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目的探讨对二甲双胍具有不同排卵反应的多囊性卵巢综合征(PCOS)患者的卵巢形态学变化。方法年轻、体重指数正常的PCOS患者接受6个月二甲双胍治疗中,选取20例治疗后仍无排卵者为无排卵组,20例有排卵但是未能成功妊娠者为排卵组。另选取20例年龄和体重指数与无排卵组、排卵组匹配的PCOS患者(未做任何治疗)作为对照组。检测3组患者的睾酮(T)、性激素结合球蛋白(SHBG)、卵泡刺激素(FSH)、黄体生成素(LH)、雌激素(E2)、催乳素(PRL)、空腹血糖、空腹胰岛素、动态平衡模型分析胰岛素抵抗指数(HOMA)、空腹血糖-胰岛素比值(G IR),B超观察卵巢形态、体积的变化。结果二甲双胍治疗6个月后,无排卵组有3例(15%)、排卵组有17例(85%)出现卵巢形态学改变,对照组无一例出现卵巢形态变化。与治疗前比较,无排卵组治疗6个月后卵巢体积无明显变化[(12.2±1.2)cm3],而排卵组则明显下降[(11.5±1.6)cm3]。结论 PCOS患者使用二甲双胍治疗后可出现与排卵反应密切相关的卵巢形态学改变。
Objective To investigate the ovarian morphological changes in patients with polycystic ovarian syndrome (PCOS) who have different ovulation responses to metformin. Methods Young, normal-weight PCOS patients undergoing metformin treatment for 6 months were enrolled in the study. Of the 20 patients who were ovulation-free, 20 were ovulation-free, and 20 were ovulation but did not succeed in pregnancy. Another 20 cases of age and body mass index and anovulation, ovulation matching PCOS patients (without any treatment) as a control group. The levels of testosterone, SHBG, FSH, LH, E2, PRL, fasting blood glucose, fasting insulin, The homeostasis model was used to analyze the change of ovarian morphology and volume with insulin resistance index (HOMA), fasting glucose-insulin ratio (GIR) and B ultrasound. Results After six months of treatment with metformin, ovariectomized group had ovarian morphological changes in 3 cases (15%) and in ovulation group (17%, 85%). No ovarian morphological changes were observed in control group. Compared with those before treatment, there was no significant change in ovarian volume [(12.2 ± 1.2) cm3] in ovulation group and in ovulation group [(11.5 ± 1.6) cm3] after ovariectomy for 6 months. Conclusion PCOS patients treated with metformin may have ovarian morphological changes closely related to ovulation response.