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目的:探讨地塞米松对伴肾上腺雄激素分泌过多PCOS患者的疗效。方法:采用前瞻、随机、对照的研究方法,将60例经达英-35治疗后高雄激素和临床表现仍然未能明显改善且伴有肾上腺雄激素分泌过多的PCOS不孕患者作为研究对象,将患者随机分成对照组(达英-35+安慰剂)和实验组(达英-35+地塞米松),所有患者治疗3个月,比较2组患者性激素水平、临床表现。随后给予氯米芬(CC)及人绝经期促性腺激素(hMG)促排卵治疗,比较分析临床结局。结果:所有患者治疗后雄烯二酮(A2)均降低,下降率组间无差异(P>0.05),实验组硫酸脱氢表雄酮(DHEAS)降低率、性结合球蛋白(SHBG)提高率明显好于对照组(P<0.05);实验组较对照组的痤疮及多毛症状改善明显(P<0.05),而体质量指数(BMI)及腰臀比(WHR)的改变不明显(P>0.05)。实验组比对照组的成熟卵泡率、排卵率及妊娠率效果更好(P<0.05)。结论:经用达英-35治疗后高雄激素血症和临床表现仍然未能明显改善,并伴肾上腺雄激素分泌过多的PCOS不孕患者,加用地塞米松,较单纯应用达英-35更能有效抑制高雄激素血症,提高SHBG,改善临床表现,提高成熟卵泡率、排卵率及妊娠率。
Objective: To investigate the effect of dexamethasone on patients with excessive secretion of adrenal androgen PCOS. Methods: A prospective, randomized, controlled study was conducted in 60 patients with PCOS infertility who were treated with Ying-35 and whose clinical manifestations still failed to be improved and with excessive adrenal androgen excretion. The patients were randomly divided into control group (up to -35 + placebo) and experimental group (up to Ying-35 + dexamethasone). All patients were treated for 3 months. The sex hormone levels and clinical manifestations of the two groups were compared. Followed by clomiphene citrate (CC) and human menopausal gonadotropin (hMG) ovulation induction treatment, comparative analysis of clinical outcomes. RESULTS: The levels of androstenedione (A2) were decreased in all the patients after treatment, but there was no difference between the two groups (P> 0.05). The decrease rate of DHEAS and the increase of SHBG (P <0.05). The acne and hirsutism symptoms in the experimental group were significantly improved compared with the control group (P <0.05), while the changes of body mass index (BMI) and WHR were not significant > 0.05). The mature follicle rate, ovulation rate and pregnancy rate in the experimental group were better than those in the control group (P <0.05). CONCLUSION: Hyperandrogenism and clinical manifestations have not been significantly improved after treatment with darun-35. Compared with PCOS infertility patients with excessive adrenal androgen excretion, dexamethasone is more effective than daphnine-35 alone Can effectively inhibit hyperandrogenism, improve SHBG, improve clinical performance, improve the rate of mature follicles, ovulation and pregnancy rates.