本文選題：多囊卵巢綜合征　切入點(diǎn)：胰島素抵抗　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:比較胰島素增敏劑及胰島素增敏劑聯(lián)合抗雄治療對(duì)PCOS合并胰島素抵抗及高雄激素血癥治療療效,為PCOS診治提供新思路。方法:前瞻性收集2012年7月-2016年12月就診于山西醫(yī)科大學(xué)第一醫(yī)院婦產(chǎn)科門診,診斷包含高雄激素血癥和/或高雄激素體征和胰島素抵抗的PCOS患者160例(所有患者均稀發(fā)排卵或無(wú)排卵)。除外僅依據(jù)高雄激素的臨床體征診斷雄激素增多及資料不完整患者,完成隨訪者共104例。結(jié)合患者意愿及隨機(jī)原則分兩組,單純胰島素增敏劑治療(二甲雙胍腸溶片500mg tid或鹽酸吡格列酮片15mg qd,或二者聯(lián)合使用)67例(觀察組),抗雄(達(dá)英-35)聯(lián)合胰島素增敏劑治療37例(對(duì)照組),所有對(duì)象給予生活方式指導(dǎo),觀察指標(biāo):人口學(xué)資料(腰圍、WHR、BMI),性激素(T、FSH/LH)、血脂(TC、TG、HDL-C、LDL-C)、糖耐量和胰島素釋放指標(biāo)包括空腹胰島素(FINS)、HOMA-IR、胰島素釋放曲線下面積(AUCINS);用藥療程3個(gè)月,用藥期間嚴(yán)格避孕。建立數(shù)據(jù)庫(kù)并進(jìn)行統(tǒng)計(jì)學(xué)處理。結(jié)果:1.兩組觀察指標(biāo)基線值比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2.治療3月后與基線值比較,觀察組BMI、T、LH/FSH值、FINS、HOMA-IR、AUCINS水平下降,HDL-C水平升高(P0.05),血脂(TC、TG、LDL-C)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但無(wú)增加趨勢(shì);對(duì)照組腰圍、WHR、BMI、T、AUCINS下降,HDL-C、TC水平升高(P0.05),HOMA-IR、FINS呈降低趨勢(shì)、血脂(TG、LDL-C)無(wú)增加趨勢(shì),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.組間比較:對(duì)照組降低雄激素、升高HDL-C更明顯(P0.05)。腰圍、WHR、BMI,胰島素抵抗評(píng)價(jià)指標(biāo)(FINS、HOMA-IR、AUCINS)及血脂(TC、TG、LDL-C)差值中位數(shù)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.胰島素增敏劑組有效、顯效、無(wú)效分別為47.8%、41.8%、10.4%,聯(lián)合達(dá)英-35組分別為64.9%、29.7%、5.4%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.胰島素增敏劑可有效降低雄激素水平及改善胰島素抵抗、體脂分布;2.與單用胰島素增敏劑相比,抗雄聯(lián)合胰島素增敏劑治療降低雄激素水平更優(yōu),但3個(gè)月的療程兩組降低雄激素水平至正常范圍并無(wú)明顯差異;抗雄聯(lián)合胰島素增敏劑改善胰島素抵抗及體脂分布無(wú)明顯優(yōu)勢(shì)。3.3個(gè)月的單獨(dú)使用胰島素增敏劑或聯(lián)合用藥均可升高HDL-C,聯(lián)合用藥效果更佳,但對(duì)TC、TG、LDL-C均無(wú)明顯改善作用。
[Abstract]:Objective: to compare the therapeutic effects of insulin sensitizer and insulin sensitizer combined with anti androgenic therapy on PCOS with insulin resistance and hyperandrogenemia, and to provide a new idea for the diagnosis and treatment of PCOS.Methods: from July 2012 to December 2016, the outpatient department of gynecology and obstetrics of the first Hospital of Shanxi Medical University was collected prospectively.One hundred and sixty PCOS patients with hyperandrogenemia and / or hyperandrogen signs and insulin resistance were diagnosed.Except for the diagnosis of androgen increase and incomplete data only according to the clinical signs of hyperandrogen 104 cases were followed up.They were divided into two groups according to patients' wishes and random principles.Insulin sensitizer alone (metformin enteric-coated tablet 500mg tid or pioglitazone hydrochloride 15mg QD), or a combination of the two in 67 patients (observation group, anti-androgen (Da-35) combined with insulin sensitizer, 37 cases (control group, all of them)Like giving guidance to the way of life,Establish database and perform statistical processing.The result is 1: 1.There was no significant difference in baseline values between the two groups (P 0.05).There was no increasing trend of serum lipids in TGN LDL-C, but there was no significant difference between them (P0.05. 3).Comparison between groups: the control group decreased androgen and increased HDL-C significantly (P 0.05).There was no significant difference in the median difference between WHRM, FINSHOMA-IRCINS and TCU TGG LDL-C0. 4.In the insulin sensitizer group, the effective, effective and ineffective were 47.8% and 10.4%, respectively, while in the combined dain-35 group it was 64.9 and 29.75.4.The difference was not statistically significant (P 0.05).Conclusion 1.Insulin sensitizer can effectively reduce androgen level and improve insulin resistance.Compared with insulin sensitizer alone, anti-androgen combined with insulin sensitizer was better in reducing androgen level, but there was no significant difference between the two groups in reducing androgen level to normal range after 3 months of treatment.The combination of anti-androgenic insulin sensitizer and insulin sensitizer had no obvious advantage in improving insulin resistance and body fat distribution. The combination of insulin sensitizer and insulin sensitizer for 3.3 months could increase HDL-C, the effect of combination therapy was better, but there was no obvious improvement on TCU TGG LDL-C.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R711.75

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