炔雌醇环丙孕酮影响非肥胖型多囊卵巢综合征患者的胰岛素敏感性研究

doi:10.3760/cma.j.issn.1673-5250.2013.06.101

目的

探讨炔雌醇环丙孕酮（达英-35）治疗非肥胖型多囊卵巢综合征(PCOS)过程中对患者内分泌代谢的影响，观察患者治疗结束后体内胰岛素敏感性变化。

方法

选取2009年1月至2011年9月于本院确诊，并在本院住院治疗的非肥胖型PCOS患者[体重指数(BMI)<25 kg/m²)]134例为研究对象。入院后对其采用炔雌醇环丙孕酮治疗12个月，观察治疗结束后6，12个月时患者BMI，腰、臀比(WHR)，多毛评分（F-G评分），痤疮评分与血清总睾酮(T)，黄体生成激素(LH)，卵泡刺激素(FSH)，空腹胰岛素(FINS),空腹血糖(FPG)水平及稳态模型胰岛素抵抗指数(HOMA-IR)，并对观察结果进行统计学分析（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，征得受试对象本人的知情同意，并与之签署临床研究知情同意书）。

结果

本组患者采用炔雌醇环丙孕酮规范治疗结束后6，12个月时，患者BMI与WHR均有所增长，但与治疗前比较，差异无统计学意义(P>0.05)。治疗结束后6个月时，患者卵巢体积、F-G评分、痤疮评分均较治疗前显著缩小及降低，治疗结束后12个月时与治疗前比较，缩小及降低幅度更大，且差异均有统计学意义(P<0. 05)。在治疗结束后6，12个月时，患者血清总T，LH及FSH水平均较治疗前显著降低，且差异有统计学意义(P<0.05)。患者接受炔雌醇环丙孕酮治疗结束6，12个月时，FPG及HOMA-IR水平与治疗前比较，差异均无统计学意义(P>0.05)。

结论

炔雌醇环丙孕酮治疗非肥胖型PCOS过程中，患者血清总T水平显著降低至正常，FPG，HOMA-IR较治疗前无显著变化。因此，该药治疗非肥胖型PCOS过程中，对患者胰岛素敏感性无影响。

关键词: 多囊卵巢综合征, 非肥胖型, 炔雌醇环丙孕酮, 胰岛素敏感性

Objective

To investigate effect of ethinylestradiol and cyproterone acetate (diane-35) on endocrinology and metabolism of non-obese patients with polycystic ovary syndrome (PCOS) , and insulin resistance(IR) after treatment.

Methods

From January 2011 to December 2012,a total of 134 non-obese patients with PCOS in Shanghai Eighth People's Hospital were enrolled into this study. Body mass index (BMI) of patients all were less than 25 kg/m² and were treated by ethinylestradiol and cyproterone acetate for 12 months. BMI, waist to hip ratio (WHR),F-G scores,acne scores, and levels of serum total testosterone (T) ,luteinizing hormone (LH),follicle-stimulating hormone (FSH) , fasting insulin(FINS), fasting plasma glucose (FPG),homeostasis model assessment insulin resistance index (HOMA-IR) were observed before treatment and at the end of 6,12 months after treatment by ethinylestradiol and cyproterone acetate. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Shanghai Eighth People's Hospital. Informed consent was obtained from all participants.

Results

BMI, WHR of patients slightly increased at the end of 6,12 months after treatment by ethinylestradiol and cyproterone acetate than those before treatment, there had no significance difference (P>0. 05). Ovarian Volume, F-G scores,acne scores were lower at the end of 6 months after treatment by ethinylestradiol and cyproterone acetate than those before treatment, and reductions much lower at the end of 6,12 months after treatment by ethinylestradiol and cyproterone acetate,there all had significance difference between these two periods than those before treatment, respectively (P<0. 05). At the end of 6 months after treatment by ethinylestradiol and cyproterone acetate,levels of serum total T,LH,and FSH were significantly reduced at the end of 12 months after treatment by ethinylestradiol and cyproterone acetate than those before treatment,and there had significance difference (P<0. 05). There had no significance difference at 6, 12 months after treatment by ethinylestradiol and cyproterone acetate and before treatment in levels of FPG and HOMA-IR(P>0. 05).

Conclusions

Total T significantly reduce to normal levels during the treatment of ethinylestradiol and cyproterone acetate on non-obese patients with PCOS,but FINS,HOMA-IR have no significance deference than those before treatment by ethinylestradiol and cyproterone acetate.

