摘要
目的 分析孕激素与短效口服避孕药治疗青春期多囊卵巢综合征(PCOS)的效果及对患者性激素、糖脂代谢和情绪状态的影响.方法 前瞻性选取2022年1月至2023年6月在秦皇岛市妇幼保健院就诊的192例青春期P-COS患者作为研究对象,按照随机数字表法将其分为孕激素组和避孕药组,每组各96例.孕激素组患者给予周期性口服地屈孕酮片,避孕药组患者给予口服屈螺酮炔雌醇片.两组患者均同时给予调整生活方式、控制体重和口服盐酸二甲双胍治疗,均连续治疗3个月经周期.比较两组患者的临床疗效及治疗前和治疗后的血清性激素[卵泡刺激素(FSH)、黄体生成素(LH)、睾酮、雄烯二酮、雌二醇]水平、糖脂代谢指标[空腹血糖、空腹胰岛素(FINS)、HOMA-IR、甘油三酯、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、抑郁自评量表(SDS)评分和焦虑自评量表(SAS)评分;并记录两组患者治疗期间的不良反应发生情况.结果 两组患者疗效分布和临床有效率比较差异均无统计学意义(P＞0.05).避孕药组患者治疗后的血清睾酮、雄烯二酮水平分别为(29.15±4.23)、(1.23±0.43)nmol/L,均低于孕激素组[(37.76±4.85)、(1.86±0.56)nmol/L],差异均有统计学意义(P＜0.05),而两组患者治疗后FSH、LH、雌二醇水平比较,差异均无统计学意义(P＞0.05).避孕药组患者治疗后的血清HDL-C水平为(1.84± 0.28)mmol/L,高于孕激素组[(1.70±0.23)mmol/L],差异有统计学意义(P＜0.05),而两组患者治疗后其他糖脂代谢指标比较,差异均无统计学意义(P＞0.05).避孕药组患者治疗后的SDS评分、SAS评分分别为(50.31±5.53)、(50.08±5.25)分,均低于孕激素组[(56.06±6.02)、(57.63±6.00)分],差异均有统计学意义(P＜0.05).在治疗过程中,避孕药组患者的总不良反应发生率为19.79％,高于孕激素组(8.33％),差异有统计学意义(P＜0.05).结论 在青春期PCOS治疗中,单独应用孕激素与短效避孕药在临床疗效和降低雌激素水平、缓解胰岛素抵抗方面的效果基本相当,短效避孕药治疗方案在纠正高雄激素血症、提升HDL-C水平和缓解负性情绪方面的作用更加显著,但可能增加治疗的不良反应,临床需要根据患者的实际情况进行合理决策.
Abstract
Objective To analyze the effects of progesterone and short-acting oral contraceptives on the treatment of adolescent polycys-tic ovary syndrome(PCOS)and its influences on sexual hormones,glucose and lipid metabolism,and emotional status of patients.Methods A total of 192 cases adolescent PCOS patients who admitted in Qinhuangdao Maternal and Child Health Hospital from January 2022 to June 2023 were prospectively selected as the study subjects.They were divided into the progesterone group and the contraceptive group according to the random number table method,each group 96 cases.The patients in the progesterone group were treated with periodic oral administration of dydrogesterone tablets.The patients in the contraceptive group were treated with oral drospirenoneand ethinylestradiol tablets.The patients in two groups were sim-ultaneously treated with lifestyle adjustment,weight control,and oral metformin hydrochloride were treated continuously for 3 menstrual cycles.The therapeutic effects and the serum sex hormone[follicle stimulating hormone(FSH),luteinizing hormone(LH),testosterone,androstenedi-one,estradiol]levels,the glucose and lipid metabolism indicators[fasting blood glucose,fasting insulin(FINS),HOMA-IR,triglycerides,to-tal cholesterol,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],the self-rating depression scale(SDS)scores,and the self-rating anxiety scale(SAS)scores before and after the treatment between the patients in the two groups were compared.The adverse reactions during treatment between the patients in the two groups were compared.Results There were no statistically sig-nificant differences in the distribution of therapeutic effects and clinical efficiency between the two groups(P＞0.05).The serum testosterone and androstenedione levels in the contraceptive group after treatment were(29.15±4.23)and(1.23±0.43)nmol/L,respectively,which were lower than those in the progesterone group[(37.76±4.85)and(1.86±0.56)nmol/L],and the differences were statistically significant(P＜0.05).However,there were no statistically significant differences in FSH,LH,and estradiol levels between the two groups after treatment(P＞0.05).The level of serum HDL-C in the contraceptive group after treatment was(1.84±0.28)mmol/L,which was higher than that in the pro-gesterone group[(1.70±0.23)mmol/L],and the difference was statistically significant(P＜0.05).However,there was no statistically sig-nificant difference in other glucose and lipid metabolism indicators between the two groups of patients after treatment(P＞0.05).The SDS score and SAS score of the contraceptive group patients after treatment were(50.31±5.53)and(50.08±5.25)points,respectively,which were low-er than those of the progesterone group[(56.06±6.02)and(57.63±6.00)points],and the differences were statistically significant(P＜0.05).During the treatment,the total incidence of adverse reactions in the contraceptive treatment group was 19.79％,which was higher than that in the progesterone treatment group(8.33％),the difference was statistically significant(P＜0.05).Conclusion In the treatment of ado-lescent PCOS,the application of progesterone alone and short-acting contraceptives has similar effects in clinical efficiency and reducing estrogen levels and alleviating insulin resistance.The short-acting contraceptives treatment plan has a more significant effect in correcting hyperandro-genism,increasing HDL-C levels,and alleviating negative emotions,but may increase adverse reactions during treatment.Clinical decisions need to be made based on the actual situation of the patients.
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维普
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