Esmaeilzadeh Sedigheh, Gholinezhad-Chari Maryam, Ghadimi Reza
Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
J Hum Reprod Sci. 2017 Apr-Jun;10(2):95-101. doi: 10.4103/jhrs.JHRS_74_16.
Hyperhomocysteinemia is a well-known risk factor for cardiovascular disease. Although metformin therapy can increase homocysteine (Hcy) levels, it frequently is used as an oral medicine in women with polycystic ovary syndrome (PCOS), who might be at risk of catching diabetes mellitus. The aim of this study was to investigate the effect of metformin on the levels of serum Hcy, vitamin B12 (vit B12), and folic acid in patients with PCOS.
An interventional study was designed with 18 patients with PCOS at the Fatemehzahra infertility Hospital in Babol, Iran. Metformin treatment (500 mg twice daily) was initiated in all patients for a period of consecutive 6 months. The levels of serum Hcy, vit B12, and folic acid were measured in the participants before and after metformin treatment.
The mean vit B12 level showed a significant decrease in patients after 6 months of metformin treatment ( = 0.002). However, there was no significant difference in serum folic acid levels. The mean Hcy levels increased after treatment, but this difference not was statistically significant. When patients were stratified into four subgroups by their insulin sensitivity and body mass index (BMI), relatively similar results were obtained in the subgroups, except that Hcy levels in the overweight/obesity group (BMI > 25 kg/m) after treatment showed a significant increase ( = 0.01).
These findings indicate that metformin increases the serum Hcy concentration in patients with PCOS especially in the women with BMI > 25 kg/m. The possible mechanism for this effect would be the obvious reduction in the levels of vit B12.
高同型半胱氨酸血症是心血管疾病的一个众所周知的危险因素。尽管二甲双胍治疗会使同型半胱氨酸（Hcy）水平升高，但它经常被用作多囊卵巢综合征（PCOS）女性的口服药物，而这些女性可能有患糖尿病的风险。本研究的目的是调查二甲双胍对PCOS患者血清Hcy、维生素B12（维生素B12）和叶酸水平的影响。
在伊朗巴博勒的法特梅赫扎赫拉不孕不育医院对18例PCOS患者进行了一项干预性研究。所有患者均开始接受二甲双胍治疗（每日两次，每次500毫克），持续6个月。在二甲双胍治疗前后测量参与者的血清Hcy、维生素B12和叶酸水平。
二甲双胍治疗6个月后，患者的平均维生素B12水平显著下降（P = 0.002）。然而，血清叶酸水平没有显著差异。治疗后平均Hcy水平有所升高，但这种差异无统计学意义。当根据胰岛素敏感性和体重指数（BMI）将患者分为四个亚组时，各亚组获得了相对相似的结果，只是治疗后超重/肥胖组（BMI>25 kg/m²）的Hcy水平显著升高（P = 0.01）。
这些发现表明，二甲双胍会增加PCOS患者的血清Hcy浓度，尤其是BMI>25 kg/m²的女性。这种作用的可能机制是维生素B12水平明显降低。
