二甲双胍治疗多囊卵巢综合征克罗米酚抵抗疗效观察

1、二甲双胍治疗多囊卵巢综合征克罗米酚抵抗疗效观察 07-08-24 11:09:00 编辑：studa20 作者：侯灵彤，田清友，韩素新，张荣华【关键词】 多囊卵巢综合征；二甲双胍；妊娠；不育；氯录芬；胰岛素抗药性Treatment effect of metformin on clomipheneresistant patients with polycystic ovary syndrome【Abstract】 AIM: To observe the treatment effect of metformin（MTF）on clomiphene (CC)resistant infertile

2、 patients with polycystic ovary syndrome (PCOS). METHODS: Among 22 CCresistant patients with POCS, 20 patients showed insulin resistance (IR). They firstly received MTF threapy for 3 months, later those who failed to conceive received MTF and CC threapy for another 3 months. At the end, the patients

3、 sexual hormone, body mass index (BMI), fasting insulin (I0), 2hour glucose to insulin ratio (G120/I120) and Homeostatic model assessmentinsulin resistance index (HOMAIR) were detected again and the results were compared with those of pretreatment. At the same time, the ovulation and pregnancy rates

4、 were calculated. RESULTS: At the end of 6month MTF treatment on 20 CCresistant patients, 12 cases (60%) resumed their ovulation, 10 cases (50%) achieved pregnancy and did not abort. In the 8 patients who did not resume ovulation, however, the level of LH, LH/FSH, BMI, I0, G120/I120 and HOMAIR decre

5、ased significantly as compared with those of pretreatment (P0.05). CONCLUSION: CCresistant infertile women with PCOS are mostly associated with IR. MTF treatment is an economic and easily performed method which can be used to improve the ovulation and pregnancy rates.【Keywords】 polycystic ovary synd

6、rome (PCOS); metformin (MTF); pregnancy; infertility; clomiphene; insulin resistance(IR)【摘要】 目的： 探讨二甲双胍（MTF）治疗多囊卵巢综合征（PCOS）不孕患者克罗米酚（CC）抵抗的效果. 方法： 22例CC抵抗PCOS不孕患者中合并胰岛素抵抗（IR）者20例，改为口服MTF，3 mo未妊娠者加服CC 3个周期. 采取自身对照法，观察其用药前后排卵恢复情况、妊娠结局及血胰岛素水平、IR指数、体重指数（BMI）、性激素等指标的变化. 结果： 20例合并IR的患者服用MTF 6 mo后12例（60%）恢复

7、排卵；其中10例（50%）妊娠，均未发生流产；8例无效，但用药6 mo后BMI、空腹胰岛素（I0）,IR指数,T及LH/FSH均明显降低（P均0.85.1.2.3.5IR诊断标准及指标计算方法5 空腹胰岛素（fasting insulin, I0）20 mU/L； 稳态模型（homeostatic model assessment）的胰岛素抵抗指数（HOMAIR）3.8，HOMAIR= G0I0/405（G0表示空腹血糖含量mg/dl,然后换成mmol/L）； G120/I1201.0. 符合其中一个条件即可.1.2.4治疗方案雄激素含量正常者服用避孕药妈富隆、高雄激素血症者服达英35，均调整

8、月经周期3 mo，同时要求超重或肥胖患者控制体重，之后于月经周期第5日每日服CC 100 mg，共5 d，超声监测卵泡发育，无排卵者逐渐增加剂量至200 mg，再连续服用3 mo，仍无排卵者确定为CC抵抗并进行OGTT和IRT检查.确诊存在IR者改为口服MTF 500 mg，3次/d，同时控制饮食，增加运动量以减轻体重（保证每月减重1 kg左右）. 服药期间监测BBT并指导性生活，发现月经延期或BBT呈双相持续超过18 d即检测尿HCG，确定妊娠后停药. 服药3 mo未妊娠者加用CC促排卵，3 mo后仍无排卵者再检测血清空腹及糖负荷后120 min胰岛素.不合并IR者应用FSH促排卵，同时超声

9、检查监测卵泡发育，当成熟卵泡数在13个时肌肉注射HCG促排卵，当成熟卵泡数4个时放弃治疗.统计学处理：应用SPSS10.0统计学软件进行t检验，以P0.05为有统计学意义.2结果2.1PCOS患者CC促排卵治疗73例患者中，妊娠38例（52.1%），其中早期流产6例（15.8%），32例（84.2%）足月分娩；5例有排卵但治疗6个周期未妊娠（6.8%）；8例合并黄素化卵泡未破裂综合征（11.0%）；CC抵抗22例（30.1%）.2.2CC抵抗者OGTT和IRT检测22例患者OGTT均正常，20例患者存在IR. IR患者I0 18.958.41（mIU /L），HOMAIR 4.901.03，G120/I120 1.090.74，BMI 27.425.31，WHR 0