Key words: polycystic ovary syndrome, non-obese, ethinylestradiol and cyproterone acetate, insulin resistance

表1 研究组治疗结束后6，12个月时与治疗前BMI、WHR、卵巢体积、F-G评分及痤疮评分结果比较（±s）

Table 1 Comparison of BMI,WHR,ovarian volume,F-G scores,acne scores before treatment and at the end of 6,12 months after treatment by ethinylestradiol and cyproterone acetate in treatment group(±s)

时间	BMI(kg/m²)	WHR	卵巢体积(cm³)	F-G评分（分）	痤疮评分（分）
治疗结束后6个月时	29. 17±1. 82^a	0. 78 ± 0. 02^a	7.31±1.06^a	5. 70±1. 03^a	0. 92 ± 0. 25^a
治疗结束12个月时	29. 93 ± 1. 74^ab	0. 81 ± 0. 01^ab	5. 18±1. 02^ab	4. 12±1. 40^ab	0. 81 ± 0. 01^ab
治疗前	29. 03 ± 2. 04	0. 74 ± 0. 01	11. 26±1. 75	6. 83 ± 2. 19	1. 53 ± 0. 03
t	8. 34	1. 04	7. 63	7. 29	5. 95
P	>0. 05	<0.05	<0.05	<0.05	<0.05

表1 研究组治疗结束后6，12个月时与治疗前BMI、WHR、卵巢体积、F-G评分及痤疮评分结果比较（±s）

时间	BMI(kg/m²)	WHR	卵巢体积(cm³)	F-G评分（分）	痤疮评分（分）
治疗结束后6个月时	29. 17±1. 82^a	0. 78 ± 0. 02^a	7.31±1.06^a	5. 70±1. 03^a	0. 92 ± 0. 25^a
治疗结束12个月时	29. 93 ± 1. 74^ab	0. 81 ± 0. 01^ab	5. 18±1. 02^ab	4. 12±1. 40^ab	0. 81 ± 0. 01^ab
治疗前	29. 03 ± 2. 04	0. 74 ± 0. 01	11. 26±1. 75	6. 83 ± 2. 19	1. 53 ± 0. 03
t	8. 34	1. 04	7. 63	7. 29	5. 95
P	>0. 05	<0.05	<0.05	<0.05	<0.05

表2 研究组患者治疗结束后6,12个月时与治疗前血清总T,LH，FSH，LH/ FSH and FPG,HOMA-IR检测结果比较(±s)

Table 2 Comparison of levels T, LH ,FSH and LH/ FSH and FPG, HOMA-IR at end of 6,12 months after treatment and before treatment by ethinylestradiol and cyproterone acetate in treatment group( ± s)

时间	T(?nmol?/L)	LH(U/L)	FSH(U/L)	FPG (?μU?/mL)	HOMA-IR
治疗结束后6个月时	1. 71±0. 14^a	7. 51 ± 0. 04^a	3. 02±1.04^a	8. 82 ± 2. 03^a	1. 63±0. 71^a
治疗结束12个月时	0. 45 ± 0. 01^ab	5. 00 ± 0. 03^ab	2. 28± 1.01^ab	8. 50±1. 04^ab	1. 59 ± 0. 62^ab
治疗前	3. 01 ± 0. 35	13. 38±1. 04	5. 04±1. 55	9. 01±2. 84	1. 82±0. 73
t	7. 12	9. 63	5. 19	1.43	0. 12
P	<0.05	<0.05	<0.05	>0. 05	>0. 05

表2 研究组患者治疗结束后6,12个月时与治疗前血清总T,LH，FSH，LH/ FSH and FPG,HOMA-IR检测结果比较(±s)

时间	T(?nmol?/L)	LH(U/L)	FSH(U/L)	FPG (?μU?/mL)	HOMA-IR
治疗结束后6个月时	1. 71±0. 14^a	7. 51 ± 0. 04^a	3. 02±1.04^a	8. 82 ± 2. 03^a	1. 63±0. 71^a
治疗结束12个月时	0. 45 ± 0. 01^ab	5. 00 ± 0. 03^ab	2. 28± 1.01^ab	8. 50±1. 04^ab	1. 59 ± 0. 62^ab
治疗前	3. 01 ± 0. 35	13. 38±1. 04	5. 04±1. 55	9. 01±2. 84	1. 82±0. 73
t	7. 12	9. 63	5. 19	1.43	0. 12
P	<0.05	<0.05	<0.05	>0. 05	>0. 05

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Effect of Ethinylestradiol and Cyproterone Acetate on Insulin Resistance of Non-Obese Patients With Polycystic Ovary Syndrome

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Effect of Ethinylestradiol and Cyproterone Acetate on Insulin Resistance of Non-Obese Patients With Polycystic Ovary Syndrome