本文選題：達(dá)英-35　切入點：二甲雙胍　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：多囊卵巢綜合征是婦科的最常見內(nèi)分泌疾病之一，常伴有胰島素抵抗以及肥胖。多項研究表明，，口服避孕藥和胰島素增敏劑之聯(lián)合用藥在治療伴有胰島素抵抗的多囊卵巢綜合征病人時，可產(chǎn)生更好的療效。本研究對達(dá)英-35單獨用藥、達(dá)英-35聯(lián)合二甲雙胍、達(dá)英-35和二甲雙胍以及吡格列酮聯(lián)用的三種不同方案治療伴有胰島素抵抗的多囊卵巢綜合征病人的臨床療效進(jìn)行比較，以探討更加有效的治療方法。 方法：收集2008年1月1日-2014年1月1日期間于我院婦產(chǎn)科治療的多囊卵巢綜合征合并胰島素抵抗病人總計60例，將其按治療方案的不同分為三組。A組（達(dá)英-35組）患者總計20例，給予口服達(dá)英-35單一用藥方案進(jìn)行治療；B組（達(dá)英-35+二甲雙胍組）患者總計20例，給予口服達(dá)英-35及二甲雙胍的聯(lián)合用藥方案進(jìn)行治療；C組（達(dá)英-35+二甲雙胍+吡格列酮組）患者總計20例，給予口服達(dá)英-35、二甲雙胍和吡格列酮三者共同用藥的方案進(jìn)行治療。治療前三組患者在年齡、性激素水平、胰島素抵抗程度、血脂水平、體重指數(shù)等方面相比，其一般資料均無統(tǒng)計學(xué)差異。三組患者均于治療3個月后采集靜脈血，監(jiān)測并比較患者治療前后的性激素水平、胰島素抵抗程度、血脂水平指標(biāo)變化情況，分別計算患者的體質(zhì)指數(shù)，并于治療后觀測隨診1-3個月，對比三組患者的排卵恢復(fù)及妊娠狀況變化。 結(jié)果：A組（達(dá)英-35組）、B組（達(dá)英-35+二甲雙胍組）及C組（達(dá)英-35+二甲雙胍+吡格列酮組）患者經(jīng)過治療，其T、LH和LH/FSH值均呈顯著下降(P0.01)，組間比較未見明顯差異(P0.05)。在胰島素抵抗和體質(zhì)指數(shù)方面，A組患者經(jīng)過治療，其FIN、FPG以及BMI均無明顯改變(P0.05)；B組、C組患者經(jīng)治療，其BMI明顯下降(P0.05)、FIN水平顯著改善(P0.01)，且C組患者的FIN水平較B組下降更為顯著(P0.05)。在血脂水平變化方面，A組患者經(jīng)過治療，其反映血脂水平的各理化指標(biāo)均未見明顯改變(P0.05)；B組患者的TG水平明顯下降(P0.05)，TC、HDL-C和LDL-C無明顯改變(P0.05)；C組患者的TC、TG值明顯下降(P0.05)，HDL-C水平明顯升高(P0.05)，且C組較B組的TC水平降低更明顯(P0.05)。經(jīng)過治療，分析患者的排卵恢復(fù)及妊娠狀況可見，對比A、B、C三組患者的排卵率以及妊娠率，雖差異無統(tǒng)計學(xué)意義(P0.05)，但有依次上升趨向，且三藥聯(lián)用的效果更佳。 結(jié)論：本研究表明，達(dá)英-35單藥治療方案、達(dá)英-35聯(lián)合二甲雙胍方案、達(dá)英-35和二甲雙胍以及吡格列酮三者聯(lián)用的三種治療方案均能明顯降低PCOS患者高雄激素水平；但是在改善胰島素抵抗及異常脂代謝方面，達(dá)英-35與胰島素增敏劑的聯(lián)合用藥的治療效果，明顯優(yōu)于達(dá)英-35的單一用藥；與達(dá)英-35、二甲雙胍兩藥聯(lián)用方案相比，同時服用吡格列酮的三者聯(lián)合用藥方案可以獲得更加全面有效的臨床療效。
[Abstract]:Objective: polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in gynecology with insulin resistance and obesity.A combination of oral contraceptives and insulin sensitizers has been shown to be more effective in the treatment of polycystic ovary syndrome (PCOS) with insulin resistance.In this study, we compared the clinical efficacy of three different regimens of diane-35 alone, combined with metformin, diane-35 and metformin, and pioglitazone in the treatment of polycystic ovary syndrome with insulin resistance.To explore more effective treatment.Methods: from January 1, 2008 to January 1, 2014, 60 patients with polycystic ovary syndrome (PCOS) complicated with insulin resistance were treated in our hospital from January 1, 2008 to January 1, 2014.The patients were divided into three groups: group A (group D) (n = 20) and group B (n = 20) treated with oral diane-35 single regimen (group B, n = 20), and group A (n = 20) were divided into two groups: group A (group A, n = 20), and group B (group B, n = 20) treated with oral diane-35 regimen, respectively.A total of 20 patients in group C (group C) were treated with the combination of oral administration of diane-35 and metformin. The patients in group C were treated with the regimen of oral administration of dain-35, metformin and pioglitazone.There were no statistical differences in age, sex hormone level, insulin resistance, blood lipid level and body mass index between the three groups before treatment.Three groups of patients were collected venous blood after 3 months of treatment to monitor and compare the changes of sex hormone levels, insulin resistance and blood lipid levels before and after treatment, and to calculate the body mass index of the patients, respectively.The ovulatory recovery and pregnancy status of the three groups were observed after treatment for 1-3 months.Results the levels of LH and LH/FSH in group A (group D) and group C (group C) were significantly lower than those in group B (group B) and group C (group C). There was no significant difference between the two groups (P0.05).In terms of changes in blood lipids, the patients in group A were treated.After treatment, the ovulatory recovery and pregnancy status of the patients were analyzed. The ovulation rate and pregnancy rate of the three groups were compared. Although the difference was not statistically significant (P 0.05), there was a tendency to increase in turn, and the effect of the combination of three drugs was better.Conclusion: the results showed that the combination of diane-35 and metformin, dianin-35 combined with metformin and pioglitazone could significantly reduce the level of hyperandrogen in patients with PCOS.However, in improving insulin resistance and abnormal lipid metabolism, the therapeutic effect of the combination of dain-35 and insulin sensitizer was significantly better than that of the combination of diane-35 and metformin.The combination of pioglitazone and pioglitazone can achieve a more comprehensive and effective clinical effect.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.75

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