34 2014

1 1

doi: 10.7669/j.issn.0253-357X.2014.01.0036 E-mail: [email protected]

Vol.34, No.1 Reproduction & Contraception

Jan. 2014

1

2

(1.

1

,

, 200032) , , 200011)

(2.

:

(PCOS)

: A

1

17

;8

PCOS B

,

,

(OGTT)

(IR) : 17

9

PCOS

17 IR

,

:

3~6 PCOS

:

,

(PCOS);

IR

;

: R711.74

,

(IR);

:A

(OC);

: 0253-357X(2014)01-0036-05

(polycystic ovary syndrome, 5%~10%, 60%

[3,4]

,

PCOS)

,

20%~

[1]

2

7

PCOS

,

, ,

,

, 17

;

(

9

)PCOS

IR

(

2

) , PCOS

(insulin resistance, IR),

IR

PCOS , IR [2]

,

1 1.1

,

2011.01~2012.11

, ,

,

PCOS

IR

IR

, :

36

; Tel: +86-21-33189900

(A

)

(B

)

1.4

1.2 1.2.1 PCOS

PCOS

SPSS16.0,

2003

:

,

;

(M)(

;

(PCO) 2~9 mm

,

12

3

,

2

2

/

, 2.1

(CAH)

17

[5]

Cushing 1.2.2 IR

,

75 g (OGTT),

1 h

2 h

0 h

3 h

PCOS 32.1

(BMI)

0.5 h

,

0.75

1h

: AUC=0.25 +2 h

IR=

3h

0.5 h

A

(mmol·h/L), HOMA-

2

(FINS,

FINS

9

,

3~4

4

;B 6

(

2 5 -35(

8

,

) ;3

,

(

1

;

1

1

)

)1

;

( )8

/d,

/d

3

(160 mg/

)1 (

, 500 mg/ /d

3

3~4

,

2

,

2.2

HOMA-IR :

,

2~ 3

1 ,

IR

,

1

,

Pharmacia &

;

(500 mg/ 1 000~1 500 mg/d,

/d

2

7

,1

,

,

,

B

21 d,

, 0.625 mg/

1

,

2 mg

0.035 mg,

,

, 2

A

1.3

Upjohn)1

,2

10 mIU/L;

1.66 mIU/L[7]

HOMA-IR

2

,

+

(FPG, mmol/L)

mIU/L)/22.5

16

HOMA-IR + 0.5

+ 0.5

,

;3 , 3

(HOMA)

IR

3.48(17.0~29.6) kg/m 2,

22.46

,

(AUC) [6]

5.0(22~44)

, ,

IR

,

, P10 ml;

Q)

HOMA-IR

)

,

,

,

(P=0.017),

,

(IAUC) (P=0.012), ,

, 3 ,

1

,

(

1)

3

, 3.1

,

1987

, ,

(hyperplasia of endometrium, EH)

, ,

,

(ISGP)

(simple hyperplasia, SH) hyperplasia, CH)

(complex (atypical hyperplasia, 37

1

[

(

)]

Table 1 Comparison of serum index before and after therapy [M(Q)] Z

P

8.62 (8.54)

0.980

0.327

5.20 (1.30)

4.70 (0.80)

1.540

0.123

3.53 (2.55)

1.68 (2.30)

2.380

0.017

IAUC

264.39 (162.55)

166.06 (151.19)

2.521

0.012

GAUC

23.44 (16.14)

21.58 (9.84)

0.420

0.674

Index

Before treatment

After treatment

13.53 (9.70)

FPG (mmol/L) HOMA-IR

FINS (U/ml)

,

AH) 3

[13]

( [1]

) AH

SH

,

30%

CH,

9

,

23%~29%

[14]

,

30%~50%

,

,

, [9]

, [10]

17

,

Montgomery [8]

,

,

,

,

, ,

, DNA

,

, 3.2

, PCOS

17 , A [11]

40%

,

,

IR

9 ,

2

,

:

, , ,

,

,

,

(PR),

, (SHBG)

PR

,

, [13]

,

, ;

,

,

IR ,

, PCOS

, , ,

(ER)

,

3 [15]

,

9.6 mm,

IR 6.4 mm

Lin

, (IGF-I),

,

50%,

,

[16]

, [12]

38

;

PCOS

IR

Iatrakis

E2

; DNA

50%~70%

IR

;

;

,

E2

30%

E2 ;

IR, ,

(IGFBP-1), IGFBP-1

,

; , (AMPK)

,

T

,

, IR

[18]

IR : IR

,

, ,

,

1 IGFBP-1

PCOS ,

IGF-

,

IR

[19]

, IR-

,

PCOS 25%,

[17]

, ,

IR

PCOS IR

, ,

, ,

, , , HOMA-IR

IR IAUC

, ,

3.3

,

17 ,

, ,

,

9

, ,

3~6 , ,

, ,

,

,

,

,

, , , PR

,

;

[1]

,

.

