刘治国;朱玲琦;祝德秋;

• 1:宿迁市第一人民医院
• 2:上海市同济医院

摘要(Abstract)：

多囊卵巢综合征(Polycystic ovary syndrome,PCOS)是女性常见的内分泌疾病,其临床表现多样。生活方式的调整和减肥是PCOS的基础治疗,可以改善多种临床症状。口服避孕药可用于调整月经周期和改善高雄激素血症。抗雄激素药物有氟他胺、非那雄胺、螺内酯等,可单用或与口服避孕药合用。枸橼酸氯米芬是促排卵的一线药物,芳香化酶抑制剂是有前景的促排卵药,在疗效和不良反应等方面可能优于枸橼酸氯米芬。改善PCOS患者的胰岛素抵抗也很重要,二甲双胍为一线药物,噻唑烷二酮类药物引起体重增加等不良反应限制了其应用,新型降糖药GLP-1可以有效地降低PCOS患者体重。有研究他汀类用于治疗PCOS,但证据尚不充分。

关键词(KeyWords)： 多囊卵巢综合征;促进排卵;胰岛素增敏剂

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘治国;朱玲琦;祝德秋;

Email:

DOI: 10.14053/j.cnki.ppcr.201509027

参考文献(References)：

• [1]Barthelmess EK,Naz RK.Polycystic ovary syndrome:current status and future perspective[J].Front Biosci(Elite Ed),2014,6:104-119.
• [2]Bhattacharya SM,Jha A.Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel,cyproterone acetate,and drospirenone in patients w ith polycystic ovary syndrome[J].Fertil Steril,2012,98(4):1053-1059.
• [3]Badawy A,Elnashar A.Treatment options for polycystic ovary syndrome[J].Int J Womens Health,2011,3:25-35.
• [4]Domecq JP,Prutsky G,Mullan RJ,et al.Lifestyle modification programs in polycystic ovary syndrome:systematic review and meta-analysis[J].J Clin Endocrinol M etab,2013,98(12):4655-4663.
• [5]Batukan C,Muderris II,Ozcelik B,et al.Comparison of two oral contraceptives containing either drospirenone or cyproterone acetate in the treatment of hirsutism[J].Gynecol Endocrinol,2007,23(1):38-44.
• [6]Calaf J,López E,Millet A,et al.Long-term efficacy and tolerability of flutamide combined w ith oral contraception in moderate to severe hirsutism:a 12-month,double-blind,parallel clinical trial[J].J Clin Endocrinol M etab,2007,92(9):3446-3452.
• [7]Huber J,Walch K.Treating acne with oral contraceptives:use of low er doses[J].Contraception,2006,73(1):23-29.
• [8]Legro RS,Arslanian SA,Ehrmann DA,et al.Diagnosis and treatment of polycystic ovary syndrome:an Endocrine Society clinical practice guideline[J].J Clin Endocrinol M etab,2013,98(12):4565-4592.
• [9]Baillargeon JP,Mc Clish DK,Essah PA,et al,Association betw een the current use of low-dose oral contraceptives and cardiovascular arterial disease:a meta-analysis[J].J Clin Endocrinol M etab,2005,90(7):3863-3870.
• [10]Lidegaard,Nielsen LH,Skovlund CW,et al.Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses:Danish cohort study,2001-9[J].BM J,2011,343:d6423.
• [11]Yazici G,Savas A,Tasdelen B,et al.Role of luteal phase support on gonadotropin ovulation induction cycles in patients w ith polycystic ovary syndrome[J].J Reprod M ed,2014,59(1-2):25-30.
• [12]Badawy A,Gibreal A.Clomiphene citrate versus tamoxifen for ovulation induction in w omen w ith PCOS:a prospective randomized trial[J].Eur J Obstet Gynecol Reprod Biol,2011,159(1):151-154.
• [13]Roy KK,Baruah J,Singla S,et al.A prospective randomized trial comparing the efficacy of Letrozole and Clomiphene citrate in induction of ovulation in polycystic ovarian syndrome[J].J Hum Reprod Sci,2012,5(1):20-25.
• [14]Kar S.Clomiphene citrate or letrozole as first-line ovulation induction drug in infertile PCOS w omen:A prospective randomized trial[J].J Hum Reprod Sci,2012,5(3):262-265.
• [15]Legro RS,Brzyski RG,Diamond MP,et al.Letrozole versus clomiphene for infertility in the polycystic ovary syndrome[J].N Engl J Med,2014,371(2):119-129.
• [16]Sastre ME,Prat MO,Checa MA,et al.Current trends in the treatment of polycystic ovary syndrome w ith desire for children[J].Ther Clin Risk Manag,2009,5(2):353-360.
• [17]Malkawi HY,Qublan HS,Hamaideh AH.Medical vs.surgical treatment for clomiphene citrate-resistant w omen w ith polycystic ovary syndrome[J].J Obstet Gynaecol,2003,23(3):289-293.
