潮汕地区多囊卵巢综合征的临床特点及疗效分析-临床医学(内分泌学)专业论文.docx

显著性（P0.001）。采用地塞米松联合达英-35 治疗的患者睾酮水平下降了 65.8%，具有 显著差异（P0.001），但是多毛改善不明显(P0.05)。 4.胰岛素抵抗及代谢情况：患者的平均空腹胰岛素水平、HOMA-IR、BMI、糖尿病前期患 病率均较治疗前有所改善（P0.05）,但糖胰比及肥胖比率下降无统计学意义（P 值分别为 0.272、0.087）。采用二甲双胍治疗的患者胰岛素抵抗各项指标均有改善(P0.05)；糖尿病 前期患病率及 BMI 较治疗前下降显著（P0.001）；二甲双胍使用时间长于半年的患者胰岛 素抵抗程度改善更明显（P0.05）。 结论 1．潮汕地区 PCOS 患者胰岛素抵抗、肥胖比例高，出现 2 型糖尿病、心血管疾病等慢性并 发症风险大。 2．达英-35 联合二甲双胍、地塞米松对改善存在胰岛素抵抗或肥胖、高雄激素血症患者的 月经情况疗效确切,使用安全。 3．胰岛素抵抗或肥胖的 PCOS 患者在常规达英‐35 治疗的基础上使用二甲双胍对诱导排卵 效果确切，并能在一定程度上增加妊娠率；而采用二甲双胍+CC+达英‐35 联合治疗可获得 更理想的排卵率及妊娠率。 4．地塞米松对抗 PCOS 患者高雄激素血症效果明确，临床上应重视小剂量糖皮质激素对 PCOS 患者的疗效。 5．二甲双胍可作为治疗 PCOS 胰岛素抵抗的一线药物，并可有效控制及预防慢性代谢性疾 病的发生。 关键词：多囊卵巢综合征（PCOS）；二甲双胍；地塞米松；达英-35；枸橼酸氯米芬（CC） Abstract Objective： To understand the clinical characteristics of polycystic ovary syndrome(PCOS) in Chaoshan area and to evaluate the therapeutic effects of Metfomin, low-dose Dexamethasone, Diane 35 and Clomiphene citrate（CC）on patients with PCOS, thus accumulating experience for clinical practice. Methods: 73 patients diagnosed as PCOS were included from the outpatient department of endocrinology of the second affiliated hospital of Shantou University Medical College. Menstruation pattern, ovulation rate , pregnancy rate, androgen levels, hirsutism, fasting insulin, glucose/insulin ratio, homeostasis model assessment estimate of insulin resistance（HOMA-IR）, acanthosisnigricans, body mass index (BMI) and pre-diabetes were investigated. All patients received lifestyle education and sexual life guidance was implemented in married patients. The patients were divided into four groups according to the degree of insulin resistance, BMI and androgen levels. 37 PCOS patients were treated with Metformin, low-dose Dexamethasone and Diane 35. 14 cases were prescribed Metformin and Diane 35. 16 patients were crued with low-dose Dexamethasone and Diane 35. And the rest of 6 had therapy of Diane 35 only . There were 16 patients prescribed CC with aspiration to pregnancy. The duration of the treatment was 3 to 12 months. Result 1. There wa