黄连素联合克罗米芬对多囊卵巢综合征并不孕症患者内皮功能及内分泌指标和临床结局的影响
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摘要
目的探讨黄连素联合克罗米芬对多囊卵巢综合征(PCOS)并不孕症患者内皮功能及内分泌指标和临床结局的影响。方法 120例PCOS并不孕症患者,采用克罗米芬治疗60例(对照组),采用黄连素联合克罗米芬治疗60例(试验组)。比较两组患者内皮功能、内分泌指标和临床结局的差异。结果两组治疗后ET、PAI-1、vWF:Ag水平低于治疗前,且试验组ET、PAI-1、vWF:Ag水平较对照组降低(均P <0.05)。两组治疗后LH、T、胰岛素、HOMA-IR水平低于治疗前,FSH、E2水平高于治疗前,且试验组LH、T、胰岛素、HOMA-IR水平较对照组降低,FSH、E2水平较对照组升高(均P <0.05)。两组治疗后卵泡直径、子宫内膜厚度高于治疗前,且试验组卵泡直径、子宫内膜厚度较对照组增加(均P <0.05)。试验组排卵率、妊娠率、临床治疗总有效率分别高于对照组(均P <0.05)。无不良反应发生。结论黄连素联合克罗米芬治疗PCOS并不孕症,可改善患者内皮功能指标、内分泌指标、卵泡直径、子宫内膜厚度,增加排卵率及妊娠率,提高临床疗效。
Objective To investigate the effects of berberine combined with clomiphene on endothelialfunction,endocrine indexes and clinical outcomes in patients with PCOS and infertility.Methods120 cases ofPCOS and infertility,60 cases(control group)were treated with clomiphene and 60 cases(experimental group)were treated with berberine combined with clomiphene. The differences of endothelial function,endocrine indexesand clinical outcomes between the two groups were compared.ResultsAfter treatment,the levels of ET,PAI-1and vWF:Ag in the two groups were lower than before treatment,and the levels of ET,PAI-1 and vWF:Ag in theexperimental group were lower than control group(all P < 0.05). The levels of LH,T,insulin and HOMA-IR werelower in the two groups than before the treatmen(P)t. The levels of FSH and E2 were higher than before the treat-ment,and the levels of LH,T,insulin and HOMA-IR in the experimental group were lower than control group,and the levels of FSH and E2 were higher than control group(all P < 0.05). The follicular diameter and endometri-al thickness of the two groups were higher than before treatment,and the follicular diameter and endometrial thick-ness of the experimental group were higher than control group(all P < 0.05). The rate of ovulation and pregnancyin the experimental group were higher than control group(all P < 0.05). The total effective rate of the experimentalgroup was higher than control group(P < 0.05). No adverse reactions occurred.ConclusionThe combination ofberberine and clomiphene in the treatment of PCOS and infertility can improve the index of endothelial function,endocrine index,follicle diameter and thickness of the endometrium,increase the rate of ovulation and pregnancy,and improve the clinical effect.
Objective To investigate the effects of berberine combined with clomiphene on endothelialfunction,endocrine indexes and clinical outcomes in patients with PCOS and infertility.Methods120 cases ofPCOS and infertility,60 cases(control group)were treated with clomiphene and 60 cases(experimental group)were treated with berberine combined with clomiphene. The differences of endothelial function,endocrine indexesand clinical outcomes between the two groups were compared.ResultsAfter treatment,the levels of ET,PAI-1and vWF:Ag in the two groups were lower than before treatment,and the levels of ET,PAI-1 and vWF:Ag in theexperimental group were lower than control group(all P < 0.05). The levels of LH,T,insulin and HOMA-IR werelower in the two groups than before the treatmen(P)t. The levels of FSH and E2 were higher than before the treat-ment,and the levels of LH,T,insulin and HOMA-IR in the experimental group were lower than control group,and the levels of FSH and E2 were higher than control group(all P < 0.05). The follicular diameter and endometri-al thickness of the two groups were higher than before treatment,and the follicular diameter and endometrial thick-ness of the experimental group were higher than control group(all P < 0.05). The rate of ovulation and pregnancyin the experimental group were higher than control group(all P < 0.05). The total effective rate of the experimentalgroup was higher than control group(P < 0.05). No adverse reactions occurred.ConclusionThe combination ofberberine and clomiphene in the treatment of PCOS and infertility can improve the index of endothelial function,endocrine index,follicle diameter and thickness of the endometrium,increase the rate of ovulation and pregnancy,and improve the clinical effect.
引文
[1]MYKHALCHENKO K,LIZNEVA D,TROFIMOVA T,et al.Genetics of polycystic ovary syndrome[J].Expert Rev Mol Diagn,2017,17(7):723-733.
