摘要目的 探讨低碳水化合物对多囊卵巢综合征(PCOS)合并肥胖患者体重、糖脂代谢、性激素和受孕情况的影响.方法 选取2015年11月至2016年12月就诊的PCOS合并肥胖且有生育要求的患者64例,按随机数字表法分为低碳水化合物饮食组(观察组)和对照组.于干预前、干预12周后分别测定患者的体重、体脂成分分析、生殖内分泌激素和糖脂代谢指标及月经周期变化、受孕情况.结果 (1)治疗12周后,观察组体重、腰围、BMI、内脏脂肪面积均低于对照组,两组间比较差异有统计学意义(P＜0.05).(2)12周时两组空腹血糖(FPG)比较差异无统计学意义(P＞0.05);而糖负荷后2h血糖(2 h PG)观察组比对照组下降更显著,差异有统计学意义(P＜0.05);两组空腹胰岛素(FINS)下降幅度差异有统计学意义(P＜0.05).(3)干预后两组总睾酮(T)、游离雄激素指数(FAI)及促黄体生成素(LH)均有下降,观察组较对照组下降明显(P＜0.05).(4)观察组恢复月经周期及自然受孕率明显优于对照组(P＜0.05).结论 低碳水化合物饮食联合二甲双胍及中等强度运动更能有效减轻体重,改善糖、脂代谢和性激素水平,提高自然受孕率.

abstractsObjective To investigate the effects of low carbohydrate on body weight,glucose and lipid metabolism,sex hormones and conception of polycystic ovary syndrome (PCOS) with obese patients.Methods Sixty-four patients with PCOS and obesity and fertility were enrolled in this study from November 2015 to December 2016,and were randomly divided into low-carbohydrate diet group (study group) and control group.Before and after the intervention,the body weight,body fat composition analysis,reproductive endocrine hormone,glucose and lipid metabolism,menstrual cycle changes and conception were measured at 12 weeks after intervention.Results (1) After 12 weeks of treatment,the body weight,waist circumference,Body Mass Index(BMI)and visceral fat area of the study group were lower than those of the control group,the difference was statistically significant (P ＜ 0.05).(2) After 12 weeks of treatment,fasting blood glucose (FPG) of the two groups had no significant difference (P ＞ 0.05),while the 2 h postprandial blood glucose (PPG) of study group was significantly lower than the control group,the difference between the two groups was statistically significant (P ＜ 0.05).After treatment,the fasting insulin (FINS) of the study group and control groupwas respectively decreased by 48.8％ and 25.3％ compared with the baseline,the difference was statistically significant (P ＜ 0.05).(3) After treatment,the testosterone (T),free androgen index (FAI) and luteinizing hormone (LH) of the two groups decreased,compared to the control group,the study group decreased significantly (P ＜ 0.05).(4) The recovery rate of menstrual cycle and natural pregnancy rate in the study group were significantly better than those in the control group (P ＜ 0.05).Conclusions Low carbohydrate diet combined with metformin and moderate intensity exercise can effectively reduce weight,improve glucose,lipid metabolism and sex hormone levels,improve the natural pregnancy rate.