利拉鲁肽治疗多囊卵巢综合征伴胰岛素抵抗患者的观察性研究

An observational study of liraglutide in treating patients with polycystic ovary syndrome complicated with insulin resistance

摘要:

目的：观察利拉鲁肽对伴胰岛素抵抗（insulin resistance，IR）的多囊卵巢综合征（polyeystic ovarian syndrome，PCOS）患者代谢和内分泌参数的影响，评价利拉鲁肽治疗多囊卵巢综合征的疗效。方法：采取自身前后对照的研究方法，随机选取32名正常人作为对照，23例确诊为多囊卵巢综合征伴IR患者使用利拉鲁肽1.8 mg/d进行干预治疗，分别于治疗前和治疗后24周进行一般情况及口服葡萄糖耐量试验、胰岛素释放试验、糖化血红蛋白、血脂、性激素等代谢指标的检测；并于治疗前和治疗后24周分别行高胰岛素-正糖钳夹检查，记录M值。结果：PCOS伴IR患者使用利拉鲁肽治疗后，体质量、体质指数、体脂含量、腰围、臀围、糖化血红蛋白、胰岛素抵抗指数较治疗前降低（P<0.05），血清睾酮、空腹胰岛素、总胆固醇、三酰甘油、低密度脂蛋白胆固醇的浓度较治疗前下降（P<0.05），M值较治疗前升高（P<0.05）。与治疗前相比，治疗后血清游离雄激素指数（free androgen in－dex，FAI）水平降低，M值水平升高。PCOS患者中血清FAI与体质量、腰围、臀围、睾酮呈正相关性，与性激素结合球蛋白（sex hormone binding globulin，SHBG）呈负相关性，多元逐步线性回归分析表明PCOS患者FAI与睾酮、SHBG相关。结论：利拉鲁肽可改善PCOS伴IR患者的体质量、血糖、胰岛素抵抗、高雄激素血症。

Abstract:

Objective：To observe the effect of liraglutide on metabolic and endocrine parameters in patients with polycystic ovary syndrome（PCOS） complicated with insulin resistance（IR），and evaluate the efficacy of liraglutide in the treatment of PCOS. Methods：Before-after study method was adopted，32 normal people were randomly selected as controls and 23 patients with PCOS complicated with IR were treated with liraglutide 1.8 mg/d. General conditions and metabolic indicators including oral glucose tolerance test，in－sulin release test，HbA1c，blood fat and sex hormones were measured before treatment and 24 weeks after treatment. Euglycemic-hy－perinsulinemic clamp was performed before treatment and 24 weeks after treatment，and M values were recorded. Results：After treat－ment with liraglutide in patients with complications of PCOS and IR，their weight，body mass index，body fat content，waist circumfer－ence，hip circumference，glycosylated hemoglobin and insulin resistance index were lower than those before treatment（P<0.05）；serum testosterone，fasting insulin，total cholesterol，triacylglycerol and low density lipoprotein cholestorol were decreased than those before treatment（P<0.05）. M value was higher than that before treatment（P<0.05）；free androgen index（FAI） after treatment was decreased when compared with that before treatment. In PCOS patients，FAI was positively correlated with body weight，waist circumference，hip circumference and testesterone，and negatively correlated with sex hormone binding globulin（SHBG）. Multiple stepwise linear regression analysis showed that FAI in PCOS patients was correlated with testesterone and SHBG. Conclusion：Liraglutide can improve body weight，blood glucose，insulin resistance and hyperandro－genism in patients with complications of PCOS and IR.