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目的 探讨罗格列酮 (rosiglitazone)和二甲双胍 (metformin)分别对有胰岛素抵抗的多囊卵巢综合征(polycysticovarysyndrome,PCOS)患者促排卵治疗的疗效对比。 方法 选择 2 0 0 2年 2月至 2 0 0 3年 6月存在胰岛素抵抗的PCOS患者 94例 ,将其随机分为A、B、C 3组。A组 36例口服罗格列酮联合克罗米芬治疗 ;B组 30例口服二甲双胍联合克罗米芬 (clomiphenecitrate ,CC)治疗 ;C组 2 8例口服克罗米芬治疗。 3组用药时间均为 3个月经周期。比较 3组用药后的胰岛素抵抗指数 (homainsulin resistance ,HomaIR)变化和排卵的发生情况。结果 A组用药 2个月后HomaIR开始由 1 12± 0 4 9下降为 0 86± 0 4 2 ,用药 3个月HomaIR由 1 12± 0 4 9降为0 6 1± 0 36 ,两者比较差异有显著性意义 (P <0 0 5 ) ;B组用药 2个月后HomaIR无明显下降 ,用药 3个月HomaIR由 1 15± 0 5 2降为 0 83± 0 32 ,两者比较差异有显著性意义 (P <0 0 5 )。C组用药前后HomaIR无变化。治疗后 3个月排卵率A组为 76 9% ,明显优于B组的 6 6 8%和C组的 5 8 8% ,差异有显著性意义 (P <0 0 5 )。结论 罗格列酮比二甲双胍能更快更好地改善PCOS的胰岛素抵抗 ,提高促排卵成功率。
Objective To investigate the curative effect of rosiglitazone and metformin on ovulation induction in patients with polycystic ovarysyndrome (PCOS) with insulin resistance. Methods 94 patients with PCOS who had insulin resistance from February 2002 to June 2003 were randomly divided into A, B and C groups. In group A, 36 patients were treated with rosiglitazone and clomiphene citrate; 30 patients in group B were treated with metformin plus clomiphene citrate (CC); and 28 patients in group C were treated with clomiphene. 3 groups medication time is 3 menstrual cycle. The changes of homainsulin resistance (Homa IR) and ovulation were compared between the three groups. Results After 2 months of treatment, the HomaIR in group A decreased from 12 ± 0 49 to 0 86 ± 0 4 2, and the HomaIR in 3 months decreased from 12 ± 0 49 to 0 6 1 ± 0 36 (P <0 05). After 2 months of treatment, there was no significant decrease of HomaIR in group B, and the HomaIR of group B decreased from 115 ± 0 5 2 to 0 83 ± 0 3 at 3 months after treatment Significant significance (P <0 05). Before and after the C group HomaIR no change. At 3 months after treatment, the ovulation rate in group A was 76.9% in group A, which was significantly better than that in group B (68.8%) and group C (58.8%) (P <0.05). Conclusion Rosiglitazone can improve the insulin resistance of PCOS faster and better than metformin and improve the success rate of ovulation induction.