• [18]Christin-Maitre S,Hugues JN,Recombinant FSH Study Group.A comparative randomized multicentric study comparing the step-up versus step-dow n protocol in polycystic ovary syndrome[J].Hum Reprod,2003,18(8):1626-1631.
• [19]J Swiglo BA,Cosma M,Flynn DN,et al.Clinical review:Antiandrogens for the treatment of hirsutism:a systematic review and metaanalyses of randomized controlled trials[J].Clin Endocrinol M etab,2008,93(4):1153-1160.
• [20]Escobar-Morreale HF,Carmina E,Dewailly D,et al.Epidemiology,diagnosis and management of hirsutism:a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society[J].Hum Reprod Update,2012,18(2):146-170.
• [21]Spritzer PM,Lisboa KO,Mattiello S,et al.Spironolactone as a single agent for long-term therapy of hirsute patients[J].Clin Endocrinol(Oxf),2000,52(5):587-594.
• [22]Mazza A,Fruci B,Guzzi P,et al.In PCOS patients the addition of low-dose spironolactone induces a more marked reduction of clinical and biochemical hyperandrogenism than metformin alone[J].Nutr M etab Cardiovasc Dis,2014,24(2):132-139.
• [23]Ganie MA,Khurana ML,Nisar S,et al.Improved efficacy of low-dose spironolactone and metformin combination than either drug alone in the management of w omen w ith polycystic ovary syndrome(PCOS):a six-month,open-label randomized study[J].J Clin Endocrinol M etab,2013,98(9):3599-3607.
• [24]Diamanti-Kandarakis E,Economou F,Palimeri S,et al.Metformin in polycystic ovary syndrome[J].Ann N Y Acad Sci,2010,1205:192-198.
• [25]Tang T,Lord JM,Norman RJ,et al.Insulin-sensitising drugs(metformin,rosiglitazone,pioglitazone,D-chiro-inositol)for w omen w ith polycystic ovary syndrome,oligo amenorrhoea and subfertility[J].Cochrane Database Syst Rev,2010,(1):CD003053.
• [26]Xiao J,Chen S,Zhang C,et al.The effectiveness of metformin ovulation induction treatment in patients w ith PCOS:a systematic review and meta-analysis[J].Gynecol Endocrinol,2012,28(12):956-960.
• [27]Ayaz A,Alwan Y,Farooq MU.Metformin-clomiphene citrate vs.clomiphene citrate alone:Polycystic ovarian syndrome[J].J Hum Reprod Sci,2013,6(1):15-18.
• [28]Du Q,Yang S,Wang YJ,et al.Effects of thiazolidinediones on polycystic ovary syndrome:a meta-analysis of randomized placebo-controlled trials[J].Adv Ther,2012,29(9):763-774.
• [29]Elkind-Hirsch K,Marrioneaux O,Bhushan M,et al.Comparison of single and combined treatment w ith exenatide and metformin on menstrual cyclicity in overw eight w omen w ith polycystic ovary syndrome[J].J Clin Endocrinol M etab,2008,93(7):2670-2678.
• [30]Jensterle Sever M,Kocjan T,Pfeifer M,et al.Short-term combined treatment w ith liraglutide and metformin leads to significant w eight loss in obese w omen w ith polycystic ovary syndrome and previous poor response to metformin[J].Eur J Endocrinol,2014,170(3):451-459.
• [31]Sathyapalan T,Kilpatrick ES,Coady AM,et al.The effect of atorvastatin in patients w ith polycystic ovary syndrome:a randomized double-blind placebo-controlled study[J].J Clin Endocrinol M etab,2009,94(1):103-108.
• [32]Kaya C,Pabuccu R,Cengiz SD,et al.Comparison of the effects of atorvastatin and simvastatin in w omen w ith polycystic ovary syndrome:A prospective,randomized study[J].Exp Clin Endocrinol Diabetes,2010,118(3):161-166.
• [33]Puurunen J,Piltonen T,Puukka K,et al.Statin therapy worsens insulin sensitivity in w omen w ith polycystic ovary syndrome(PCOS):a prospective,randomized,double-blind,placebocontrolled study[J].J Clin Endocrinol M etab,2013,98(12):4798-4807