Effects Of Metformin Hydrochloride And Rosiglitazone Maleate Tablets On Insulin Resistance, Hyper-androgenism And Plasma Very Long Chain Fatty Acids Levels In Women With PCOS

OBJECTIVE:The aim of the study is to evaluate the therapeutic effects of metformin hydrochloride and rosiglitazone maleate tablets on insulin resistance(IR), androgen concentration and plasma very long chain fatty acids(VLCFAs) levels in women with polycystic ovarian syndrome (PCOS).METHOD:Seventy women(aged 18 to 40 years) with PCOS were enrolled into this study according to the diagnostic criteria of Rotterdam conference(2003).The women with PCOS were divided into the obese group(BMI= 25 kg/m2, n=34) and the nonobese group(BMI< 25 kg/m2,n=36) according to BMI. In the corresponding period,35 infertile women due to the problems of uterine tube or spouses was taken as the control group.All women with PCOS had metformin hydrochloride and rosiglitazone maleate tablets twice daily for 3 months. There were some tests as the following before and after the treatment:height (Ht),weight(Wt),waist circumference(WC), liver function, lipids were tested; the fasting plasma glucose (FPG) was detected by glucose oxidase;the luteinizint hormone(LH),follicle stimulating hormone (FSH),total testosterone(T) and fasting plasma insulin (FINS) were examined by chemiluminescence method;the follicular number and ovarian area were checked in follicle period or amenorrhoea period; the plasma free testosterone was examined by enzyme-linked immunosorbentassay (ELISA);the BMI, waist to hip ratio (WHR),and homeostasis model assessment for insulin resistance (HOMA-IR), insulin sensitivity index(ISI) were calculated;the plasma VLCFAs were analysed by gas chromatography-mass spectrometry (GC-MS),including very long chain saturated fatty acids (VLCSFAs),n-9 very long chain monounsaturated fatty acids (n-9VLCMUFAs),n-3 very long chain polyunsaturated fatty acids (n-3VLCPUFAs) and n-6 very long chain polyunsaturated fatty acids (n-6VLCPUFAs).RESULT:â‘ Compared with the control group, LH, LH/FSH, T,FT, FINS, HOMA-IR were significantly higher and FSH, ISI were obviously lower in women with PCOS(P<0.05). Compared with the nonobese group, dramatic increases in HOMA-IR and follicle number were observed in obese group(P<0.05), while LH, LH/FSH, T, FT had no significant difference between two gruops.â‘¡After the treatment with metformin hydrochloride and rosiglitazone maleate tablets, Wt, BMI, WC, hip circumference, FPG, FINS, HOMA-IR significantly decreased and ISI rised apparently in two groups(P<0.05). There were also significant declines of LH, LH/FSH, FT,ovarian area, follicular number,especially in the obese women with PCOS(P<0.05),while T and FSH did not change significantly.â‘¢Compared with the control,the levels of VLCSFAs in both groups, and the levels of n-3VLCPUFAs and n-9VLCMUFAs in obese group were significant higher(P<0.05),while n-6VLCPUFAs had no significant difference among these groups. Compared with the nonobese group, there was an increase of n-9VLCMUFAs in obese group(P<0.05).Clinically significant increases of n-3VLCPUFAs in both groups,n-9VLCMUFAs in nonobese group and significant reduction in VLCSFAs of obese group were observed after the treatment with metformin hydrochloride and rosiglitazone maleate tablets(P<0.05), while n-6 VLCPUFAs did not change significantly in either group after the treatment.â‘£The incidence of gastrointestinal adverse reactions happened in nonobese and obese group was 9.3% and 6.3% respectively, and no liver toxicity, edema, hypoglycemia and other adverse reactions was observed in the treatment.CONCLUSION:â‘ Compared with the nonobese group, there were severer insulin resistance and polycystic ovary in obese women with PCOS, while T and FT had no significant difference between two gruops.â‘¡Metformin hydrochloride and rosiglitazone maleate tablets can ameliorate insulin resistance and polycystic ovary,and also reduce BMI and FT in women with PCOS particularly in the obese,which may have no significant adverse reaction.â‘¢The metabolic disorders of plasma very long chain fatty acids existed in women with PCOS. After the treatment with metformin hydrochloride and rosiglitazone maleate tablets for three months, the concentration of n-3VLCPUFAs in both groups and n-9VLCMUFAs in nonobese group was significantly increased, while the concentration of VLCSFAs in obese group decreased.