| Objectives To investigate the clinical manifestations, endocrinological and metabolic characteristics of the child-bearing and the puberty polycystic ovary syndrome (PCOS). To investigate the relationship of leptin, free testosterone and sexual hormone binding protein (SHBG) level with clinical manifestation and insulin resistance (IR). To evaluate and compare the therapeutic effect, compliance and side effects of behavior treatment (diet and exercise), metformin and rosiglitazone treatment by randomized controlled trial (RCT). To make a prolonged clinical trail in continuation with the above RCT study and summary the therapeutic effect, compliance and side effects again.Methods There were four parts in this study: Part one is to describe the clinical manifestations, endocrinological and metabolic characteristics of the childbearing and the puberty PCOS patients in our gynecologic endocrinological clinic from June 2003 till June 2006 separately. Part two is to measure the serum leptin, free testosterone and SHBG level of PCOS patient and analyse the relationship between the level of free androgen index (FAI) and diagnostic criteria as well as body mass index (BMI). Part three is a RCT study to evaluate the effect of behavior treatment (diet and exercise), metformin and rosiglitazone treatment by randomized controlled trial from June 2003 to January 2005 to compare the therapeutic effect, compliance and side effects of the three treatment groups, Part four is to continue the RCT study and compare the therapeutic effect, compliance and side effects again from June 2003 to June 2006.ResultsPart one Among the 194 cases of PCOS patients, there are 139 in child-bearing age and 55 in puberty. The chief complains are oligomenorrhea, annovulation, infertility and clinical manifestations linked to hyperandrogen including hirsutism, acne, alopecia. The metabolic problems include fat or overweight, diabetes or impaired glucose tolerance, hypertension, nonalcoholic fatty liver and lipid disturbance. The occurrence of the main characters concerning PCOS were 66.2% and 85.5% of overweight patients, 25.9% and 47.2% of acanthosis nigricans (25.9%), 25.4%～76.1% and 62.9%～97.4% of insulin resistance in the child-bearing group and puberty group, respectively. Part two Ninety samples were measured by leptin, SHBG, T and FT, and FAI was calculated. There are 3 diagnostic criteria of PCOS: 1. aovulation; 2. PCO in ovarian ultrasonography; 3. hyperangrogenic clinical manifestation or laboratory hyperandrogenemia. One can be diagnosed as PCOS with 2 of the above 3 diagnostic criteria. The above measured parameters were compared among groups with different diagnostic criteria, BMI and IR. In the group with diagnostic criteria 1 and 2, the level of T, FT, FAI are lower than two other groups. The levels of T, FT, FAI and IR are increased along with the increase of BMI, the level of SHBG is decreased along with the increase of BMI. The correlation analysis showed that the relativity between the level of leptin and body weight, body mass index, waist circumference and FAI was significant. The relativity between the level of SHBG and body weight, BMI, waist circumference and FAI was significant too.Part three There were 106 cases who receive the treatment and 62 cases completed the treatment. There were no difference between the body mass index, waist circumference, biochemical markers and hormone level before the treatment among three groups. There were 43 cases who receive the behavior treatment and 22 cases complete the treatment, the regular menstruation and ovulation ratio was 36.4% and 22.7% respectively. There were 36 cases who receive the metformin treatment and 21 cases completed the treatment, the regular menstruation and ovulation ratio was 66.7% and 42.9% respectively. There were 27 cases who receive the rosiglitazone treatment and 17 cases completed the treatment, the regular menstruation and ovulation ratio was 70.6% and 58.8% respectively. There was no difference between the BMI, waist circumference, biochemical markers and hormone level after the treatment among three groups. The rosigitazone group was better than behavior group in regular menstruation and ovulation ratio significantly.Part four There were 141 cases who receive the treatment and 75 cases completed the treatment totally. There was no difference between the BMI, waist circumference, biochemical markers markers and hormone levels before the treatment among three groups. There were 67 cases who receive the behavior treatment and 31 cases completed the treatment, the regular menstruation and ovulation ratio was 38.7% and 25.8% respectively. There were 43 cases who receive the metformin treatment and 25 cases completed the treatment, the regular menstruation and ovulation ratio was 64.0%and 60.0% respectively. There were 31 cases who receive the rosiglitazone treatment and 19 cases completed the treatment, the regular menstruation and ovulation ratio was 68.4% and 52.6% respectively. Ther are no difference between the BMI, waist circumference, biochemical markers and hormone level after the treatment among three groups. The rosigitazone group was better than behavior group in regular menstruation and ovulation ratio significantly.Conclusion PCOS is a kind of multisystemic disease. We should emphasize to screen and treat the metabolic syndrome of PCOS patients, especially in the puberty PCOS patients. Systemic treating program should be set up to execute and monitor the behavior treatment for overweight patients. The metformin and rosiglitazone are suitable for the PCOS patients who complicated with IR only. More study should be done for indications of insulin sensitizing treatment. The examination of free testosterone, sex hormone binding protein and leptin level are useful.
|
PDF Full Text Request