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目的探讨复方醋酸环丙孕酮、二甲双胍对存在雄激素过多、胰岛素拮抗的多囊卵巢综合征(Polycystic ovary syndrome,PCOS)患者促排卵治疗以及提高妊娠率的效果。方法选择存在雄激素过多、胰岛素拮抗的耐克罗米酚的PCOS患者50例,口服复方CPA、二甲双胍治疗,3个月后,未恢复正常月经者联合克罗米酚促排卵,治疗前或治疗后每隔3个月分别测量体重、卵巢体积、空腹胰岛素、服糖后2h胰岛素、空腹血糖、服糖后2h血糖、睾酮(T)、性激素结合蛋白(SHBG)、促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)。结果经3个月治疗,治疗前后相比,血糖水平无改变,体重指数有下降,但无显著差异(P>0.05);卵巢体积由(17.6±7.3)mm3下降至(7.4±0.1)mm3,差异有显著性(P<0.01);空腹胰岛素及服糖后胰岛素有明显下降(P<0.01),LH和LH/FSH有明显下降(P<0.05),SHBG显著上升(P<0.01),FSH、E2无改变。成熟卵泡发育44例(88%),排卵34例(68%),妊娠17例(34%)。结论复方醋酸环丙孕酮、二甲双胍能有效地降低雄激素、改善胰岛素拮抗,提高排卵率和妊娠成功率。
Objective To investigate the effect of compound prescription of cyproterone acetate and metformin on ovulation induction and pregnancy rate in patients with polycystic ovary syndrome (PCOS) with hyperandrogenism and insulin resistance. Methods 50 cases of PCOS patients with hyperandrogenism and insulin antagonism were treated with oral compound CPA and metformin. After 3 months, the patients with normal menstruation and clomiphene did not resume ovulation induction. Before treatment or treatment Body weight, ovarian volume, fasting insulin, insulin at 2h after oral administration, fasting blood glucose, blood glucose at 2h after oral administration, testosterone (T), sex hormone binding protein (SHBG), follicle stimulating hormone (FSH) , Luteinizing hormone (LH), estradiol (E2). Results After 3 months of treatment, the blood glucose level did not change and the body mass index decreased compared with that before treatment (P> 0.05). The ovarian volume decreased from (17.6 ± 7.3) mm3 to (7.4 ± 0.1) mm3, (P <0.01), LH and LH / FSH decreased significantly (P <0.05), SHBG increased significantly (P <0.01), FSH , E2 no change. Mature follicles developed in 44 cases (88%), ovulation in 34 cases (68%) and pregnancy in 17 cases (34%). Conclusion Compound cyproterone acetate and metformin can effectively reduce androgen, improve insulin antagonism, improve ovulation rate and pregnancy success rate.