·糖尿病临床研究·

　　【摘要】 目的 比较二肽基肽酶4(DPP-4)抑制剂与二甲双胍对多囊卵巢综合征(PCOS)合并糖代谢异常患者代谢和内分泌参数的影响。 方法 24例PCOS合并糖代谢异常患者被分为二甲双胍组和(DPP-4)抑制剂组，各12例。分别服用二甲双胍500 mg，3次/d或(DPP-4)抑制剂100 mg，1次/d，治疗12周。评估治疗前后各项代谢指标和性激素水平的变化。 结果 与治疗前比较，两组HbA1c水平和胰岛素抵抗指数(HOMA-IR)均降低[HbA1c:( 5.8±0.7)% vs (6.9±1.7)%， (5.8±0.3) vs (6.5±1.1)%;HOMA-IR: (3.8±2.5) vs (6.6±4.3)，(4.6±2.0) vs (6.2±3.2)，P<0.05]。二甲双胍组血清睾酮(T)水平降低[(1.2±0.6) vs (2.0±1.1) nmol/L,P<0.05]，(DPP-4)抑制剂组血清T水平也有降低的趋势，但比较差异无统计学意义。 结论 (DPP-4)抑制剂显著改善PCOS合并糖代谢异常患者的高血糖和IR，并可能有助于改善高雄激素血症。

　　【关键词】 多囊卵巢综合征;(DPP-4)抑制剂;二甲双胍

　　【Abstract】 Objective To investigate the efficacy of DPP-4 inhibitor versus metformin on metabolic and endocrine parameters in polycystic ovary syndrome (PCOS) patients with abnormal glucose metabolism . Methods 24 PCOS patients with abnormal glucose metabolism were divided into metformin and DPP-4 inhibitor group in this study. All subjects were given metformin 500 mg thrice daily or DPP-4 inhibitor in 100 mg once daily for 12 weeks, respectively. Metabolic parameters and sexual hormones were evaluated before and after treatments. Results Both metformin and DPP-4 inhibitor significantly reduced HbA1c levels and insulin resistance index (HOMA-IR)from the baseline [HbA1c of post- vs pre-metformin :( 5.8±0.7)% vs (6.9±1.7)%， post- vs pre- DPP-4 inhibitor: (5.8±0.3) vs (6.5±1.1)%;HOMA-IR of post- vs pre-metformin : 4.0(3.0,5.2)vs2.3(1.1,4.2)， post- vs pre- DPP-4 inhibitor :7.1(5.4,8.6)vs5.7(3.9,6.7)(P<0.05). Moreover, metformin significantly reduced serum testosterone level [1.8(1.2,2.8) vs 1.1(0.7,1.7) nmol/L, P<0.05)]. DPP-4 inhibitor also had a trend in decreasing serum testosterone level, but without statistically significant difference. Conclusion DPP-4 inhibitor can attenuate hyperglycemia and insulin resistance in PCOS patients with abnormal glucose metabolism, and may also be helpful to improve hyperandrogenism.

　　【Key words】 Polycystic ovary syndrome; Dipeptidyl peptidase-4(DPP-4)inhibitor; Metformin