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目的:分析高原地区不同治疗方案治疗合并胰岛素抵抗(IR)、多囊卵巢综合征(PCOS)患者后对排卵率和月经恢复规律的疗效,以及对腰围与臀围比(WHR)、体重指数(BMI)、空腹胰岛素(INS)和睾酮(T)等指标的影响。方法:将我院2013年5月—2015年5月期间确诊的120例高原地区合并胰岛素抵抗多囊卵巢综合征患者随机分为三组,治疗方法分别为:A组:行为治疗+达因-35方案;B组:行为治疗+达因-35+盐酸二甲双胍片方案;C组:行为治疗+达因-35+罗格列酮方案。疗程为3个月经周期,记录排卵率及月经恢复情况,检测治疗前后空腹胰岛素(INS)、血清睾酮(T)、血脂、空腹血糖(GLU)水平,对比治疗前后WHR及BMI变化。结果:三组患者经治疗,排卵率和月经规律均明显提高,WHR、BMI、INS、T各指标与治疗前相比均明显下降,P<0.05,治疗前后三组患者的血脂指标对比差异无统计学意义,P>0.05,三组患者的临床疗效对比差异无统计学意义;对比排卵率和月经率两指标,A组和C组之间对比有统计学意义,P<0.05。结论:对于治疗合并胰岛素抵抗PCOS患者,应当遵循个体化治疗原则,在积极引导患者行为治疗基础上需要慎重考虑利弊,适当选择二甲双胍、达因-35、罗格列酮等药物治疗,应用胰岛素增敏剂联合其他药物治疗前景广阔,有望获得更高疗效。
OBJECTIVE: To analyze the curative effect on ovulation rate and menstruation recovery after treatment with insulin resistance (IR) and polycystic ovary syndrome (PCOS) patients with different treatment regimens in the plateau region and to evaluate the effect of waist circumference to hip ratio (WHR), body mass index BMI), fasting insulin (INS) and testosterone (T) and other indicators. Methods: One hundred and twenty cases of insulin resistance polycystic ovary syndrome diagnosed in our hospital from May 2013 to May 2015 were randomly divided into three groups. The treatment methods were as follows: Group A: Behavioral therapy + 35 program; group B: behavioral therapy + dyne-35 + metformin hydrochloride tablets program; group C: behavioral therapy + darin-35 + rosiglitazone program. The course of treatment was 3 menstrual cycles and the ovulation rate and menstruation recovery were recorded. The levels of fasting insulin (INS), serum testosterone (T), serum lipids and fasting blood glucose (GLU) were measured before and after treatment. Results: The three groups of patients after treatment, ovulation rate and menstrual regularity were significantly increased, WHR, BMI, INS, T indicators were significantly decreased compared with before treatment, P <0.05, before and after treatment of three groups of patients with lipid indicators no difference Statistical significance, P> 0.05, the clinical efficacy of the three groups was no significant difference in clinical efficacy; ovulation rate and menstrual rate of two indicators, A and C were statistically significant, P <0.05. Conclusion: For the treatment of patients with PCOS with insulin resistance, we should follow the principle of individualized treatment. We should carefully consider the pros and cons on the basis of actively guiding patients’ behavioral therapy. Appropriate choice of metformin, dyne-35, rosiglitazone and other drugs, Sensitizer combined with other drugs have broad prospects for treatment, is expected to obtain higher efficacy.