Pasquali Renato, Gambineri Alessandra
Unité Operativa di Endocrinologia, Dipartimento di Medicina Interna, Università Alma Mater Studiorum, Azienda Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy.
Eur J Endocrinol. 2006 Jun;154(6):763-75. doi: 10.1530/eje.1.02156.
Insulin-sensitizing agents have been recently proposed as the therapy of choice for polycystic ovary syndrome (PCOS), since insulin resistance and associated hyperinsulinemia are recognized as important pathogenetic factors of the syndrome. Moreover, since almost all obese PCOS women and more than half of those of normal weight are insulin resistant, and therefore present some degree of hyperinsulinemia, the use of insulin sensitizers should be suggested in most patients with PCOS. Insulin sensitizer treatment has been associated with a reduction in serum androgen levels and gonadotropins, and with an improvement in serum lipids and in prothrombotic factor plasminogen-activator inhibitor type 1, whatever the insulin sensitizer used. This therapy has also been associated with a decrease in hirsutism and acne, and with a regulation of menses and an improvement of ovulation and fertility. Notable improvements in all these parameters have also been described after a change in lifestyle approach, particularly in the presence of obesity. Lifestyle interventions should therefore be combined with insulin sensitizers in PCOS when obesity is present.
胰岛素增敏剂最近已被提议作为多囊卵巢综合征（PCOS）的首选治疗方法，因为胰岛素抵抗及相关的高胰岛素血症被认为是该综合征的重要发病因素。此外，几乎所有肥胖的PCOS女性以及超过半数体重正常的PCOS女性都存在胰岛素抵抗，因此都有一定程度的高胰岛素血症，所以大多数PCOS患者都应使用胰岛素增敏剂。无论使用何种胰岛素增敏剂，胰岛素增敏剂治疗都与血清雄激素水平和促性腺激素的降低以及血清脂质和血栓前因子纤溶酶原激活物抑制剂1型的改善有关。这种疗法还与多毛症和痤疮的减轻、月经的调节以及排卵和生育能力的改善有关。在改变生活方式后，尤其是存在肥胖的情况下，所有这些参数也都有显著改善。因此，当PCOS患者存在肥胖时，生活方式干预应与胰岛素增敏剂联合使用。
