综合管理下达英-35与达英-35联合二甲双胍治疗多囊卵巢综合征的疗效研究

doi:10.3969/j.issn.1006-7795.2014.04.005

首都医科大学学报 ›› 2014, Vol. 35 ›› Issue (4): 407-413.doi: 10.3969/j.issn.1006-7795.2014.04.005

• 更年期与妇科内分泌专题 • 上一篇下一篇

综合管理下达英-35与达英-35联合二甲双胍治疗多囊卵巢综合征的疗效研究

武红琴¹, 阮祥燕¹, 卢永军¹, 田玄玄¹, 张颖¹, 刘玉兰¹, 甄洁¹, Diethelm Wallwiener², Alfred O. Mueck^1,2

1. 首都医科大学附属北京妇产医院内分泌科, 北京 100026;
2. 德国图宾根大学妇产医院内分泌与绝经中心, 德国图宾根 D-72076

收稿日期:2014-06-10 出版日期:2014-08-21 发布日期:2014-07-22
通讯作者: 阮祥燕 E-mail:ruanxiangyan@163.com
基金资助:
北京市卫生系统高层次卫生技术人才培养计划项目（2009-3-52），首都医科大学附属北京妇产医院、北京妇幼保健院学科带头人项目（2013-1），国家外国专家局2014年度北京市引进国外技术、管理人才项目（GDJ20141100017）。

Efficacy of Diane 35 vs Diane 35 plus metformin on polycystic ovarian syndrome women under comprehensive management

Wu Hongqin¹, Ruan Xiangyan¹, Lu Yongjun¹, Tian Xuanxuan¹, Zhang Ying¹, Liu Yulan¹, Zhen Jie¹, Diethelm Wallwiener², Alfred O. Mueck^1,2

1. Department of Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, Chinaa;
2. Department of Endocrinology, University Women's Hospital of Tubingen, Tubingen D-72076, Germany

Received:2014-06-10 Online:2014-08-21 Published:2014-07-22
Supported by:
This study was supported by Beijing Municipality Health Technology High-level Talent(2009-3-52); Project of Discipline Leader, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Health Care Hospital(2013-1); Foreign Technical and Administrative Talent Introduction Project in 2014, State Administration of Foreign Experts Affairs, the People’s Republic of China(GDJ20141100017).

摘要/Abstract

摘要：

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-35 3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。

关键词: 多囊卵巢综合征, 达英-35, 二甲双胍, 综合管理

Abstract:

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). 4 The 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.

Key words: polycystic ovary syndrome, Diane 35, metformin, comprehensive treatment

中图分类号:

R711

武红琴, 阮祥燕, 卢永军, 田玄玄, 张颖, 刘玉兰, 甄洁, Diethelm Wallwiener, Alfred O. Mueck. 综合管理下达英-35与达英-35联合二甲双胍治疗多囊卵巢综合征的疗效研究[J]. 首都医科大学学报, 2014, 35(4): 407-413.

Wu Hongqin, Ruan Xiangyan, Lu Yongjun, Tian Xuanxuan, Zhang Ying, Liu Yulan, Zhen Jie, Diethelm Wallwiener, Alfred O. Mueck. Efficacy of Diane 35 vs Diane 35 plus metformin on polycystic ovarian syndrome women under comprehensive management[J]. Journal of Capital Medical University, 2014, 35(4): 407-413.

