CAJ | 학술논문

目的：在个体化营养和运动指导的前提下，比较达英-35和达英-35联合二甲双胍治疗多囊卵巢综合征（ polycystic ovarian syndrome，PCOS）的疗效，为PCOS患者的规范化管理和治疗提供理论依据。方法将确诊为PCOS的患者60例采用数字随机表法随机分为达英-35治疗组和达英-35联合二甲双胍治疗组，每组各30例。在入组时根据静息能量消耗测定及体成分运动功能测定等，给予患者个体化营养运动指导。两组患者均服用达英-353个周期，联合用药组加服二甲双胍片3个月，1日2次，1次500 mg。分别在治疗前后测量身高、体质量、腰围、臀围、全身脂肪含量；进行痤疮评分、多毛评分；于月经2～5 d空腹测定卵泡刺激素、黄体生成素、睾酮、血糖、血脂、胰岛素等。结果①治疗3个月后，达英-35治疗组和达英-35联合二甲双胍治疗组的体质量指数、痤疮评分、黄体生成素、睾酮，高密度脂蛋白胆固醇升高，差异具有统计学意义；多毛评分稍有下降，差异无统计学意义；总胆固醇、三酰甘油升高，差异无统计学意义。②治疗3个月后，联合用药组全身脂肪含量、空腹血糖、胰岛素抵抗指数下降，差异有统计学意义。③治疗3个月后，达英-35治疗组空腹血糖升高，空腹胰岛素降低，差异无统计学意义。④体质量指数、空腹血糖的变化在两组之间差异有统计学意义，其余各指标在两组间的差异均无统计学意义。结论在个体化营养和运动指导的前提下应用达英-35或达英-35联合二甲双胍干预3个周期均能有效降低血清睾酮质量浓度，改善痤疮症状，但尚不足以改善多毛症状。达英-35联合二甲双胍能降低PCOS患者脂肪含量，改善血糖血脂代谢，单用达英-35并不恶化PCOS患者的糖脂代谢状态。
목적：재개체화영양화운동지도적전제하，비교체영-35화체영-35연합이갑쌍고치료다낭란소종합정（ polycystic ovarian syndrome，PCOS）적료효，위PCOS환자적규범화관리화치료제공이론의거。방법장학진위PCOS적환자60례채용수자수궤표법수궤분위체영-35치료조화체영-35연합이갑쌍고치료조，매조각30례。재입조시근거정식능량소모측정급체성분운동공능측정등，급여환자개체화영양운동지도。량조환자균복용체영-353개주기，연합용약조가복이갑쌍고편3개월，1일2차，1차500 mg。분별재치료전후측량신고、체질량、요위、둔위、전신지방함량；진행좌창평분、다모평분；우월경2～5 d공복측정란포자격소、황체생성소、고동、혈당、혈지、이도소등。결과①치료3개월후，체영-35치료조화체영-35연합이갑쌍고치료조적체질량지수、좌창평분、황체생성소、고동，고밀도지단백담고순승고，차이구유통계학의의；다모평분초유하강，차이무통계학의의；총담고순、삼선감유승고，차이무통계학의의。②치료3개월후，연합용약조전신지방함량、공복혈당、이도소저항지수하강，차이유통계학의의。③치료3개월후，체영-35치료조공복혈당승고，공복이도소강저，차이무통계학의의。④체질량지수、공복혈당적변화재량조지간차이유통계학의의，기여각지표재량조간적차이균무통계학의의。결론재개체화영양화운동지도적전제하응용체영-35혹체영-35연합이갑쌍고간예3개주기균능유효강저혈청고동질량농도，개선좌창증상，단상불족이개선다모증상。체영-35연합이갑쌍고능강저PCOS환자지방함량，개선혈당혈지대사，단용체영-35병불악화PCOS환자적당지대사상태。
Objective To provide theoretical basis of standardized management and treatment for polycystic ovarian syndrome ( PCOS) patients through the study of Diane 35 vs Diane 35 plus metformin on PCOS women under comprehensive management .Methods Sixty patients with PCOS were randomly divided into two groups , Diane-35-only group and Diane-35 plus metformin(the combination) group, each with 30 cases.Their resting-energy-consumption and body-composition-measurement on movement functionality were analyzed to offer individualized nutrition and exercise guidance .Three Diane-35 cycles were administered;metformin was added in one group .We selected the data of patients'height, weight, waist circumference, hip circumference, body fat percentage, acne score, hirsutism score; serum hormone level were tested between 2nd and 5th days of menstrual cycle, such as follicle-stimulating hormone, luteinizing hormone, testosterone, blood glucose, blood lipids, insulin, etc.Results ① After three months'treatment, body mass index, acne score, LH levels and T levels dropped in both groups, while HDL-C concentration elevated, the difference was statistically significant(P<0.05);the hairy score decreased slightly(P>0.05); total cholesterol and triglycerides concentration elevated (P>0.05).② After three months'treatment, the body fat content , fasting glucose and insulin resistance index in combined treatment group decreased , the difference was statistically significant(P<0.05).③ After three months'treatment, fasting blood sugar was elevated and fasting insulin concentration dropped in Diane-35 treatment group(P>0.05).④The body mass index, fasting blood glucose changes were significant different between two groups(P<0.05), while the rest indicators were not significantly different (P>0.05).Conclusion Under the individualized nutrition and exercise guidance , Diane-35 only group or Diane-35 plus metformin group could both effectively reduce serum testosterone levels, improve acne symptoms, but not hirsutism.The combination group can reduce the fat content in patients with PCOS , improve glucose and lipid metabolism , and Diane-35 alone does not worsen glucose and lipid metabolism in patients with PCOS .