modified by either treatment.
The modifications of glucose-insulin metabolism induced by the GnRH agonist are of no relevance for the short-term use of this molecule. Even if the modification induced by the etonogestrel implant is subtle and of no major impact, it should be taken into consideration for the long-term treatment of individuals with abnormalities of glucose-insulin metabolism.
评估两种子宫内膜异位症治疗方法对胰岛素敏感性的影响。
手术后，26名子宫内膜异位症女性被随机分配接受为期6个月的促性腺激素释放激素（GnRH）激动剂（亮丙瑞林3.75毫克/28天）或皮下孕激素植入剂（依托孕烯68毫克）治疗。在基线和6个月后，通过与最小模型法相关的频繁采样静脉葡萄糖耐量试验（FSIGT）研究胰岛素敏感性（SI）和独立于胰岛素的葡萄糖利用率（Sg）。
两种治疗方法均倾向于降低SI，但在GnRH激动剂组中该效应未达到统计学显著性（5.43±1.29对3.99±0.8），而在依托孕烯组中具有显著性（5.74±1.12对3.95±0.78；p = 0.046）。两种治疗均未改变Sg、空腹血糖、胰岛素、C肽及C肽/胰岛素水平。
GnRH激动剂诱导的葡萄糖 - 胰岛素代谢改变与该分子的短期使用无关。即使依托孕烯植入剂诱导的改变细微且无重大影响，但对于葡萄糖 - 胰岛素代谢异常个体的长期治疗仍应予以考虑。