[2]PALOMBA S,DAOLIO J,LA S G B.Oocyte competence in women with polycystic ovary syndrome[J].Trends Endocrinol Metab,2017,28(3):186-198.
[3]陆月红,夏舟岚,陈惠娟,等.多囊卵巢综合征患者克罗米芬抵抗的临床特征[J].实用医学杂志,2017,33(5):725-727.
[4]WELLER A,DANIEL S,KOREN G,et al.The fetal safety of clomiphene citrate:a population based retrospective cohort study[J].BJOG,2017,124(11):1664-1670.
[5]MANOSALVA L,MUTIS A,URZUA A,et al.Antibacterial activity of alkaloid fractions from berberis microphylla G forst and study of synergism with ampicillin and cephalothin[J].Molecules,2016,21(1):76-85.
[6]AN Y,SUN Z,ZHANG Y,et al.The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment[J].Clin Endocrinol,2014,80(3):425-431.
[7]中华医学会妇产科学分会内分泌学组.多囊卵巢综合征的诊断和治疗专家共识[J].中华妇产科杂志,2008,43(7):553-555.
[8]DIEDRICH K,FELBERBAUM R.The European society of human reproduction and embryology(ESHRE)[J].Der Gyn?kologe,2002,35(5):444-446.
[9]WU X K,STENERVICTORIN E,KUANG H Y,et al.Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome:a randomized clinical trial[J].JAMA,2017,317(24):2502-2514.
[10]SPRITZER P M,MOTTA A B,SIRPETERMANN T,et al.Novel strategies in the management of polycystic ovary syndrome[J].Minerva Endocrinol,2015,40(3):195-212.
[11]ZHANG Y,SUN J,ZHANG Y J,et al.The effect of berberine on insulin resistance in women with polycystic ovary syndrome:detailed statistical analysis plan(SAP)for a multicenter randomized controlled trial[J].Trials,2016,17(1):512-520.
[12]WU X K,WANG Y Y,LIU J P,et al.Randomized controlled trial of letrozole,berberine,or a combination for infertility in the polycystic ovary syndrome[J].Fertil Steril,2016,106(3):757-765.
[13]WANG Y,FU X,XU J,et al.Systems pharmacology to investigate the interaction of berberine and other drugs in treating polycystic ovary syndrome[J].Sci Rep,2016,6(1):28089-28097.
[2]PALOMBA S,DAOLIO J,LA S G B.Oocyte competence in women with polycystic ovary syndrome[J].Trends Endocrinol Metab,2017,28(3):186-198.
[3]陆月红,夏舟岚,陈惠娟,等.多囊卵巢综合征患者克罗米芬抵抗的临床特征[J].实用医学杂志,2017,33(5):725-727.
[4]WELLER A,DANIEL S,KOREN G,et al.The fetal safety of clomiphene citrate:a population based retrospective cohort study[J].BJOG,2017,124(11):1664-1670.
[5]MANOSALVA L,MUTIS A,URZUA A,et al.Antibacterial activity of alkaloid fractions from berberis microphylla G forst and study of synergism with ampicillin and cephalothin[J].Molecules,2016,21(1):76-85.
[6]AN Y,SUN Z,ZHANG Y,et al.The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment[J].Clin Endocrinol,2014,80(3):425-431.
[7]中华医学会妇产科学分会内分泌学组.多囊卵巢综合征的诊断和治疗专家共识[J].中华妇产科杂志,2008,43(7):553-555.
[8]DIEDRICH K,FELBERBAUM R.The European society of human reproduction and embryology(ESHRE)[J].Der Gyn?kologe,2002,35(5):444-446.
[9]WU X K,STENERVICTORIN E,KUANG H Y,et al.Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome:a randomized clinical trial[J].JAMA,2017,317(24):2502-2514.
[10]SPRITZER P M,MOTTA A B,SIRPETERMANN T,et al.Novel strategies in the management of polycystic ovary syndrome[J].Minerva Endocrinol,2015,40(3):195-212.
[11]ZHANG Y,SUN J,ZHANG Y J,et al.The effect of berberine on insulin resistance in women with polycystic ovary syndrome:detailed statistical analysis plan(SAP)for a multicenter randomized controlled trial[J].Trials,2016,17(1):512-520.
[12]WU X K,WANG Y Y,LIU J P,et al.Randomized controlled trial of letrozole,berberine,or a combination for infertility in the polycystic ovary syndrome[J].Fertil Steril,2016,106(3):757-765.
[13]WANG Y,FU X,XU J,et al.Systems pharmacology to investigate the interaction of berberine and other drugs in treating polycystic ovary syndrome[J].Sci Rep,2016,6(1):28089-28097.