目的 探讨达英-35联合二甲双胍治疗青春期多囊卵巢综合征(PCOS)的疗效.方法 选取2014年9月至2016年11月在淮安市第二人民医院接受治疗的青春期PCOS患者96例,采用随机数表法分为对照组和观察组,每组48例.对照组给予达英-35治疗,观察组在达英-35治疗基础上加用二甲双胍治疗,均连续治疗3个月.观察并比较两组患者的临床治疗效果、性激素水平、糖代谢指标、血脂指标、瘦素、体质指数及Ferriman-Gallway体毛(F-G)评分.结果 观察组患者的治疗总有效率为95.83%,略高于对照组的89.53%,但差异无统计学意义(P>0.05);两组患者治疗前的卵泡雌激素(FSH)、黄体生成素(LH)、雌激素(E2)、孕酮(P)、雄性激素(T)及催乳素(PRL)水平比较差异均无统计学意义(P>0.05).观察组患者治疗后的LH和T水平分别为(1.04±0.15)mIU/mL、(2.02±0.13)nmol/L,均低于对照组治疗后的(1.19±0.14)mIU/mL、(2.74±0.12)nmol/L,差异均有统计学意义(P<0.05).两组患者治疗前的空腹血糖(FBS)、空腹胰岛素(FINS)、HOME-IR、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)水平比较差异均无统计学意义(P>0.05).对照组患者治疗后的FINS和HOME-IR分别为(9.57±5.10)mIU/L、(1.85±1.69),均低于治疗前的(16.76±9.94)mIU/L、(2.71±1.52),而TG,LDL-C分别为(1.57±0.22)mmol/L、(3.33±0.33)mmol/L,均高于治疗前的(1.48±0.27)mmol/L、(2.79±0.17)mmol/L,差异均有统计学意义(P<0.05).观察组患者治疗后的FINS、HOME-IR及TG水平分别为(7.38±4.34)mIU/L,(1.66±1.79)、(1.24±0.27)mmol/L,均低于治疗前,而HDL-C为(2.71±0.15)mmol/L,高于治疗前,差异均有统计学意义(P<0.05).观察组患者治疗后的FINS和LDL-C高于对照组,HDL-C水平低于对照组,差异均有统计学意义(P<0.05).两组患者治疗前的LP、BMI及F-G评分比较差异均无统计学意义(P>0.05);观察组患者治疗后的LP、BMI及F-G评分分别为(5.82±2.30)μg/L、(20.45±1.59)kg/m2、(6.25±0.75)分,均较治疗前的(10.92±2.75)μg/L、(22.31±2.35)kg/m2、(7.30±1.34)分下降,差异均有统计学意义(P<0.05).对照组患者治疗后的F-G评分为(6.26±0.77)分,较治疗前的(7.32±1.33)分下降,差异有统计学意义(P<0.05);观察组患者治疗后的LP、BMI均低于对照组治疗后的(9.94±2.89)μg/L,(22.27±2.13)kg/m2,差异均有统计学意义(P<0.05).结论 达英-35联合二甲双胍治疗青春期多囊卵巢综合征能有效降低雄激素水平,调整月经异常,改善胰岛素抵抗及脂代谢紊乱,疗效优于单用达英-35.%Objective To investigate the clinical effect of Diane-35 plus metformin in the treatment of adolescent polycystic ovary syndrome (PCOS). Methods A total of 96 cases of adolescent PCOS patients, who admitted to Huai'an Second People's Hospi-tal from September 2014 to November 2016, were selected and divided into the control group and the observation group according to random number table, with 48 cases in each group. The control group received treatment with Diane-35, and the observation group was treated with Diane-35 plus metformin. The treatment course of the two groups was 3 months. The clinical effects, sex hormone levels, glucose metabolism indexes, blood lipid indexes, leptin, body mass index (BMI) and Ferriman-Gallway (F-G) score were observed and compared between the two groups. Results The total effective rate was 95.83%in the observation group versus 89.53%in the control group (P>0.05). There were no statistically significant differences between the two groups in terms of follicular estrogen (FSH), luteiniz-ing hormone (LH), estrogen (E2), progesterone (P), androgen (T) and prolactin (PRL) levels before treatment (P>0.05). The levels of LH and T in the observation group after the treatment were (1.04±0.15) mIU/mL, (2.02±0.13) nmol/L, respectively, which were significant-ly lower than (1.19±0.14) mIU/mL and (2.74±0.12) nmol/L in the control group (P<0.05). There was no significant difference between the two groups in the fasting blood glucose (FBS), fasting insulin (FINS), HOME-IR three (TG), triglyceride, low density lipoprotein choles-terol (LDL-C) and high density lipoprotein cholesterol (HDL-C) levels before the treatment (P>0.05). In the control group, FINS and HOME-IR after treatment were respectively (9.57±5.10) mIU/L, (1.85±1.69), which were significantly lower (16.76±9.94) mIU/L, (2.71± 1.52) before the treatment (P<0.05);while TG and LDL-C after the treatment were respectively (1.57±0.22) mmol/L and (3.33±0.33) mmol/L, which were significantly higher than (1.48 ± 0.27) mmol/L, (2.79 ± 0.17) those before the treatment (P<0.05). In the observation group, FINS, HOME-IR and TG after the treatment were respectively (7.38±4.34) mIU/L, (1.66±1.79), (1.24±0.27) mmol/L, which were significantly lower than those before treatment (P<0.05);which HDL-C level after the treatment was (2.71±0.15) mmol/L, which was significantly higher than that before the treatment (P<0.05). After the treatment, FINS and LDL-C in the observation group was significantly higher than the con-trol group, HDL-C level in the observation group was significantly lower than that the control group (P<0.05). There was no significant difference between the two groups before the treatment in LP, BMI and F-G score (P>0.05). In the observation group, LP, BMI and F-G scores after the treatment were (5.82 ± 2.30) g/L, (20.45 ± 1.59) kg/m2, (6.25 ± 0.75), respectively, which were significantly lower than (10.9±2.75) g/L, (22.31±2.35) kg/m2, (7.30±1.34) before the treatment (P<0.05). In the control group, F-G score after the treatment was (6.26±0.77), which was significantly higher than (7.32±1.33) before the treatment (P<0.05). After the treatment, LP, BMI in the observa-tion group were significantly lower than (9.94 ± 2.89) g/L, (22.27 ± 2.13) kg/m2 in the control group (P<0.05). Conclusion Diane-35 plus metformin treatment can effectively reduce androgen levels in adolescent PCOS, adjust abnormal menstruation, and improve insu-lin resistance and lipid metabolism disorder, which is better than that single Diane-35 in term of curative effect.
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