多囊卵巢综合征长期及短期治疗后停用二甲双胍的效果：观察性纵向研究

Effects of metformin withdrawal after long and short term treatment in PCOS: observational longitudinal study.

作者信息

Kravos Nika Aleksandra, Janež Andrej, Goričar Katja, Dolžan Vita, Jensterle Mojca

机构信息

Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.

Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.

出版信息

Diabetol Metab Syndr. 2021 Apr 12;13(1):43. doi: 10.1186/s13098-021-00660-5.

DOI:10.1186/s13098-021-00660-5

PMID:33845893

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8042848/

Abstract

BACKGROUND

Metformin plays a consolidated role in the management of polycystic ovary syndrome (PCOS). However, there is no clear answer on how long we should treat and on how long its beneficial impact sustain after we stop treatment. We compared the effects of metformin withdrawal after long-term (LT) and short term (ST) treatment in PCOS women that had previously well responded to metformin.

METHODS

We conducted observational longitudinal study including 44 PCOS women (31 (28-36) years and BMI 32.5 (27.7-34.9) kg/m) that were followed for 6 months after metformin withdrawal. Prior inclusion, ST group had been treated with metformin on average for 1.03 ± 0.13 year, LT group for 5.07 ± 2.52 years. We followed anthropometric, metabolic, reproductive parameters and eating behavior as assessed by TFEQ-R18.

RESULTS

After metformin withdrawal, ST group gained significant amount of weight (from 92 (75.5-107.3) kg to 96 (76-116) kg; p = 0.019). Weight tended to increase also in LT users (from 87 (75-103) to 87 (73-105) kg; p = 0.058). More women in LT group maintained stable weight (27% in LT group vs 15% in ST group). Eating behavior deteriorated in both groups. Withdrawal of metformin resulted in a decrease of menstrual frequency (6 (6-6) to 6 (4-6) menstrual bleeds per 6 months; p = 0.027) and in borderline increase of androstenedione (6.4 (4.6-7.6) to 7.8 (4.8-9.6) nmol/L; p = 0.053) in LT group. Waist circumference, HOMA and glucose homeostasis remained stable in both groups. There were no differences between groups at 6-month follow up.

CONCLUSION

Collectively, present study implies some metabolic and endocrine treatment legacy in both groups as well as some group-specific deteriorations in clinical parameters 6 months after metformin withdrawal.

TRIAL REGISTRATION

The study is registered at Clinical Trials with reference No. NCT04566718.

摘要

背景

二甲双胍在多囊卵巢综合征（PCOS）的管理中发挥着巩固作用。然而，对于我们应该治疗多长时间以及停止治疗后其有益影响能持续多久，尚无明确答案。我们比较了长期（LT）和短期（ST）治疗后停用二甲双胍对先前对二甲双胍反应良好的PCOS女性的影响。

方法

我们进行了一项观察性纵向研究，纳入44名PCOS女性（年龄31（28 - 36）岁，体重指数32.5（27.7 - 34.9）kg/m²），在停用二甲双胍后随访6个月。在纳入研究前，ST组平均接受二甲双胍治疗1.03±0.13年，LT组为5.07±2.52年。我们随访了人体测量学、代谢、生殖参数以及通过TFEQ - R18评估的饮食行为。

结果

停用二甲双胍后，ST组体重显著增加（从92（75.5 - 107.3）kg增至96（76 - 116）kg；p = 0.019）。LT组使用者体重也有增加趋势（从87（75 - 103）kg增至87（73 - 105）kg；p = 0.058）。LT组更多女性体重保持稳定（LT组为27%，ST组为15%）。两组的饮食行为均恶化。停用二甲双胍导致LT组月经频率降低（每6个月月经出血次数从6（6 - 6）次降至6（4 - 6）次；p = 0.027），雄烯二酮略有升高（从6.4（4.6 - 7.6）nmol/L升至7.8（4.8 - 9.6）nmol/L；p = 0.053）。两组的腰围、HOMA及血糖稳态均保持稳定。6个月随访时两组间无差异。