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目的探讨二甲双胍对多囊卵巢综合征(PCOS)患者耐氯米芬的治疗作用。方法将108例P-COS耐氯米芬不孕症患者分为3组,A组38例,口服二甲双胍片,500mg/次,3次/d,连服3个月;B组36例,于月经或黄体酮撤退性出血第5天口服氯米芬50mg/d,共服5d;C组34例,于月经或黄体酮撤退性出血第3天开始口服二甲双胍500mg/次,3次/d,连续服至下一次月经来潮。同时于月经或黄体酮撤退性出血第5天加用氯米芬50mg/d,共服5d。观察月经情况及基础体温,于停氯米芬后7～9d开始B型超声波监测卵泡,若基础体温上升,于月经黄体中期测定孕酮水平。有排卵者,继续服用氯米芬50mg/d,无排卵者氯米芬逐渐加量至100、150mg/d。观察各组治疗前后黄体生成素/促卵泡激素,睾酮,胰岛素,月经,排卵情况。结果二甲双胍治疗后黄体生成素/促卵泡激素、睾酮、胰岛素明显下降,A组34例月经恢复,32例排卵,8例妊娠;B组31例月经恢复,20例排卵,8例妊娠;C组32例月经恢复,30例排卵,28例妊娠。结论二甲双胍可改善PCOS患者的生殖内分泌激素、糖代谢、月经失调、排卵等,增加耐氯米芬的患者对氯米芬的敏感性。
Objective To investigate the therapeutic effect of metformin on clomiphene citrate in patients with polycystic ovary syndrome (PCOS). Methods 108 cases of P-COS resistance to clomiphene were divided into 3 groups, 38 cases in group A received metformin tablets 500 mg once daily for 3 months, and group B 36 cases Menstrual or progesterone withdrawal bleeding on the 5th day clomiphene citrate 50mg / d, a total of 5d; C group 34 cases, menstruation or progesterone withdrawal bleeding on the 3rd day began oral metformin 500mg / time, 3 times / d, Continuous service until the next menstrual cramps. At the same time in menstruation or progesterone withdrawal bleeding on the 5th plus clomiphene citrate 50mg / d, a total of 5d. Observation of menstrual conditions and basal body temperature, in the clomiphene citrate after 7 ~ 9d began to type B ultrasound monitoring of follicles, if basal body temperature rise in the mid-menstrual luteal determination of progesterone levels. Ovulation, continue taking clomiphene citrate 50mg / d, anovulatory clomiphene gradually increase to 100,150mg / d. Before and after treatment in each group observed luteinizing hormone / follicle stimulating hormone, testosterone, insulin, menstruation, ovulation. Results After treatment with metformin, the levels of luteinizing hormone / follicle stimulating hormone, testosterone and insulin decreased significantly. A group of 34 patients recovered menstruation, 32 patients ovulated, and 8 patients were pregnant. In group B, 31 patients recovered menstruation, 20 patients were ovulation and 8 patients were pregnant. 32 cases of menstruation recovery, 30 cases of ovulation, 28 cases of pregnancy. Conclusion Metformin can improve reproductive endocrine hormones, glucose metabolism, menstrual disorders and ovulation in patients with PCOS, and increase the susceptibility to clomiphene in patients with clomiphene.