27 nov. METFORMIN – ADJUVANT IN STIMUAREA OVARIANA LA PACIENTELE CU SOPC
Mihai Surcel*, Florin Stamatian*, Mohamed Hammadeh**, Micu Romeo*, Remus Campean***, Stela Surd*, Marinela Garlovan*
* Departamentul de Reproducere Asistata din cadrul Universitatii de Medicina “Iuliu Hatieganu “ Cluj Napoca Roumania
** Departamentul de Obstetrica si Ginecologie din cadrul Universitatii Saarland, Homburg/Sssar, Germany
*** Departmentul de Biostatistica al Universitatii of Medicina “Iuliu Hatieganu “ Cluj Napoca
Rezumat
Introducere Insulinorezistenta este o trasatura distincta a sindromului ovarelor micropolichistice si joaca un rol important in derularea fenomenelor patogenetice ce definesc acest sindrom. Utilitazarea insulinosensibilizantelor de tipul metforminului are acoperire teoretica certa pentru pacientele ce prezinta insulinorezistenta dar ramâne discutabila pentru celelalte forme.
Obiectivul studiului este de a evalua distinct eficienta metforminului in functie de prezenta insulinorezistentei.
Material si metoda: In studiu au fost incluse 51 de paciente. S-au format patru grupe: insulinorezistente + metformin; insulinorezistente fara metformin; insulinosensibile cu metformin; insulinosensibile fara metformin. Tuturor pacientelor li s-a efectuat un bilant clinic si hormonal. Stimularea ovarians s-a realizat cu clomifen in doze progresive pâna la obtinerea ovulatiei. Parametrii principali urmariti: prezenta ovulatiei, dozele de clomifen necesare pentru obtinerea ovulatiei respectiv numarul de foliculi > 13mm rezultati.
Rezultate: In grupul pacientelor insulinorezistente s-a obiectivat o ameliorare certa atât din perspectiva ovulatiei cât i a dozelor de clomifen necesare. In schimb din perspectiva recrutarii s-a putut obiectiva un raspuns favorabil pentru ambele forme insulinosensibile sau rezistente.
Concluzii Utilitatea metforminului este certa pentru grupul insulinorezistent si pare pe anumite segmente sa se extinda si asupra grupului insulinosensibil.
Abstract – THE ANALISYS OF THE PREMATURE BIRTH IN 1ST OBSTETRIC ANG GYNECOLOGY CLINIC BETWEEN 1993-2007
Background: Insulin resistance plays a very important role in ovarian dysfunctions encountered in PCOS. Therefore, the treatment with insulin-lowering agents appears the most logic first line approach for these patients. However, a certain clinical improvement in terms of ovarian response is acknowledged in all forms of PCOS treated with metformin independent of the presence of the insulin resistance.
Objective: to evaluate distinctively the effects of metformin on PCOS patients with and without insulin resistance
Materials and methods: 51 PCOS patients were enrolled after informed consent. The patients were subdivided into four groups: insulin resistance +/ – metformin (13 patients; 12 patients) and insulin sensitive +/- metformin (14 patients; 12 patients). All patients underwent clinical and hormonal evaluation and received clomiphen citrate. Doses were increased until ovulation was obtained. Main outcome measures: ovulation, doses of clomiphen required by patients who were able to ovulate, number of follicles.
Results: Ovulation was significantly improved and clomiphen doses decreased by metformin in PCOS patients insulin resistant. There was no amelioration for these two parameters in insulin sensitive patients treated with metformin. With respect to the recruitment process, metformin was efficient for both insulin resistant and sensitive patients.
Conclusions: Metformin is useful for both insulin resistant and insulin sensitive patients, however the mechanisms of action seem to be distinctive for these two groups.
Key words: hyperinsulinaemia, metformin, polycystic ovary syndrome
