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目的:比较复方醋酸环丙孕酮和螺内酯治疗以高雄激素血症为主要表现的非肥胖型多囊卵巢综合征(PCOS)的临床疗效和对内分泌代谢的影响。方法:按前瞻性随机对照研究方法选择以高雄激素血症为主要表现的非肥胖型PCOS患者80例,按随机化分组方案分为复方醋酸环丙孕酮(EE-CA)组和螺内酯(Sp)组,每组40例,分别口服相应的药物6个月,比较治疗前、后的体质量指数(BMI)、腰臀比(WHR)、多毛体征、痤疮程度以及卵巢体积,并测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、泌乳素(PRL)、总睾酮(T)、性激素结合球蛋白(SHBG)、硫酸脱氢表雄酮(DHEAS)、空腹血糖(FPG)、空腹胰岛素(FINS)和血脂的水平,记录服药后不良反应。结果:治疗多毛EE-CA和Sp疗效接近(P>0.05);EE-CA组治疗6个月后痤疮评分下降较Sp组作用明显(P<0.05),在缩小卵巢体积方面显著优于Sp(P<0.05),降低血LH、LH/FSH、T、游离雄激素指数(FAI)、DHEAS和升高SHBG的作用较Sp组显著(P<0.05,P<0.01);EE-CA组FINS、甘油三酯(TG)和高密度脂蛋白(HDL)高于Sp组(P<0.05)。结论:本研究用于治疗以高雄激素血症为主要表现的非肥胖型PCOS的药物都是有效的;EE-CA降低高雄激素血症的效果优于Sp,但对高甘油三酯的患者使用要慎重;Sp亦有较好的降雄激素作用,且对糖、脂代谢没有显著影响。
OBJECTIVE: To compare the clinical efficacy and the effect of compound prescriptions of cyproterone acetate and spironolactone on endocrine and endocrine metabolism in non-obese polycystic ovary syndrome (PCOS) with androgenic hyperandrogenism as the main manifestation. Methods: According to the prospective randomized controlled study, 80 non-obese PCOS patients with hyperandrogenism were selected and divided into two groups according to the randomized grouping plan: compound cyproterone acetate (EE-CA) group and Sporolactone ) Group, 40 cases in each group. The corresponding drugs were orally administered for 6 months respectively. The body mass index (BMI), waist-hip ratio (WHR), hirsutism, acne and ovarian volume were compared before and after treatment. Serum follicles (FSH), LH, E2, PRL, SH, SHE, DHEAS, Fasting blood glucose (FPG), fasting insulin (FINS) and blood lipid levels, record the adverse reactions after taking medicine. Results: Acne scars decreased significantly in EE-CA group compared with Sp group (P <0.05) at 6 months after treatment, and were significantly better than those in Sp (P <0.05) (P <0.05). The effects of lowering blood LH, LH / FSH, T, free androgen index (FAI), DHEAS and increasing SHBG were significantly higher than those of Sp group Triglyceride (TG) and high density lipoprotein (HDL) were higher than those in Sp group (P <0.05). CONCLUSIONS: This study is valid for the treatment of non-obese PCOS with androgenic hyperandrogenism; EE-CA is superior to Sp in reducing hyperandrogenism but in hypertriglyceridemic patients To be careful; Sp also has a better androgen effect, and sugar, lipid metabolism had no significant effect.