Clinical Analysis Of PCOS With Insulin Resistance In Reproductive Age And Evaluation Of Metformin Therapy

Objective To investigate the clinical manifestation and endocrine characteristics of women with polycystic ovary syndrome（PCOS）in reproductive age with insulin resistance（IR）and evaluate the clinical efficacy of metformin therapy.Methods Medical records of PCOS women in reproductive age who were admitted to the gynecological endocrine clinic of General Hospital of Ningxia Medical University from June 2018 to June 2019 were collected.（1）Patients were divided into IR group and non-IR group.Among them,25 patients in the IR group were of complete data and completed observation,while 33 patients in the non-IR group had complete medical records.The clinical indexes,including body mass index（BMI）,waist-hip ratio（WHR）,hairy score and acne score,and laboratory indexes,including fasting plasma glucose（FPG）,fasting insulin（FINS）,2hours postprandial blood glucose（2hPBG）,2 hours postprandial insulin（2hPINS）,sex hormones,including luteinizing hormone（LH）,follicle-stimulating hormone（FSH）,LH/FSH ratio,prolactin（PRL）,estradiol（E₂）and testosterone（T）were compared between IR group and non-IR group to observe the clinical and endocrine features of two groups.（2）Then patients in IR group were divided into obesity group and non-obesity group according to their BMI.What’s more,they were also divided into two groups according to their age:low age group（20²9 years old）and old age group（30⁴0 years old）.The above indexes were compared in each subgroup.（3）Patients in the IR group were treated with metformin and dydrogesterone for 3 cycles to compare the changes of the above indicators before and after treatment.Results（1）Comparison of clinical and laboratory indexes between IR group and non-IR group:BMI of IR group was higher than that of non-IR group（P（27）0.05）,while there was no significant difference in the comparison of WHR,hairy score and acne score between IR group and non-IR group.The levels of FPG,FINS,2hPBG and 2hPINS in IR group were higher than those in control group（P（27）0.05）.The serum LH level of IR group was higher than that of control group（P<0.05）,while the levels of FSH,LH/FSH ratio,PRL,E₂ and T were not significantly different from those of control group（P>0.05）.（2）There were no significant differences in WHR,hairy score,acne score,FPG,FINS,2hPBG,2hPINS,LH,FSH,LH/FSH ratio,PRL,E₂ between the obese and non-obese subgroups of IR group（P>0.05）.There were also no significant differences in the above indexes between the younger subgroups and the older subgroups in childbearing age.（3）Comparison of clinical and laboratory indexes of IR group before and after metformin therapy:BMI and WHR in IR group after treatment were lower than those before（P<0.05）.There were statistically significant differences in the levels of serum FINS and 2hPINS between the values of before and after treatment（P<0.05）,and the levels of serum FINS and 2hPINS were decreased after treatment.There were no significant differences in FPG and 2hPBG levels before and after treatment.The serum LH level was lower than before（P<0.05）,while the FSH,LH/FSH ratio,PRL,E₂ and T levels were not significantly different after treatment.Conclusion（1）PCOS women with IR are of more serious disorders of glucose metabolism and sex hormones.（2）Metformin can improve the metabolic and endocrine disorders in PCOS patients with insulin resistance in reproductive age.