Mathur Ruchi, Alexander Carolyn J, Yano Jacqueline, Trivax Bradley, Azziz Ricardo
Department of Obstetrics/Gynecology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Am J Obstet Gynecol. 2008 Dec;199(6):596-609. doi: 10.1016/j.ajog.2008.09.010.
Women with polycystic ovary syndrome (PCOS) have a myriad of phenotypic and clinical features that may guide therapeutic options for metabolic protection and ovulation induction. The use of metformin may prove beneficial in a subset of the population of women with PCOS. Hyperinsulinemia, as demonstrated by elevated insulin levels on a 2-hour 75-g load glucose tolerance test, is an important parameter in deciding whether or not to initiate metformin therapy to women with PCOS with the hope of preventing or delaying the onset of type 2 diabetes mellitus (DM). Cardiovascular risk factors including markers of subclinical inflammation, and dyslipidemia may also be improved by metformin therapy. For ovulation induction, metformin is not as effective as clomiphene citrate as first-line therapy for women with PCOS. There are no clear data to suggest that metformin reduces pregnancy loss or improves pregnancy outcome in PCOS, and it is currently recommended that metformin be discontinued with the first positive pregnancy test result, unless there are other medical indications (eg, type 2 DM). This review addresses practical management guidelines for the uses of metformin in women with PCOS.
患有多囊卵巢综合征（PCOS）的女性具有众多表型和临床特征，这些特征可能指导代谢保护和促排卵的治疗选择。二甲双胍的使用可能对一部分PCOS女性有益。在口服75克葡萄糖耐量试验2小时后胰岛素水平升高所显示的高胰岛素血症，是决定是否对患有PCOS的女性启动二甲双胍治疗以预防或延缓2型糖尿病（DM）发病的重要参数。二甲双胍治疗也可能改善包括亚临床炎症标志物和血脂异常在内的心血管危险因素。对于促排卵，二甲双胍作为PCOS女性的一线治疗药物不如枸橼酸氯米芬有效。没有明确数据表明二甲双胍能降低PCOS患者的流产率或改善妊娠结局，目前建议在首次妊娠试验呈阳性时停用二甲双胍，除非有其他医学指征（如2型DM）。本综述阐述了二甲双胍在PCOS女性中的实际应用管理指南。
