Efekat metformina na kliničke karakteristike žena sa sindromom poličističnih jajnika
Sažetak
Uvod: Insulinska rezistencija (IR) je jedna od glavnih karakteristika sindroma policističnih jajnika (Engl. Polycystic ovary syndrome-PCOS), a metformin je jedan od najčešće prepisivanih insulinskih senzitajzera u njegovom lečenju. Do sada sprovedena istraživanja pokazuju heterogene rezultate o uticaju metformina na hormonski i metabolički status žena sa PCOS.
Cilj rada: Ispitivanje efekta šestomesečnog lečenja metforminom (2000mg dnevno) na hormonske i metaboličke karakteristike žena sa PCOS, uparenih sa zdravim ženama prema indeksu telesne mase (ITM) i godinama starosti.
Materijal i metode: Ispitano je 20 žena sa PCOS [starost:23.5±5.9godina, ITM:24.8±4.2kg/m2] i 20 zdravih žena kontrolne grupe (ZK) (starost:24.5±5.3 godina, ITM:23.6±3.0kg/m2). PCOS je dijagnostikovan pomoću ESHRE/ASRM kriterijuma. Određivani su standardni biohemijski i hormonski parametri, koji su u PCOS grupi ponavljani i nakon šest meseci terapije metforminom. IR je određivana pomoću homeostatskog modela (HOMA-IR).
Rezultati: Nakon šest meseci terapije metforminom u PCOS grupi je došlo do značajnog povećanja frekvence menstrualnih ciklusa (65% vs. 87%, p<0.001) i ovulatornosti (27% vs. 53%, p=0.029), smanjenja stepena hirzutizma prema Ferrimann-Galway skoru (9.5 vs. 8.5, p=0.025), s tim da su nakon terapije svi parametri i dalje bili značajno različiti u odnosu na ZK grupu. Nakon terapije nije više bilo razlike u koncentraciji triglicerida između PCOS i ZK (1.3±0.7 vs. 0.9±0.4mmol/L, p=0.19), a koji su bili značajno veći u PCOS u odnosu na ZK pre terapije (1.4±0.8 vs. 0.9±0.4mmol/L, p=0.03). Nije zabeležen značajniji efekat terapije na ITM, kao ni na HOMA-IR i koncentraciju androgena koji su bili značajno veći u PCOS u odnosu na ZK, dok je postojao povoljan efekat metformina na jetru.
Zaključak: Šestomesečno lečenje metforminom u dozi od 2000mg dnevno kod žena sa PCOS dovodi do značajnog povećanja učestalosti menstrualnih ciklusa, ovulacije i smanjenja stepena hirzutizma, kao i povoljnog efekta na lipide i jetru, a nezavisno dejstva leka na ITM i IR.
Ključne reči: sindrom policističnih jajnika, metformin, insulinska rezistencija, hiperlipidemija, masna jetra
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