| Objective Polycystic ovary syndrome(PCOS)is a kind of common endocrine disease in clinical diagnosis and treatment of department of gynaecology,It’s closely related to metabolism and common in adolescence and childbearing age.severely affected the physical and sychological health of women.Insulin resistance plays an important role not only in the psychopathology of the PCOS,but also in the incidence and development of the PCOS.Therefore,treating PCOS coexists with insulin resistance effectively is the focus in clinical study.In this study,we analyzed the therapy effect of metformin in patients with PCOS and insulin resistance,and provided the evidence for treating patients with PCOS.At the same time,the effects and clinical efficacy of high protein and low Glycemic index GI diet and lifestyle adjustment on the relevant clinical variables in obese women with insulin resistant polycystic ovary syndrome(PCOS)were evaluated,and the long-term clinical value of scientific diet and life intervention on PCOS patients was discussed.Methods A total of 112 patients with PCOS combined with insulin resistance admitted to The Second Hospital of Tianjin Medical University and The Tianjin First Hospital from January 2015 to December 2016 were selected in accordance with the international guidelines for clinical trial design.The first part: to analyze the clinical effect of metformin combined with Diane-35 on PCOS patients with insulin resistance.Patients with PCOS combined with insulin resistance were divided into obese type and non-obese type according to their Body Mass Index9(BMI).There were 80 cases of obese type and 32 cases of non-obese type.Test each part respectively,according to the statistics of simple random sampling method,will participate in this study group of PCOS patients were divided into control group and experimental group,there were 15 cases in the experimental group and 17 cases in the control group.while the control group patients were treated with Darin-35,the experimental group patients were treated with metformin combined with Diane-35,The was set as 4 months,followed up once a month,and the follow-up records including patients’ medication compliance and therapeutic effect,side effects,hairy,acne and other symptoms.At the end of the follow-up period,BMI,clinical symptoms,reproductive hormone levels,blood glucose levels and insulin resistance levels were compared between the two groups.To analyze the effect of metformin combined with Diane-35 in the treatment of PCOS patients with insulin resistance of different body weight.The second part: to study the effect of different intervention methods on obese PCOS patients with insulin resistance.From August 2016 to December 2017,26 cases of overweight/obese PCOS patients with insulin resistance were selected from The Second Hospital of Tianjin Medical University and The First Hospital of Tianjin.The 26 patients in the experimental group were treated with simple weight loss,strict diet with high protein and low glycemic index and lifestyle adjustment.Six of them dropped out of the trial because they had difficult maintaining or gaining weight during treatment,and 20 were enrolled.The 40 patients in the control group were treated with metformin and dacine,and the efficacy of the two groups was observed.Patients were informed and voluntarily followed up every month for 4 months.The indexes recorded in the follow-up records and analyzed after the follow-up were the same as those in the first part,and the detection of blood lipid was increased.Results The first part:Obese group:(1)Before treatment,the control group and the experimental group were statistically analyzed according to the mean age,body mass index,systolic blood pressure,diastolic blood pressure,common symptoms of PCOS,reproductive hormone,blood glucose level,and insulin resistance status.The results were not statistically significant,and the two groups were comparable in equilibrium.(2)After 4 months of treatment,the BMI of patients in the experimental group decreased compared with that before treatment,with menstrual thinning or amenorrhea(63.3% vs 36.7%),hairy and acne symptoms reduced compared with that before treatment,and the differences were statistically significant.In the control group,menstrual thinning or amenorrhea(70.0% vs.30%)and acne symptoms were reduced compared with those before treatment,and the difference was statistically significant.(3)After treatment,patients in the experimental group showed decreased testosterone(T)(1.42 nmol/L vs.3.31 nmol/L),LH(4.17 IU/L vs.9.26 IU/L)and follicle stimulating hormone(FSH)(4.15 IU/L vs.5.72 IU/L).The difference was statistically significant compared with that before treatment.In the control group,decreased testosterone(T)(2.49 nmol/L vs.3.27 nmol/L),LH(6.68 IU/L vs.8.82 IU/L),and the difference was statistically significant compared with that before treatment.After treatment,the T and LH levels were lower than those in the control group,with statistically significant differences.(4)After treatment,the insulin resistance(IR)of patients in the control group and the experimental group changed to different degrees,and the change trend was decreased,but the difference between the experimental group and the treatment group was statistically significant.Non-obese group:(1)After 4 months of treatment,PCOS symptoms in the control group were alleviated compared with before,the difference was meaningful;PCOS symptoms in the experimental group were alleviated compared with the before,and the difference was meaningful.The difference between the two groups was insignificant.(2)Compared with before treatment,patients in the control group and the experimental group showed significantly decreased T and LH.After treatmeng,,there was no significant difference in the levels of reproductive hormones between the two groups.(3)IR level in the experimental group decreased,and the difference was statistically significant compared with that before treatment.IR level in the control group were not statistically significant compared with those before treatment.The IR level of the experimental group was lower than that of the control group after treatment,and the difference was statistically significant.However,there were more side effects such as diarrhea and nausea in the treatment group.Between the obese group and the non-obese group:After treatment,the results of the obese group and the non-obese group were compared.The obese group was significantly superior to the non-obese group in terms of IR level,In terms of reproductive hormones,there were statistically significant differences between the obese T group and the non-obese T group,and no significant differences in other hormones.The second part:(1)After treatment,the body mass index,systolic blood pressure and PCOS symptoms in the experimental group minus recombination all decreased compared with that before treatment,and the differences were meaningful.Compared with the control group,the decrease of body mass index and blood pressure was lower,and the difference was meaningful.(2)Compared with that before treatment,E2 was significantly increased in the experimental group(minus recombination),while T、LH and FSH were both decreased after treatment,and the difference was meaningful.Compared between the two groups after treatment,the improvement of reproductive hormone level was more obvious after medicine,and the differences were meaningful.(3)In the experimental group(minus recombination),IR level、 blood lipid level and blood glucose level decreased significantly after treatment,with statistically significant differences compared with that before treatment.Compared with the control group after treatment,the effect of minus reduction and recombination was better than that of combination group in IR resistance,lipids metabolism and the difference was meaningful.Conclusion(1)Metformin combined with Diane-35 can effectively reduce the BMI,androgen leve and insulin resistance of patients with PCOS combined with insulin resistance,and improve the symptoms of patients with PCOS combined with insulin resistance better than the simple Diane-35 group.(2)In obese patients with PCOS complicated with insulin resistance,Metformin combined with Diane-35 treatment and strict weight loss combined with lifestyle intervention have a good effect on PCOS patients’ basic metabolism and hormone levels,and lifestyle changes(through reasonable health guidance of diet and exercise)can reduce weight more than metformin combined with Diane-35 treatment.It is superior to drug therapy in improving IR and lipid metabolism.Metformin combined with Diane-35 is superior to non-drug therapy in reducing the level of hyperandrogrnism. |
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