胰岛素增敏治疗对合并胰岛素抵抗的高雄激素性PCOS疗效观察研究

发布时间：2018-04-09 08:12

本文选题：多囊卵巢综合征　切入点：胰岛素抵抗　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:比较胰岛素增敏剂及胰岛素增敏剂联合抗雄治疗对PCOS合并胰岛素抵抗及高雄激素血症治疗疗效,为PCOS诊治提供新思路。方法:前瞻性收集2012年7月-2016年12月就诊于山西医科大学第一医院妇产科门诊,诊断包含高雄激素血症和/或高雄激素体征和胰岛素抵抗的PCOS患者160例(所有患者均稀发排卵或无排卵)。除外仅依据高雄激素的临床体征诊断雄激素增多及资料不完整患者,完成随访者共104例。结合患者意愿及随机原则分两组,单纯胰岛素增敏剂治疗(二甲双胍肠溶片500mg tid或盐酸吡格列酮片15mg qd,或二者联合使用)67例(观察组),抗雄(达英-35)联合胰岛素增敏剂治疗37例(对照组),所有对象给予生活方式指导,观察指标:人口学资料(腰围、WHR、BMI),性激素(T、FSH/LH)、血脂(TC、TG、HDL-C、LDL-C)、糖耐量和胰岛素释放指标包括空腹胰岛素(FINS)、HOMA-IR、胰岛素释放曲线下面积(AUCINS);用药疗程3个月,用药期间严格避孕。建立数据库并进行统计学处理。结果:1.两组观察指标基线值比较差异无统计学意义(P0.05),具有可比性。2.治疗3月后与基线值比较,观察组BMI、T、LH/FSH值、FINS、HOMA-IR、AUCINS水平下降,HDL-C水平升高(P0.05),血脂(TC、TG、LDL-C)比较差异无统计学意义(P0.05),但无增加趋势;对照组腰围、WHR、BMI、T、AUCINS下降,HDL-C、TC水平升高(P0.05),HOMA-IR、FINS呈降低趋势、血脂(TG、LDL-C)无增加趋势,差异无统计学意义(P0.05)。3.组间比较:对照组降低雄激素、升高HDL-C更明显(P0.05)。腰围、WHR、BMI,胰岛素抵抗评价指标(FINS、HOMA-IR、AUCINS)及血脂(TC、TG、LDL-C)差值中位数比较差异无统计学意义(P0.05)。4.胰岛素增敏剂组有效、显效、无效分别为47.8%、41.8%、10.4%,联合达英-35组分别为64.9%、29.7%、5.4%,差异无统计学意义(P0.05)。结论:1.胰岛素增敏剂可有效降低雄激素水平及改善胰岛素抵抗、体脂分布;2.与单用胰岛素增敏剂相比,抗雄联合胰岛素增敏剂治疗降低雄激素水平更优,但3个月的疗程两组降低雄激素水平至正常范围并无明显差异;抗雄联合胰岛素增敏剂改善胰岛素抵抗及体脂分布无明显优势。3.3个月的单独使用胰岛素增敏剂或联合用药均可升高HDL-C,联合用药效果更佳,但对TC、TG、LDL-C均无明显改善作用。
[Abstract]:Objective: to compare the therapeutic effects of insulin sensitizer and insulin sensitizer combined with anti androgenic therapy on PCOS with insulin resistance and hyperandrogenemia, and to provide a new idea for the diagnosis and treatment of PCOS.Methods: from July 2012 to December 2016, the outpatient department of gynecology and obstetrics of the first Hospital of Shanxi Medical University was collected prospectively.One hundred and sixty PCOS patients with hyperandrogenemia and / or hyperandrogen signs and insulin resistance were diagnosed.Except for the diagnosis of androgen increase and incomplete data only according to the clinical signs of hyperandrogen 104 cases were followed up.They were divided into two groups according to patients' wishes and random principles.Insulin sensitizer alone (metformin enteric-coated tablet 500mg tid or pioglitazone hydrochloride 15mg QD), or a combination of the two in 67 patients (observation group, anti-androgen (Da-35) combined with insulin sensitizer, 37 cases (control group, all of them)Like giving guidance to the way of life,Establish database and perform statistical processing.The result is 1: 1.There was no significant difference in baseline values between the two groups (P 0.05).There was no increasing trend of serum lipids in TGN LDL-C, but there was no significant difference between them (P0.05. 3).Comparison between groups: the control group decreased androgen and increased HDL-C significantly (P 0.05).There was no significant difference in the median difference between WHRM, FINSHOMA-IRCINS and TCU TGG LDL-C0. 4.In the insulin sensitizer group, the effective, effective and ineffective were 47.8% and 10.4%, respectively, while in the combined dain-35 group it was 64.9 and 29.75.4.The difference was not statistically significant (P 0.05).Conclusion 1.Insulin sensitizer can effectively reduce androgen level and improve insulin resistance.Compared with insulin sensitizer alone, anti-androgen combined with insulin sensitizer was better in reducing androgen level, but there was no significant difference between the two groups in reducing androgen level to normal range after 3 months of treatment.The combination of anti-androgenic insulin sensitizer and insulin sensitizer had no obvious advantage in improving insulin resistance and body fat distribution. The combination of insulin sensitizer and insulin sensitizer for 3.3 months could increase HDL-C, the effect of combination therapy was better, but there was no obvious improvement on TCU TGG LDL-C.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.75

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