复方醋酸环丙孕酮与螺内醋干预对非肥胖型多囊卵巢综合征((PCOS)内分泌代谢的影响

摘要

目的:比较复方醋酸环丙孕酮和螺内醋治疗以高雄激素血症为主要表现的非肥胖型多囊卵巢综合征(PCOS)的临床疗效和对内分泌代谢的影响.方法:按前瞻性随机对照研究方法选择以高雄激素血症为主要表现的非肥胖型PCOS患者80例,按随机化分组方案分为复方醋酸环丙孕酮(EE-CA)组和螺内6a(Sp)组,每组40例,分别口服相应的药物6个月,比较治疗前、后的体质量指数((BMI),腰臀比(WHR)、多毛体征、痤疮程度以及卵巢体积,并测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、泌乳素(PRL),总睾酮(T)、性激素结合球蛋白(SHBG)、硫酸脱氮表雄酮(DHEAS)、空腹血糖(FPG)、空腹胰岛素(FINS)和血脂的水平,记录服药后不良反应.结果:治疗多毛EE-CA和Sp疗效接近((P>0.05); EE-CA组治疗6个月后痤疮评分下降较Sp组作用明显(P< 0.05),在缩小卵巢体积方面显著优于Sp(P<0.05),降低血 LH、LH/FSH、T、游离雄激素指数(FAI)、DHEAS和升高SHBG的作用较Sp组显著(P<0.05,P<0.01); EE-CA组FINS、甘油三醋(TG)和高密度脂蛋白(HDL)高于Sp组(P<0.05).结论:本研究用于治疗以高雄激素血症为主要表现的非肥胖型PCOS的药物都是有效的;EE-CA降低高雄激素血症的效果优于Sp,但对高甘油三酯的患者使用要慎重;Sp亦有较好的降雄激素作用,且对糖、脂代谢没有显著影响.%Objective: To evaluate the efficacy and endocrinologic & metabolic consequences of ethinyl estradiol-cyproterone acetate (EE-CA) versus spironolactone (Sp) in treating hyperandrogenism of non-obese women with polycystic ovarian syndrome (PCOS). Methods: Eighty non-obese women with PCOS were included in this prospective randomise controlled study. According to randomisation, patients were allocated to receive either EE-CA or Sp for 6 months. Body mass index (BMI), waist-to-hip ratio (WHR), hirsutism, acne degree and ovarian volume, serum samples for hormones, fasting glucose (FPG) and fasting insulin (FINS) levels, sex hormone-binding globulin (SHGB) levels, and lipid profile were measured at baseline, after the third treatment cycle and sixth treatment cycle. The incidence of side effects was recorded. Results: There was nodifference in the effect of treating hirsutism between the two groups (P>0.05). Compared with Sp, EE-CA decreased the acne scores significantly after 6 months of treatment (P<0.05), and was superior in reducing the size of the ovary, decreasing the serum LH level, LH/FSH ratio, FAI, DHEAS and increasing the SHBG level (P＜0.05, P<0.01). The FINS, triglyceride and HDL level of EE-CA group were higher than those of Sp group (P<0.05). Conclusion: Both EE-CA and Sp are effective in treating hyperandrogenism of non-obese women with PCOS. EE-CA is superior to Sp in improving hyperandrogenism, however, should be cautious to apply to the patients with high triglyceride; Sp also has good effect on decreasing the T level, and has no significant influence on glucose and lipid metabolism.