和罗格列酮序贯用药对氯米芬抵抗的多囊卵巢综合征患.doc

【摘要】 目的 探讨复方醋酸环丙孕酮和罗格列酮序贯用药对改善多囊卵巢综合征(PCOS)患者生育功能的临床疗效。方法 30例氯米芬抵抗的PCOS胰岛素抵抗患者，口服复方醋酸环丙孕酮3个月后，罗格列酮联合氯米芬用药6个月，比较用药前后体重指数、月经周期、生殖激素水平、排卵率、妊娠率、血糖和胰岛素水平的变化。结果 与用药前相比，服用复方醋酸环丙孕酮后，雄激素水平和LH/FSH值明显降低(P＜0.05)，服用罗格列酮后，胰岛素抵抗指数(Homa IR)、胰岛素分泌指数(Homa β)以及β细胞功能评定指数(MBCI)均较用药前降低(P＜0.05)。结论 复方醋酸环丙孕酮和罗格列酮序贯用药可有效地抑制氯米芬抵抗的PCOS患者的高雄激素血症，改善胰岛素抵抗及生育功能。 　　【关键词】 多囊卵巢综合征;复方醋酸环丙孕酮;罗格列酮 　　Endocrine and fertile effects of successive therapy both cyproterone acetate and rosiglitazone in women with polycystic ovary syndrome accompanied clomiphene citrate 　　ZHENG Jian-huai,CAO Zuan-sun,CHEN Xiao-yan,et al. 　　Research Laboratory of Reproductive Endocrinology,First Hospital of Xian Jiao Tong University,Xian 710061,China 　　【Abstract】 Objective To evaluate the clinical efficacy of an original sequent therapy both ethinylestradiol/cyproterone acetate (CPA) and rosiglitazone on endocrine and fertile effects in women with polycystic ovary syndrome (PCOS) accompanied clomiphene citrate (CC) resistance.Methods 30 subjects received cyproterone acetate,ethinylestradiol on cycle day 1 to day 21 for 3 months.Then,received rosiglitazone 4mg/day for 6 months,and plus clomiphene citrate on cycle 5～9th.The clinical features,reproductive hormone,serum glucose and insulin levels were observed before and after CPA and rosiglitazone respectively.The differences were detected by using self-controlled studies.Results There were significantly decrease in the hirsutism score,serum LH,LH/FSH ratio and testosterone level after CPA for 3 months.Combined rosiglitazone and CC treatment lead to a significantly improvement in insulin resistance and ovulation.Conclusion The sequent therapy both CPA and rosiglitszone with CC is an effective therapeutic regiment in inducing androgen and improving ovulation in women with PCOS accompanied CC resistance. 　　【Key words】 polycystic ovary syndrome;cyproterone acetate;rosiglitazone 多囊卵巢综合征(PCOS)是女性常见的内分泌紊乱疾患，临床表现为闭经、肥胖、多毛和不孕，病理生理学特征是胰岛素抵抗(IR)、高雄激素血症、持续性无排卵以及糖脂代谢异