利拉鲁肽联合二甲双胍在超重或肥胖PCOS患者中的临床疗效观察

Clinical efficacy of Liraglutide combined with metformin in overweight or obese patients with PCOS

摘要:

目的 回顾性分析利拉鲁肽联合二甲双胍治疗超重或肥胖多囊卵巢综合征（polycystic ovarian syndrome，PCOS）患者的临床疗效。方法 选取2018年6月至2023年4月在陆军军医大学第二附属医院就诊符合入选标准的125例PCOS患者作为研究对象，根据体质指数（body mass index，BMI）≥24 kg/m²分为超重组（n=56）和肥胖组（n=69）。2组受试者均给予利拉鲁肽联合二甲双胍治疗12周，评估治疗后的临床疗效。结果 ①治疗后，2组体质量、BMI、腰围、臀围、谷丙转氨酶较前下降（P<0.05）。肥胖组体质量、体质指数下降更显著（P<0.05）；治疗后，2组糖脂代谢指标均较前下降（P<0.05），但2组间绝对值变化差异无统计学意义（P>0.05）；治疗后，2组性激素球蛋白较前上升，总睾酮、游离雄激素指数、促黄体生成素、促黄体生成素/促卵泡激素较前下降（P<0.05），且超重组下降更显著（P<0.05）。治疗后2组月经恢复率、优势卵泡形成率较前改善，卵巢多囊样改变较前减少（P<0.05）。②安全性评价2组中最常见的不良反应是恶心和腹泻、消化不良。所有的不良反应都在用药后4周内逐渐减少。结论 利拉鲁肽联合二甲双胍在减轻超重或肥胖PCOS患者体质量、BMI，改善糖脂代谢紊乱及卵巢功能均有较好的疗效，尤其对于肥胖型PCOS患者在降低体质量方面获益更多，超重型PCOS患者在改善性激素水平方面更具优势，且安全性尚可。

Abstract:

Objective To review the clinical efficacy of liraglutide combined with metformin in the treatment of overweight or obese patients with polycystic ovarian syndrome（PCOS）.Methods 125 patients with PCOS from The First Affiliated Hospital of Army Medical University who met the inclusion criteria from June 2018 to April 2023 were selected as study subjects and divided into hyperrecombination（n=56） and obesity group（n=69） according to body mass index（BMI）≥24 kg/m². Both groups were treated with Liraglutide combined with metformin for 12 weeks to evaluate the clinical efficacy after treatment.Results ①After treatment，the body weight，BMI，waist circumference，hip circumference and alanine aminotransferase in two groups were decreased（P<0.05）. The decrease of body weight and BMI in obese group was more significant（P<0.05）. After treatment，the indexes of glucose and lipid metabolism were decreased in both groups（P<0.05），but there was no significant difference in absolute value between the two groups（P>0.05）. After treatment，sex hormone globulin increased，while total testosterone，free androgen index，luteinizing hormone，luteinizing hormone/follicle-stimulating hormone decreased（P<0.05），and superrecombinant decreased more significantly（P<0.05）. After treatment，the recovery rate of menstruation and dominant follicle formation rate were improved，and the polycystic changes of ovary were decreased（P<0.05）.②The most common adverse reactions in the two groups were nausea，diarrhea and dyspepsia. All of the adverse reactions were gradually reduced within 4 weeks of administration.Conclusion Liraglutide combined with metformin has good efficacy in reducing body weight and body mass index in overweight or obese PCOS patients，improving glycemic and lipid metabolism disorders and ovarian function，especially in obese PCOS patients with more benefits in reducing body weight，and patients with super severe PCOS have more advantages in improving sex hormone levels.