.2 .

:

, 2004:

2449-57.

,

[2] Fornes R, Ormazabal P, Rosas C, et al. Changes in the expression of insulin signaling pathway molecules in endome-

IR

tria from polycystic ovary syndrome women with or without hyperinsulinemia. Mol Med, 2010, 16(3/4):129-36.

,

[3] Shen ZQ, Zhu HT, Lin JF. Reverse of progestin-resistant

,

, , ,

contraceptives. Obstet Gynecol, 2008, 112(2 Pt 2):465-7. [4]

,

.

, ,

,

atypical endometrial hyperplasia by metformin and oral

,

IR IGF-I,

.

, 2010,

45(1):56-7. [5] Cannina E. Dignosis of polycystic ovary syndrome: from NIH criteria to ESHRE

ASRM guidelines. Minerva Gineeol,

39

2004, 56(1):126. [6] Mather KJ, Hunt AJ, Steinberg HO, et al. Repeatability characteristics of simple indices of insulin resistance: implications for research applications. J Clin Endocrinol Metab, [7]

2001, 86(6):5457-64. , , .

. , 2007, 23(9):663-6. [8] Randall TC, Kuman RJ. Progestin treatment of atypical hyperplasia and well differentiated carcinoma of the endometriumin women under age 40. Obstet Gynecol, 1997, 90(3):434-40. . . : , 1999: [9] 1836-44. [10] Akhmedkhanov A, Zeloniuch-Jacquotte A. Role of exogenous and endogenous hormones in endometrial cancer: review of the evidence and research perspectives. Ann N Y Acad Sci, 2001, 943:296-315. [11] Davidson BJ, Gambone JC, Lagasse LD, et al. Free estradiol in postmenopausal women with and without endometrial cancer. J Clin Endocrinol Metab, 1981, 52(3):404-8. [12] Grigoris G, Tsalikis T, Tzioufa V, et al. Regression of endometrial hyperplasia after treatment with the gonadotrophin releasing hormone analogue triptorelin: a prospective study.

Hum Reprod, 1999, 14(2):479-84. [13] Zhao S, Chen X, Lu X, et al. Epidermal growth factor receptor signaling enhanced by long-term medroxyprogesterone acetate treatment in endometrial carcinoma. Gynecol Oncol, 2007, 105(1):45-54. [14]Montgomery BE, Daum Gs, Dunton CJ. Endometrial hyperplasia: a review. Obstet Gynecol Sarv, 2004, 59(5): 368-78. [15] Iatrakis G, Tsionis C. Polycystic ovarian syndrome, insulin resistance and thickness of the endometrium. Eur J Obstet Gynecol Reprod Biol, 2006, 127(2):218-21. [16] Lin JF, Li RZ, Zhou J. The influence of insulin on secretion of IGF - I and IGFBP - I in cultures of human endometrial stromal cells. Chinese Med J, 2003, 2003(2):301-4. , . [17] . : , 2007, 34(1):44-6. [18] , , . . , 2011, 31(2):138-40. [19] Tan BK, Adya R, Chen J, et al. Metformin treatment exerts antiinvasive and antimetastatic effects in human endometrial carcinoma cells. J Clin Endocrinol Metab, 2011, 96 (3):808-16.

(2013

7

15

)

Drug Transformation Analysis of Endometrial Atypical Hyperplasia in Patients with Polycystic Ovary Syndrome (PCOS) Xiao-fang LOU1, Jin-fang LIN2, Su-ping FANG1, Feng-ling WANG1 (1. Hospital of Shanghai Institute of Planned Parenthood Research, Shanghai, 200032) (2. Department of Obstetrics and Gynecology Hospital Affiliated to Fudan University, Shanghai, 200011)

ABSTRACT

Objective: To analyze the efficacy and safety of drugs on reverse of atypical endometrial

hyperplasia in patients with polycystic ovary syndrome (PCOS). Methods: A retrospective analysis on 17 patients with PCOS complicated by atypical endometrial hyperplasia was performed (9 patients who were treated with progestin but not reversed were considered as group A; 8 patients who were untreated were considered as group B). Both groups received OGTT and insulin release test, to check whether the patients had insulin resistance (IR) or hyperinsulinemia. The 17 patients were treated with oral contraceptives combined with metformin. Results: After the 17 patients with PCOS complicated by IR and hyperinsulinemia received drug treatment for 3 6 cycles, atypical endometrial hyperplasia was successfully reversed. Conclusion: Oral contraceptives combined with metformin is a clinically practical and effective method for treatment of PCOS complicated by atypical IR endometrial hyperplasia. Key words: polycystic ovary syndrome (PCOS); endometrial atypical hyperplasia; insulin resistance (IR); oral contraceptive pills (OC); metformin

40