目的 探讨司美格鲁肽联合克罗米芬治疗肥胖型多囊卵巢综合征(polycystic ovary syndrome，PCOS)胰岛素抵抗患者的效果。方法 选取2022年1月至2023年12月西安交通大学第一附属医院榆林医院收治的102例肥胖型PCOS胰岛素抵抗患者进行随机对照试验。采用随机数字表法将其分为对照组和研究组，各51例。对照组年龄(28。45±3。21)岁，病程(5。36±0。76)年。研究组年龄(28。38±3。19)岁，病程(5。41±0。77)年。对照组采用克罗米芬治疗，研究组采用克罗米芬和司美格鲁肽治疗，疗程12周。对比两组患者体质量指数(bodymassindex，BMI)、糖脂代谢指标[胰岛β细胞功能指数(homeostatic model assessment of beta-cell function，HOMA-β)、胰岛素抵抗指数(homeostatic model assessment of insulin resistance，HOMA-IR)、三酰甘油(triglycerides，TG)、总胆固醇(total cholesterol，TC)]、子宫内膜与排卵情况(子宫内膜厚度、宫颈黏液评分、成熟卵泡数量)、血清学指标[蛋白酪氨酸磷酸酶 1B(protein tyrosine phosphatase 1B，PTP1B)、成纤维细胞生长因子 21(fibroblast growth factor 21，FGF21)、胰岛素样生长因子(insulin-like growth factor，IGF)]、肠道菌群(肠球菌、肠杆菌、双歧杆菌、乳杆菌)、不良反应(恶心呕吐、低血糖、疲劳感、头晕头痛)。统计学方法采用t检验、x2检验。结果 治疗后，研究组BMI、HOMA-IR、TG和TC水平均低于对照组，HOMA-β高于对照组(t=2。433、6。282、3。749、9。145、7。105，均P＜0。05);研究组子宫内膜厚度、宫颈黏液评分、成熟卵泡数量均高于对照组(t=27。240、10。097、6。883，均P＜0。05);研究组PTP1B、FGF21和IGF水平均低于对照组(t=4。558、14。640、5。001，均P＜0。05);研究组肠球菌和肠杆菌菌群数低于对照组[(7。01±0。33)比(7。98±0。39)、(7。24±0。47)比(7。85±0。51)]，而双歧杆菌、乳杆菌菌群数高于对照组[(9。88±0。71)比(9。13±0。67)、(9。89±0。36)比(9。73±0。34)](t=13。559、6。281、5。487、2。308，均 P＜0。05);研究组不良反应发生率低于对照组[3。92％(2/51)比11。76％(6/51)]，但差异无统计学意义(x2=2。170，P=0。141)。结论 司美格鲁肽联合克罗米芬治疗肥胖型PCOS胰岛素抵抗患者能有效降低其BMI，改善患者糖脂代谢指标，促进患者子宫内膜发育和排卵，调整患者血清学指标，改善患者肠道菌群组成。
Semaglutide combined with clomiphene for obese patients with polycystic ovary syndrome and insulin resistance
Objective To evaluate the effect of semaglutide combined with clomiphene for obese patients with polycystic ovary syndrome(PCOS)and insulin resistance.Methods A total of 102 obese patients with PCOS and insulin resistance who were treated at Yulin Hospital,First Hospital,Xi'an Jiaotong University from January 2022 to December 2023 were selected for the randomized controlled trial.They were divided into a control group and a study group by the random number table method,with 51 cases in each group.The control group were(28.45±3.21)years old;their disease course was(5.36±0.76)years.The study group were(28.38±3.19)years old;their disease course was(5.41±0.77)years.The control group took clomiphene,and the study group clomiphene and semaglutide,for 12 weeks.The body mass indexes(BMI),glycemic and lipid metabolism indicators[homeostatic model assessment of beta-cell function(HOMA-β),homeostatic model assessment of insulin resistance(HOMA-IR),triglycerides(TG),and total cholesterol(TC)],endometrial and ovulation conditions(endometrial thickness,cervical mucus score,and number of mature follicles),serological indicators[protein tyrosine phosphatase 1B(PTP1B),fibroblast growth factor 21(FGF21),and insulin-like growth factor(IGF)],changes in intestinal floras(Enterococcus,Enterobacteriaceae,Bifidobacterium,and Lactobacillus),and adverse reactions(nausea and vomiting,hypoglycemia,fatigue,and dizziness and headache)were compared between the two groups.t and x2 tests were used for the statistical analysis.Results After the treatment,the BMI and levels of HOMA-IR,TG,TC,and HOMA-β in the study group were better than those in the control group(t=2.433,6.282,3.749,9.145,and 7.105;all P＜0.05);the endometrial thickness,cervical mucus score,and number of mature follicles in the study group were higher than those in the control group(t=27.240,10.097,and 6.883;all P＜0.05);the levels of PTP1B,FGF21,and IGF in the study group were lower than those in the control group(t=4.558,14.640,all 5.001;P＜0.05);the numbers of Enterococcus and Enterobacteriaceae in the study group were lower than those in the control group[(7.01±0.33)vs.(7.98±0.39)and(7.24±0.47)vs.(7.85±0.51)],while the numbers of Bifidobacterium and Lactobacillus in the study group were higher than those in the control group[(9.88±0.71)vs.(9.13±0.67)and(9.89±0.36)vs.(9.73±0.34)](t=13.559,6.281,5.487,and 2.308;all P＜0.05).The incidence of adverse reactions in the study group was lower than that in the control group[3.92％(2/51)vs.11.76％(6/51)],but the difference was not statistically significant(x2=2.170,P=0.141).Conclusion Semaglutide combined with clomiphene for obese patients with PCOS can effectively reduce their BMI,improve their glucose and lipid metabolism indicators,promote the development of their uterine endometrium and ovulation,adjust their serological indicators,and improve the composition of intestinal floras.
万方数据
维普
