炔雌醇环丙孕酮片联合二甲双胍对多囊卵巢综合征 患者血清DHEA、AMH 及SHBG 水平的影响

Effects of ethinylestradiol and cyproterone acetate tablets combined with metformin on serum DHEA, AMH and SHBG in patients with polycystic ovary syndrome

摘要:

目的 探讨多囊卵巢综合征（PCOS）患者血清硫酸脱氢表雄酮（DHEA）、抗缪勒管激素（AMH）、 性激素结合球蛋白（SHBG）水平及经炔雌醇环丙孕酮片联合二甲双胍治疗后的变化。方法 选取2018 年 12 月—2019 年10 月在重庆三峡中心医院妇产科就诊的PCOS 患者52 例作为观察组。另取同期有规律月经 周期、卵巢功能正常的育龄期女性55 例作为对照组。观察组应用炔雌醇环丙孕酮片联合二甲双胍治疗，疗程 3 个月。比较两组治疗前血清DHEA、AMH 及SHBG 水平和观察组治疗前后血清DHEA、AMH 及SHBG 水平。采用Pearson 法分析血清DHEA、AMH、SHBG 与PCOS 病情严重程度的关系。结果 观察组治疗前 DHEA、AMH 较对照组高（P <0.05），SHBG 较对照组低（P <0.05）。1 型组治疗前血清DHEA、AMH 水平 高于3 型组、4 型组（P <0.05），SHBG 水平低于3 型组、4 型组（P <0.05），2 型组患者治疗前血清DHEA、 AMH 水平高于4 型组（P <0.05），SHBG 水平低于4 型组（P <0.05）。血清DHEA、AMH 与PCOS 病情严 重程度呈正相关（r =0.827 和0.764，P <0.05），SHBG 与PCOS 病情严重程度呈负相关（r =-0.852，P <0.05）。 观察组治疗后血清DHEA、AMH 较治疗前低（P <0.05），SHBG 较治疗前高（P <0.05）。结论 PCOS 患者 血清DHEA、AMH 水平升高，SHBG 水平降低。血清DHEA、AMH 及SHBG 均能有效反映PCOS 患者的病 情严重程度。炔雌醇环丙孕酮片联合二甲双胍对PCOS 患者具有良好的疗效，能有效改善患者血清DHEA、 AMH 及SHBG 水平。

Abstract:

Objective To investigate the levels of serum Dehydroepiandrosterone sulfate (DHEA), anti- Müllerian hormone (AMH) and sex hormone-binding globulin (SHBG) in patients with polycystic ovary syndrome (PCOS) and their changes after the treatment of ethinylestradiol and cyproterone acetate tablets (Diane-35) combined with metformin. Methods Fifty two PCOS patients were rolled in the gynecology department of our hospital from December 2018 to October 2019, and selected as the observation group. 55 women of reproductive age with regular menstrual cycle and normal ovarian function were selected as the control group at the same time. The observation group was treated with Diane-35 and metformin for 3 months. The levels of serum DHEA, AMH and SHBG in the control group and in the observation group before and after treatment were detected and compared. Pearson correlation was used to analyze the relationship between serum DHEA, AMH, SHBG and the severity of PCOS. Results The levels of serum DHEA and AMH in the observation group were higher than those in the control group, while the level of SHBG was lower than that in the control group (P < 0.05). Before treatment, the levels of serum DHEA and AMH in patients with type 1 were higher than those in patients with type 3 and type 4 (P < 0.05), while SHBG level was lower than that in patients with type 3 and type 4 (P < 0.05). The levels of serum DHEA and AMH in patients with type 2 were higher than that in patients with type 4 (P < 0.05), and SHBG level was lower than that in patients with type 4 (P < 0.05). Pearson correlation analysis showed that there was a positive correlation between serum DHEA (r = 0.827), AMH (r = 0.764) and severity of PCOS (P < 0.05), and a negative correlation between serum SHBG (r = -0.852) and severity of PCOS (P < 0.05). After treatment, the levels of serum DHEA and AMH in the observation group were lower than those before treatment (P < 0.05), and the level of serum SHBG was higher than that before treatment (P < 0.05). Conclusions The levels of serum DHEA and AMH increase while the serum SHBG level decrease in PCOS patients. DHEA, AMH and SHBG in PCOS patients can effectively reflect the severity of PCOS. Diane-35 combined with metformin have a good therapeutic effect on PCOS patients, which can effectively ameliorate the levels of serum DHEA, AMH and SHBG.