Effect Of Cyproterone Acetate Co. And Pioglitazone On Insulin Resistance In Polycystic Ovary Syndrome

Objective: To know the affect of the endocrine, metabolism, ovulation, pregnancy outcome in PCOS patients with IR treated with CPA Co plus Pioglitazone.It can offer a way to cure PCOS patients with IR as a new drug of euglycemic agent.Materials and Methods: Fifty-two proved PCOS patients were enrolled who were 26.54±2.67 aged. They were separated into two groups at random. The study group included twenty-three patients and the control group included twenty-nine patients. The study group was treated with CPA Co plus Pioglitazone for three cycles, and the control group was treated with CPA Co plus Metformin. Two groups were treated with CPA Co from day 5 to day 26 of natural menstruation or withdrawal bleeding every cycles. Pioglitazone was taken daily 15mg, Metformin was taken daily with 1500mg. After the treatment with these drugs, they accepted the same therapy for inducing ovulation.Fasting blood samples of two groups were obtained on the day 3 to 5 of the menstrual cycle or withdrawal bleeding. All samples were used to assess serum levels of LH, FSH, E2, PRL, A2, fasting INS, fasting glucose, blood-fat, APN, and caculated the levels of ISI, HOMA IR, HOMA IS and the radio of FBS/FIN. Samples of the two groups were obtained and assessed again after three cycles of treatment. Side effects of these drugs such as nausea, disgorge, ect were evaluated. The changes of weight, waistline, buttock, hirsutism and acne were observed. Bilateral ovarian volume and follicle numbers of patients were measured with vaginal ultrasound (US) before and after treatment.The protocol of induced ovulation was clomiphene (CC) + HMG/FSH low dose step-up protocol for the two groups for three cycles. To compare the rate of ovulation, single dominant follicle growth, pregnancy, LUFs and OHSS in the two groups.Statistics analysis was performed with the SPSS 11.5. All data are presented as the mean±SD. The significant differences between before and after treatment was tested with paired t-test. The difference with the effect of after the treatment in both groups was group t-test. The induced ovulation result was tested withχ~2 test. The possible correlation of APN with other factors of PCOS was analyzed with Pearson correlation analysis. The level of statistical significance was set at P<0.05.Results: The liver and renal function and the FBG of every patient was normal during the treatment. In the study group, all patients had no anaemia, dropsy, nausea, emesia, swirl, headache and so on. In the control group, sixteen patients felt nausea, ten patients felt emesia, eight patients felt diarrhea, three patients felt swirl. In these patients, negative correlation was found between APN and IR, TG, LDL-C(p<0.05); Positive correlation was found between APN and HDL(p<0.05); There were no correlation between APN and the other paramenters(p>0.05).In the study group, the mean serum LH, FSH, A2, fasting INS, ISI, Homa IR, Homa IS levels and LH/FSH ratio, FBS/FIN ratio, the score of F-G after treatment were significantly lower than before(P<0.01). The mean serum TC, TG, LDL-C levels were also lower (P<0.05). The mean serum HDL-C levels were higher(P<0.05). The mean serum APN levels were aslo higher(P<0.01). But the weight, BMI and WHR of patients have no difference than before.In the control group, the mean serum LH, FSH, A2, fasting INS, ISI, Homa IR levels and LH/FSH ratio, FBS/FIN ratio, the score of F-G after treatment were significantly lower than before(P<0.01). But the mean serum TC, TG, LDL-C, HDL-C, APN levels and Homa IS have no change. The WHR of patients have no change too. But The weight and BMI of patients were lower than before(p<0.05).There was significantly difference of the mean serum A2, fasting INS, ISI, Homa IR, Homa IS, TC, TG, LDL-C levels is lower in the study group than in the control group.After 3 months of therapy, all of the patients' bilateral ovarian volumes and follicle numbers decreased significantly(P<0.01). But there were no significant differences between the two groups(p>0.05). The result of induced ovulation: The ovulation rate per cycle, the single dominant follicle growth rate per cycle and the pregnancy rate was 96.22%,90.57%,56.5% in study group, and it is higher than 92.6%, 86.76%, 51.72% in control group. But there were no significant differences of them between two groups(p>0.05).There was no praecox endogenesis apex of LH confirmed by a urinary ovulation test paper. No patient suffered from ovarian hyperstimulation syndrome(OHSS). There was two cases of LUFs in control group higher than 0 case in study group.But there were no significant differences of them between two groups(p>0.05).Conclusions: 1 the clinical manifestation and endocrine disturbance of PCOS patients with IR, but the study group has more significant effect. 2 Both treatments can improve the glycometabolism disturbance, but the study group has more significant effect. And indicate that Pioglitazone can defend the function of beta Cell of islet in the therapy of HI. 3 In the study group, the level of HDL-C and APN were increased, and the level of TC, TG and LDL-C were decreased. But in the control group those levels had no difference. It indicates that Pioglitazone can improve lipid metabolism and preclude metabolism syndrome. 4 Negative correlation was found between APN and IR. It indicates that decreasing of APN coincidents with increasing of IR and decresing of insulin sensitivity. It suggested that there were some linkage between PCOS and DIDMOAD. 5 Pioglitazone compared with Metformin has fewer side effects and adverse reaction, and can be well accepted by the patients.