参考文献

[1] Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report[J]. Fertil Steril, 2009,91(2):456-488.
[2] Fauser B C, Tarlatzis B C, Rebar R W, et al. Consensus on women's health aspects of polycystic ovary syndrome(PCOS): the Amsterdam ESHRE/ ASRM-Sponsored 3rd PCOS Consensus Workshop Group[J]. Fertil Steril, 2012,97(1):28-38.
[3] 卢永军,阮祥燕,田玄玄,等.多囊卵巢综合征综合治疗疗效的评价[J].首都医科大学学报,2013,34(4):525-529.
[4] Calaf J, López E, Millet A, et al. Long-term efficacy and tolerability of flutamide combined with oral contraception in moderate to severe hirsutism: a 12-month, double-blind, parallel clinical trial[J]. J Clin Endocrinol Metab, 2007,92(9):3446-3452.
[5] Demircay Z, Kus S, Sur H. Predictive factors for acne flare during isotretinoin treatment[J]. Eur J Dermatol, 2008,18(4):452-456.
[6] Thessalonkik ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome[J]. Fertil Steril, 2008,89(3):505-522.
[7] Baptiste C G, Battista M C, Trottier A, et al. Insulin and hyperandrogenism in women with polycystic ovary syndrome[J]. J Steroid Biochem Mol Biol, 2010,122(1-3):42-52.
[8] Domecq J P, Prutsky G, Mullan R J, et al. Lifestyle modification programs in polycystic ovary syndrome: systematic review and meta-analysis[J]. J Clin Endocrinol Metab, 2013,98(12):4655-4663.
[9] Yildiz B O, Knochenhauer E S, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome[J]. J Clin Endocrinol Metab, 2008,93(1):162-168.
[10] Svendsen P F, Nilas L, Norgaard K, et al. Obesity, body composition and metabolic disturbances in polycystic ovary syndrome[J]. Hum Reprod, 2008,23(9):2113-2121.
[11] Lord J, Thomas R, Fox B, et al. The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome[J]. BJOG, 2006,113(10):1203-1209.
[12] Gallo M F, Lopez L M, Grimes D A,et al. Combination contraceptives: effects on weight[J]. Cochrane Database Syst Rev, 2014,1:CD003987.
[13] Glintborg D, Altinok M L, Mumm H, et al. Body composition is improved during 12 months treatment with metformin alone or combined with oral contraceptives compared to treatment with oral contraceptives in polycystic ovary syndrome[J]. J Clin Endocrinol Metab, 2014,17:jc20141135.
[14] Tan J. Hormonal treatment of acne: review of current best evidence[J]. J Cutan Med Surg, 2004,8 Suppl 4:11-15.
[15] 党慧敏.达英-35联合二甲双胍治疗多囊巢综合征疗效观察.大连:大连医科大学,2012.
[16] Caruso S, Cianci S, Malandrino C, et al. Hyperandrogenic women treated with a continuous-regimen oral contraceptive[J]. Eur J Obstet Gynecol Reprod Biol, 2013,171(2):307-310.
[17] Kahraman K, Sükür Y E, Atabekoglu C S, et al. Comparison of two oral contraceptive forms containing cyproterone acetate and drospirenone in the treatment of patients with polycystic ovary syndrome: a randomized clinical trial[J]. Arch Gynecol Obstet, 2014,.
[18] Prelević G M, Würzburger M I, Balint-Perić L, et al. Effects of a low-dose estrogen-antiandrogen combination(Diane-35) on clinical signs of androgenization, hormone profile and ovarian size in patients with polycystic ovary syndrome[J]. Gynecol Endocrinol, 1989,3(4):269-280.
[19] Rautio K, Tapanainen J S, Ruokonen A, et al. Effects of metformin and ethinyl estradiol-cyproterone acetate on lipid levels in obese and non-obese women with polycystic ovary syndrome[J]. Eur J Endocrinol, 2005,152(2):269-275.
[20] Wu J, Zhu Y, Jiang Y, et al. Effects of metformin and ethinyl estradiol-cyproterone acetate on clinical, endocrine and metabolic factors in women with polycystic ovary syndrome[J]. Gynecol Endocrinol, 2008,24(7):392-398.
[21] Orbetsova M, Kamenov Z, Kolarov G, et al. Effect of 6-month treatment with oral antiandrogen alone and in combination with insulin sensitizers on body composition, hormonal and metabolic parameters in women with polycystic ovary syndrome(PCOS) in order to determine therapeutic strategy[J]. Akush Ginekol(Sofiia), 2006,45(7):16-28.
[22] Elter K, Imir G, Durmusoglu F. Clinical, endocrine and metabolic effects of metformin added to ethinyl estradiol-cyproterone acetate in non-obese women with polycystic ovarian syndrome: a randomized controlled study[J]. Hum Reprod, 2002,17(7):1729-1737.

综合管理下达英-35与达英-35联合二甲双胍治疗多囊卵巢综合征的疗效研究

Efficacy of Diane 35 vs Diane 35 plus metformin on polycystic ovarian syndrome women under comprehensive management

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