Glueck Charles J, Aregawi Dawit, Agloria Mahlia, Winiarska Magdalena, Sieve Luann, Wang Ping
Cholesterol Center, Jewish Hospital, Cincinnati, OH 45229, USA.
Metabolism. 2006 Dec;55(12):1582-9. doi: 10.1016/j.metabol.2006.08.001.
In 74 women with polycystic ovary syndrome, treated for 4 years with metformin (MET) and diet, we prospectively assessed whether, and to what degree, weight loss, reduction of insulin resistance, and amelioration of coronary heart disease risk factors could be sustained. We hypothesized that response to MET-diet would not differ by pretreatment body mass index (BMI) classes <25 (normal), > or =25 to <30 (overweight), > or =30 to <40 (obese), and > or =40 (extremely obese). [table: see text] Metformin-diet was successful in producing stable approximately 8% weight reduction for all 4 years (trend P < .0001). Percentage of reductions in weight on MET-diet was significant (P < .05) and did not differ among the 3 highest BMI categories (> or =40, > or =30 to <40, > or =25 to <30), but were not significant in the normal-weight category (BMI, <25). On MET-diet, median homeostasis model assessment of insulin resistance (HOMA-IR) was 33% lower than entry at 1 year, 50% at 2 years, 51% at 3 years, and 50% at 4 years (trend, P < .0001). On MET-diet, median low-density lipoprotein cholesterol (LDL-C) was 6% lower than entry at year 1, 6% at year 2, 7% at year 3, and 11% at year 4 (trend P < .0001). On MET-diet, median high-density lipoprotein cholesterol (HDL-C) was 3% higher than entry at year 2, 8% higher at year 3, and 11% higher at year 4 (trend P < .0001). Percentage of reductions in HOMA-IR, LDL-C, triglyceride, and systolic blood pressure, and increments in HDL-C did not differ (P > .1) in the 4 BMI categories. By stepwise regression, weight loss was a significant (P < or = .01) positive explanatory variable for reduction in HOMA-IR for all 4 follow-up years. Metformin-diet in women with polycystic ovary syndrome effectively and safely reduces weight and LDL-C while raising HDL-C, and maintains these outcomes stable over 4 years.
在74例接受二甲双胍（MET）和饮食治疗4年的多囊卵巢综合征女性中，我们前瞻性评估了体重减轻、胰岛素抵抗降低以及冠心病危险因素改善的情况能否持续，以及持续的程度。我们假设，对于治疗前体重指数（BMI）分类为<25（正常）、≥25至<30（超重）、≥30至<40（肥胖）以及≥40（极度肥胖）的患者，对MET-饮食的反应不会有所不同。[表格：见正文]二甲双胍-饮食在4年中成功使体重稳定减轻约8%（趋势P <.0001）。MET-饮食导致的体重减轻百分比具有显著性（P <.05），在3个最高BMI类别（≥40、≥30至<40、≥25至<30）之间没有差异，但在正常体重类别（BMI，<25）中不显著。在MET-饮食治疗下，胰岛素抵抗的稳态模型评估（HOMA-IR）中位数在1年时比治疗前降低33%，2年时降低50%，3年时降低51%，4年时降低50%（趋势，P <.0001）。在MET-饮食治疗下，低密度脂蛋白胆固醇（LDL-C）中位数在第1年比治疗前降低6%，第2年降低6%，第3年降低7%，第4年降低11%（趋势P <.0001）。在MET-饮食治疗下，高密度脂蛋白胆固醇（HDL-C）中位数在第2年比治疗前升高3%，第3年升高8%，第4年升高11%（趋势P <.0001）。在4个BMI类别中，HOMA-IR、LDL-C、甘油三酯和收缩压的降低百分比以及HDL-C的升高百分比没有差异（P >.1）。通过逐步回归分析，在所有4年的随访中，体重减轻都是HOMA-IR降低的显著（P≤.01）正解释变量。多囊卵巢综合征女性接受二甲双胍-饮食治疗可有效且安全地减轻体重和降低LDL-C，同时升高HDL-C，并在4年内维持这些效果稳定。
