单药及不同联合用药方案治疗多囊卵巢综合征疗效比较

发布时间：2018-04-01 23:23

本文选题：达英-35　切入点：二甲双胍　出处：《大连医科大学》2014年硕士论文

【摘要】：目的：多囊卵巢综合征是妇科的最常见内分泌疾病之一，常伴有胰岛素抵抗以及肥胖。多项研究表明，，口服避孕药和胰岛素增敏剂之联合用药在治疗伴有胰岛素抵抗的多囊卵巢综合征病人时，可产生更好的疗效。本研究对达英-35单独用药、达英-35联合二甲双胍、达英-35和二甲双胍以及吡格列酮联用的三种不同方案治疗伴有胰岛素抵抗的多囊卵巢综合征病人的临床疗效进行比较，以探讨更加有效的治疗方法。方法：收集2008年1月1日-2014年1月1日期间于我院妇产科治疗的多囊卵巢综合征合并胰岛素抵抗病人总计60例，将其按治疗方案的不同分为三组。A组（达英-35组）患者总计20例，给予口服达英-35单一用药方案进行治疗；B组（达英-35+二甲双胍组）患者总计20例，给予口服达英-35及二甲双胍的联合用药方案进行治疗；C组（达英-35+二甲双胍+吡格列酮组）患者总计20例，给予口服达英-35、二甲双胍和吡格列酮三者共同用药的方案进行治疗。治疗前三组患者在年龄、性激素水平、胰岛素抵抗程度、血脂水平、体重指数等方面相比，其一般资料均无统计学差异。三组患者均于治疗3个月后采集静脉血，监测并比较患者治疗前后的性激素水平、胰岛素抵抗程度、血脂水平指标变化情况，分别计算患者的体质指数，并于治疗后观测随诊1-3个月，对比三组患者的排卵恢复及妊娠状况变化。结果：A组（达英-35组）、B组（达英-35+二甲双胍组）及C组（达英-35+二甲双胍+吡格列酮组）患者经过治疗，其T、LH和LH/FSH值均呈显著下降(P0.01)，组间比较未见明显差异(P0.05)。在胰岛素抵抗和体质指数方面，A组患者经过治疗，其FIN、FPG以及BMI均无明显改变(P0.05)；B组、C组患者经治疗，其BMI明显下降(P0.05)、FIN水平显著改善(P0.01)，且C组患者的FIN水平较B组下降更为显著(P0.05)。在血脂水平变化方面，A组患者经过治疗，其反映血脂水平的各理化指标均未见明显改变(P0.05)；B组患者的TG水平明显下降(P0.05)，TC、HDL-C和LDL-C无明显改变(P0.05)；C组患者的TC、TG值明显下降(P0.05)，HDL-C水平明显升高(P0.05)，且C组较B组的TC水平降低更明显(P0.05)。经过治疗，分析患者的排卵恢复及妊娠状况可见，对比A、B、C三组患者的排卵率以及妊娠率，虽差异无统计学意义(P0.05)，但有依次上升趋向，且三药联用的效果更佳。结论：本研究表明，达英-35单药治疗方案、达英-35联合二甲双胍方案、达英-35和二甲双胍以及吡格列酮三者联用的三种治疗方案均能明显降低PCOS患者高雄激素水平；但是在改善胰岛素抵抗及异常脂代谢方面，达英-35与胰岛素增敏剂的联合用药的治疗效果，明显优于达英-35的单一用药；与达英-35、二甲双胍两药联用方案相比，同时服用吡格列酮的三者联合用药方案可以获得更加全面有效的临床疗效。
[Abstract]:Objective: polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in gynecology with insulin resistance and obesity.A combination of oral contraceptives and insulin sensitizers has been shown to be more effective in the treatment of polycystic ovary syndrome (PCOS) with insulin resistance.In this study, we compared the clinical efficacy of three different regimens of diane-35 alone, combined with metformin, diane-35 and metformin, and pioglitazone in the treatment of polycystic ovary syndrome with insulin resistance.To explore more effective treatment.Methods: from January 1, 2008 to January 1, 2014, 60 patients with polycystic ovary syndrome (PCOS) complicated with insulin resistance were treated in our hospital from January 1, 2008 to January 1, 2014.The patients were divided into three groups: group A (group D) (n = 20) and group B (n = 20) treated with oral diane-35 single regimen (group B, n = 20), and group A (n = 20) were divided into two groups: group A (group A, n = 20), and group B (group B, n = 20) treated with oral diane-35 regimen, respectively.A total of 20 patients in group C (group C) were treated with the combination of oral administration of diane-35 and metformin. The patients in group C were treated with the regimen of oral administration of dain-35, metformin and pioglitazone.There were no statistical differences in age, sex hormone level, insulin resistance, blood lipid level and body mass index between the three groups before treatment.Three groups of patients were collected venous blood after 3 months of treatment to monitor and compare the changes of sex hormone levels, insulin resistance and blood lipid levels before and after treatment, and to calculate the body mass index of the patients, respectively.The ovulatory recovery and pregnancy status of the three groups were observed after treatment for 1-3 months.Results the levels of LH and LH/FSH in group A (group D) and group C (group C) were significantly lower than those in group B (group B) and group C (group C). There was no significant difference between the two groups (P0.05).In terms of changes in blood lipids, the patients in group A were treated.After treatment, the ovulatory recovery and pregnancy status of the patients were analyzed. The ovulation rate and pregnancy rate of the three groups were compared. Although the difference was not statistically significant (P 0.05), there was a tendency to increase in turn, and the effect of the combination of three drugs was better.Conclusion: the results showed that the combination of diane-35 and metformin, dianin-35 combined with metformin and pioglitazone could significantly reduce the level of hyperandrogen in patients with PCOS.However, in improving insulin resistance and abnormal lipid metabolism, the therapeutic effect of the combination of dain-35 and insulin sensitizer was significantly better than that of the combination of diane-35 and metformin.The combination of pioglitazone and pioglitazone can achieve a more comprehensive and effective clinical effect.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.75

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