Glintborg Dorte, Altinok Magda Lambaa, Mumm Hanne, Hermann Anne Pernille, Ravn Pernille, Andersen Marianne
Departments of Endocrinology and Metabolism (D.G., M.L.A., H.M., A.P.H., M.A.) and Gynecology and Obstetrics (P.R.), Odense University Hospital, 5000 Odense C, Denmark.
J Clin Endocrinol Metab. 2014 Jul;99(7):2584-91. doi: 10.1210/jc.2014-1135. Epub 2014 Apr 17.
Central obesity in polycystic ovary syndrome (PCOS) is associated with increased inflammatory markers and increased risk for type 2 diabetes.
The objective of the study was to evaluate whether treatment with metformin (M) or M combined with oral contraceptive pills (OCPs) resulted in a more advantageous body composition than treatment with OCP alone.
The study was conducted at an outpatient clinic.
This was a randomized, controlled clinical trial. Ninety patients with PCOS were randomized to 12 months' treatment with M (2 g/d), M + OCP (150 mg desogestrel+30 μg ethinylestradiol), or OCP. Whole-body dual-energy x-ray absorptiometry scans and clinical and hormonal evaluations were performed before and after the intervention period. A total of 65 of 90 patients completed the study.
Changes in weight at 6 and 12 months and changes in regional fat mass estimates at 12 months were measured.
Dropout rates between intervention groups were not significantly different. Treatment with M and M+OCP were superior to OCP regarding weight and regional fat mass. The median (quartiles) weight changes during 12 months of M, M+OCP, and OCP treatment were -3.0 (-10.3; 0.6), -1.9 (-4.9; 0.1), and 1.2 (-0.8; 3.0) kg, respectively, P < .05. Upper to lower fat mass ratio was unchanged. Changes in body composition were predicted by the type of medical intervention (M, M+OCP, or OCP) and not by body mass index at study inclusion. OCP and M+OCP were superior to M regarding reduction in free T levels.
M treatment alone or in combination with OCP was associated with weight loss and improved body composition compared with OCP, whereas free T levels decreased during M+OCP or OCP. Combined treatment with M+OCP should be considered as an alternative to treatment with OCP alone to avoid weight gain in PCOS.
多囊卵巢综合征（PCOS）中的中心性肥胖与炎症标志物增加及2型糖尿病风险增加相关。
本研究的目的是评估二甲双胍（M）治疗或M联合口服避孕药（OCPs）治疗是否比单独使用OCP治疗能带来更有利的身体成分。
该研究在门诊诊所进行。
这是一项随机对照临床试验。90例PCOS患者被随机分为接受M（2 g/d）治疗12个月、M + OCP（150 mg去氧孕烯 + 30 μg炔雌醇）治疗12个月或OCP治疗12个月。在干预期前后进行全身双能X线吸收法扫描以及临床和激素评估。90例患者中有65例完成了研究。
测量6个月和12个月时的体重变化以及12个月时局部脂肪量估计值的变化。
各干预组之间的脱落率无显著差异。在体重和局部脂肪量方面，M治疗和M + OCP治疗优于OCP治疗。M、M + OCP和OCP治疗12个月期间的体重变化中位数（四分位数）分别为-3.0（-10.3；0.6）kg、-1.9（-4.9；0.1）kg和1.2（-0.8；3.0）kg，P <.05。上下脂肪量比值未改变。身体成分的变化由医疗干预类型（M、M + OCP或OCP）预测，而非研究纳入时的体重指数。在降低游离睾酮水平方面，OCP和M + OCP优于M。
与OCP相比，单独使用M治疗或M与OCP联合治疗与体重减轻和身体成分改善相关，而在M + OCP或OCP治疗期间游离睾酮水平降低。应考虑将M + OCP联合治疗作为单独使用OCP治疗的替代方案，以避免PCOS患者体重增加。
