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目的:分析多囊卵巢综合征(PCOS)伴有胰岛素抵抗患者的临床及内分泌代谢特征,观察有无胰岛素抵抗P-COS妇女经二甲双胍治疗3个月后的变化。方法:收集2007年8月～2008年12月在该院就诊的PCOS不孕患者且服用二甲双胍后未妊娠的72例妇女作为研究对象,根据HOMA胰岛素抵抗指数(HOMAIR)分为胰岛素抵抗组(n=18)和非胰岛素抵抗组(n=54),其中HOMAIR≥2.77确定胰岛素抵抗(A组),HOMAIR<2.77确定非胰岛素抵抗(B组)。比较两组之间的体重指数(BMI)、腰臀比(WHR)、F-G评分、基础LH水平,LH/FSH比值、睾酮(T)、性激素结合球蛋白(SHBG)和卵巢体积,并观察两组在二甲双胍治疗3个月后的各项指标变化。结果:①A、B两组患者的年龄、不孕年限、F-G评分、卵巢体积、基础FSH、T水平、SHBG和空腹血糖(FPG)等方面无明显差异,但A组患者的BMI、WHR和空腹胰岛素(FINS)明显大于B组;A组患者基础LH和基础LH/FSH比值明显低于B组,差异均有统计学意义(P<0.05);②A组患者经二甲双胍治疗后,16例胰岛素抵抗改善,BMI、WHR和FINS显著下降,而性激素结合球蛋白显著升高,基础LH、基础LH/FSH比值、T水平和卵巢体积在治疗后有一定程度的下降,但无统计学意义;B组在二甲双胍治疗后,FINS、基础LH和LH/FSH比值显著下降,而睾酮有一定程度的下降和性激素结合球蛋白水平有较大幅度的升高。结论:胰岛素抵抗PCOS患者较非胰岛素抵抗患者高LH的发生率低,但肥胖更明显,提示胰岛素抵抗与肥胖在多囊卵巢综合征的发生发展中起协同作用;无胰岛素抵抗组患者经二甲双胍治疗后一些内分泌指标得到改善,提示二甲双胍对无胰岛素抵抗的患者也有一定的治疗作用。
OBJECTIVE: To analyze the clinical and endocrine metabolic characteristics of patients with polycystic ovary syndrome (PCOS) accompanied by insulin resistance and to observe the changes of P-COS women with or without insulin resistance after 3 months of metformin treatment. Methods: Seventy-two women without PCOS who were treated with metformin in our hospital from August 2007 to December 2008 were enrolled in this study. According to the HOMA insulin resistance index (HOMAIR), insulin resistance group (n = 18) and non-insulin resistance group (n = 54), HOMAIR≥2.77 to determine insulin resistance (A group), HOMAIR <2.77 to determine non-insulin resistance (B group). The body mass index (BMI), WHR, FG score, basal LH level, LH / FSH ratio, testosterone (T), sex hormone binding globulin (SHBG) and ovarian volume were compared between the two groups. Group metformin after 3 months of treatment of various indicators. Results: ① There was no significant difference in age, duration of infertility, FG score, ovarian volume, basal FSH, T level, SHBG and fasting plasma glucose (FPG) between groups A and B (FINS) was significantly higher than that of group B. The ratio of basic LH to basic LH / FSH in group A was significantly lower than that in group B (P <0.05) .②After treatment with metformin in group A, 16 cases of insulin resistance BMI, WHR and FINS decreased significantly, and sex hormone binding globulin increased significantly. The basal LH, basal LH / FSH ratio, T level and ovarian volume decreased to a certain extent after treatment, but there was no statistical significance. In group B After metformin treatment, FINS, basal LH and LH / FSH ratio decreased significantly, while testosterone decreased to a certain extent and sex hormone binding globulin levels have a more substantial increase. Conclusion: The incidence of LH in insulin resistance patients with PCOS is lower than that in non-insulin resistance patients, but obesity is more obvious, suggesting that insulin resistance and obesity play a synergistic role in the occurrence and development of PCOS. Patients without insulin resistance group were treated with metformin After some endocrine indicators have been improved, suggesting that metformin in patients with insulin resistance also have some therapeutic effect.