| [Object] Polycystic ovary syndrome (PCOS) is the most prevalent female endocrinopathy affecting 3%-8% of women of reproductive age and the largest single cause of anovulatory infertility, characterized by multiple small antral follicles arrested in their development and hyperandrogenmia. The exact cause of PCOS is not clear. The classic description of the syndrome, which includes clinical findings of amenorrhea, hirsutism and bilateral enlarged ovaries, is representative of more advanced cases. PCOS is now recognized as a heterogeneous syndrome with a wide spectrum of clinical presentations, which might be related to many factors including hypothalamus, hypophysis, ovary adrenal gland, pancreas and heredity etc. The underlying defect in PCOS remains unknown, but there is growing consensus that key features include insulin resistance, androgen excess and abnormal gonadotropindynamics. Recent evidence suggests that the principal underlying disorder is one of insulin resistance, with resulting hyperinsulinemia stimulating excess ovarian androgen production. Women with PCOS have higher rates of hyperinsulinemia and insulin resistance (30% to 70%) than weight-matched control subjects. In women with PCOS, cardinal features regarding reproductive system are a failure of the follicles to develop and functional hyperandrogenism while the metabolic abnormalities manifested inaulin resistance and hyperinsulinemia The data from clinic test have shown 10% of women with PCOS, who are in childbearing age, happend impaired glucose tolerance. Thus, PCOS is a special disease that cause dysfunction of fecundity associated with glycometabolism disorder. It is a good clinical model for studying the relationship between energy metabolism with a lower level and reproduction. The IR and glycometabolism disorder existed not only in the tissues outside the ovary but also in the ovary itself, which is more important to the ovarian function. At this point, the application of the medicine that is capable of enhancing sensitivity to insulin provide a new insight of treatment for patients with PCOS. In order to find out a effective therapy for patients with PCOS, the effects of medicines enhanced sensitivity to insulin were investigated.[Materials] Cases: 94 cases with IR selected by oral glucose tolerance test (OGTT) and insulin test from 156 cases of the infertilewomen with PCOS were subjected for treatment since February 2002 to June 2004. The average age among ^elected cases was 25.40±0.16.Criterion for subjects: (1) to be considered as PCOS according to clinical signs and ultrasound or the signs plus biochemical parameters including higher levei of luteal hormone, androgen and insulin. (2) The homa insu'in resistance (Homa IR)> 1.468. (3) has any one of situations as follows: fasting insulin (FIS) >15 miu/ml; the postprandial 12 hours insulin level over 80miu/ml 9r the insulin persisting at higher level after glucose loading; the results of OGTT are IGT or diabetic patients.Methods: The 94 cases were divided randomly into three groups.Group A (36 cases) were treated by Rosiglitazone and clomiphene Citrate (CC). The detail method was that the patients took Rosiglitazone (4mg/d) for three months combining with the CC (lOOmg/d) for 5 days from the fifth day per menstral cycle.Group B (30 cases) were treated by Metaformine combined with CC. The dose of Metaformine used in treatment was 1500mg/d, which was taken with three meals every day for three months. The way of application of CC was the same as Group A.Group C (28 cases) were treated only by CC, Yvhi.cn was taken lor 5 days from the fifth day of the menstral cycle. The dose was varied from 50mg/d to 150mg/d according the ovarian response.After treatment of medicines for 1, 2 and 3 months, liver function,Fasting blood insulin level, OGTT as well as Homa-IR were tested respectively. The development of follicle was monitored by transvaginal ultrasound. Usage of Rosiglitazone would be stopped when the average follicle diameter was over 16mm. Criterion for biochemical test and ultrasound:1. Fasting Insulin (FIS): It was considered as insulin resistance if the FIS^15min/L according the results of the automatic radio-immunity analyzer. r2. OGTT: The normal range of OGTT is: fasting glucose (FG)<6.1 mmol/L; 2 houres glucose (2 HG) <7.8 mmol/L.3. Homa I ^ 1.468 was abnormal (Homa IR=FISxFG/22.5)4. Ovalation Rate: It was defined as the rate of ovulation when the diameter of the growing follicle beyond 16mm.All of data were expressed as mean + SD. Comparison before and after application of medicines was assessed by paired Student's / test; while comparison among groups were analyzed by using one-way analysis of variances. Values of P<0.05 were considered significant.[Results] 1. 94 cases happened to have IR within the 156 PCOS patients, the rate account for 60.26%.2. The results after treatment for 2 months: there were no significant changes in Homa IR> ovalation rate and Fins (P>0.05) before treatment among three groups. However, Fins and Homa IR were significantdepressed (P<0.05) as compared with control after treatment for 2 months in group A, no distinct changes in both group B and C. The ovulation rated were apparently increased (P<0.05) among three groups, especially in group A.3. The results alter 3 months treatment: The ovulation rates were significantly enhanced among three groups (PO.005). The enhancement in group A is more prominent than group B and C. (P<0.05). The FINS and Homa IR were well-marked declined in both group A and B, especially in group A (P <0.05).4. There was no any liver dysfunction to be found among three groups, after treatment for 3 months.[Conclusion] Insulin resistance and hyperinsulinmia are common features in patients with PCOS. The Homa IR is one of the reliable test index for assessment IR.1. All clinical representation, such as IR, Hyperinsulinmia, Glycometabolism disorder and dysfunction of reproduction in patients with PCOS were effectively improved by application of the medicines enhanced insulin sensitivity.2. The medicines enhanced insulin sensitivity combined with follicle-stimulating medicine are more effective administration for patients with PCOS.3. Compared with Metformin, Rosiglitazone is more effective medicinewith lower dosage and less side-action. |
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