CAJ | 학술논문

目的探讨二甲双胍马来酸罗格列酮对肥胖及非肥胖多囊卵巢综合征(PCOS)患者胰岛素抵抗、高雄激素血症等的影响.方法选取符合2003年鹿特丹诊断标准的PCOS患者70例,根据体重指数分为超重/肥胖组(34例)和非肥胖组(36例).2组PCOS患者口服二甲双胍马来酸罗格列酮片3个月.治疗前后检查:身高、体重、腰围、臀围、空腹血糖、空腹胰岛素、黄体生成素(LH)、卵泡刺激素(FSH)、总睾酮、游离睾酮、卵巢面积及卵泡数目;计算体重指数、稳态模型评估的胰岛素抵抗指数(HOMA-IR).结果 (1)与非肥胖组相比,超重/肥胖组PCOS患者HOMA-IR及卵泡数目增加(均P＜0.05),但LH、LH/FSH、总睾酮、游离睾酮及卵巢面积差异无统计学意义.(2)治疗后2组PCOS患者体重指数、空腹血糖、空腹胰岛素、HOMA-IR明显下降(均P＜0.05);超重/肥胖组LH、LH/FSH、游离睾酮及非肥胖组游离睾酮明显下降(均P＜0.05),且超重/肥胖组游离睾酮下降的差值大于非肥胖组(P＜0.05);2组卵巢面积、卵泡数目均减少(P＜0.05);总睾酮、FSH无明显变化.(3)治疗过程中胃肠道不良反应发生率非肥胖组为9.3％,超重/肥胖组为6.3％,无肝毒性、水肿及低血糖等不良反应.结论超重/肥胖较非肥胖的PCOS患者胰岛素抵抗及卵巢多囊样改变更明显,但总睾酮、游离睾酮差异无统计学意义.二甲双胍马来酸罗格列酮能降低PCOS患者的体重指数和游离睾酮,改善胰岛素抵抗及卵巢多囊样改变,对超重/肥胖PCOS患者作用更显著,无明显不良反应.
목적 탐토이갑쌍고마래산라격렬동대비반급비비반다낭란소종합정(PCOS)환자이도소저항、고웅격소혈증등적영향.방법 선취부합2003년록특단진단표준적PCOS환자70례,근거체중지수분위초중/비반조(34례)화비비반조(36례).2조PCOS환자구복이갑쌍고마래산라격렬동편3개월.치료전후검사:신고、체중、요위、둔위、공복혈당、공복이도소、황체생성소(LH)、란포자격소(FSH)、총고동、유리고동、란소면적급란포수목;계산체중지수、은태모형평고적이도소저항지수(HOMA-IR).결과 (1)여비비반조상비,초중/비반조PCOS환자HOMA-IR급란포수목증가(균P＜0.05),단LH、LH/FSH、총고동、유리고동급란소면적차이무통계학의의.(2)치료후2조PCOS환자체중지수、공복혈당、공복이도소、HOMA-IR명현하강(균P＜0.05);초중/비반조LH、LH/FSH、유리고동급비비반조유리고동명현하강(균P＜0.05),차초중/비반조유리고동하강적차치대우비비반조(P＜0.05);2조란소면적、란포수목균감소(P＜0.05);총고동、FSH무명현변화.(3)치료과정중위장도불량반응발생솔비비반조위9.3％,초중/비반조위6.3％,무간독성、수종급저혈당등불량반응.결론 초중/비반교비비반적PCOS환자이도소저항급란소다낭양개변경명현,단총고동、유리고동차이무통계학의의.이갑쌍고마래산라격렬동능강저PCOS환자적체중지수화유리고동,개선이도소저항급란소다낭양개변,대초중/비반PCOS환자작용경현저,무명현불량반응.
Objective To evaluate the therapeutic effects of metformin hydrochloride and rosiglitazone maleate tablets on insulin resistance and androgen concentration in obese and nonobese women with polycystic ovarian syndrome (PCOS).Methods Seventy women with PCOS were enrolled into this study according to the diagnostic criteria of Rotterdam conference (2003).The women with PCOS were divided into the over weight/obese group (body mass index ≥ 25 kg/m2,n =34) and the nonobese group (body mass index＜25 kg/m2,n =36).All women with PCOS took metformin hydrochloride and rosiglitazone maleate tablets twice daily for 3 months.The following indexes were measured before and after the treatment:height,weight,waist circumference,hip circumference,fasting plasma glucose,fasting plasma insulin,luteinizing hormone (LH),follicle stimulating hormone (FSH),total testosterone,free testosterone,follicular number and ovarian area,body mass index,waist to hip ratio,and homeostasis model assessment for insulin resistance (HOMA-IR) were calculated.Results (1) Compared with the nonobese group,dramatic increases in HOMA-IR and follicle number were observed in over weight/obese group(P＜0.05),while LH,LH/FSH,total testosterone,free testosterone showed no significant difference between two groups.(2) After the treatment with metformin hydrochloride and rosiglitazone maleate tablets,weight,body mass index,fasting plasma glucose,fasting plasma insulin,HOMA-IR significantly decreased in two groups (P ＜ 0.05).There were also significant declines of LH,LH/FSH,free testosterone,ovarian area,follicular number,especially in the over weight/ obese women with PCOS (P＜0.05),while total testosterone and FSH did not change significantly.(3) The incidence of gastrointestinal adverse reactions in nonobese and over weight/obese group was 9.3％ and 6.3％ respectively,and no liver toxicity,edema,hypoglycemia and other adverse reactions was observed during treatment.Conclusion Compared with the nonobese group,there were severer insulin resistance and more marked polycystic change of ovary in over weight/obese women with PCOS,while total testosterone and free testosterone showed no significant difference between two gruops.Metformin hydrochloride and rosiglitazone maleate tablets can ameliorate insulin resistance and polycystic ovary,and also reduce body mass index and free testosterone in women with PCOS particularly in the over weight/obese individuals.