한국인 다낭성난소증후군 여성에서 Metformin과 Rosiglitazone의 치료효과 = Therapeutic Effects of Metformin and Rosiglitazone in Korean Women with Polycystic Ovary Syndrome

국문 초록 (Abstract)

연구배경: 인슐린저항성은 다낭성난소증후군(polycystic ovary syndrome, PCOS)의 주된 병인이며, 고인슐린혈증이 월경장애나 불임, 고안드로겐혈증에 기여하는 것으로 알려져 있다. 최근 PCOS에서 메트포민이나 글리타존과 같은 인슐린감수성개선제의 사용이 효과적인 것으로 보고되고 있다. 본 연구에서는 PCOS에서 인슐린감수성개선제 투여 후 대사적, 내분비적 이상의 개선 여부와, 인슐린감수성개선제 효과의 예측인자를 알아보고자 하였다.
방법: 총 62명의 PCOS 여성을 대상으로 하여 기초검사인 체질량지수, 75 그람 경구당부하검사, 혈청지질, 성호르몬을 측정하고, 정상혈당 클램프 검사를 시행하였다. 메트포민 1.5g/day 혹은 로지글리타존 4mg/day를 투여한 후 8~12주 후에 클램프검사를 재시행하였다. 약물투여 후 적어도 3개월 동안 지속적인 질출혈이 있는 경우에 월경이 회복된 것으로 정하였다.
결과: 36명이 월경이 회복되었고 5명이 임신이 되어 약물반응도는 66.7%였다. 약물 반응군과 무반응군 사이의 유의한 대사적 지표나 성호르몬의 차이는 없었다. PCOS 여성에서 약물치료 후 인슐린감수성은 유의하게 증가하고(4.7 ±0.2 vs 5.5±0.4mg/kg/min, P<0.05), 유리 테스테스테론 농도는 유의하게 감소되었으나(72.5±39.9 vs 45.8± 3.8pmol/L, P<0.05), 체중의 유의한 변화는 없었다.
결론: 한국인 PCOS 여성에서 적어도 12주 이상 인슐린감수성개선제를 사용하는 것은 월경의 회복 및 고안드로겐혈증의 개선에 효과적이었다. 하지만 약물 반응을 예측할 수 있는 대사 지표나 성호르몬의 특징은 관찰할 수 없었다.

다국어 초록 (Multilingual Abstract)

Background: Insulin resistance is a central feature of polycystic ovary syndrome (PCOS), and hyperinsulinemia contributes to anovulation, oligo or amenorrhea, hyperandrogenism and infertility in women with PCOS. The use of insulin sensitizers, such as metformin or thiazolidinedione, in PCOS is becoming increasingly accepted. The purpose of our study was to evaluate the therapeutic effects of metformin and rosiglitazone on the metabolic and reproductive derangement, and find parameters predicting their therapeutic efficacy in Korean PCOS women. Methods: Sixty-two women with PCOS were recruited. The baseline characteristics, including BMI, glucose tolerance test, lipid profiles, sex hormones and hyperinsulinemic euglycemic clamp test, were assessed. After the administration of the insulin sensitizer (metformin 1.5g/day or rosiglitazone 4mg/day) for 3 months, the insulin sensitivity was reassessed. A drug response was defined as menstrual restoration or pregnancy. Results: Of the 62 women with PCOS, 36 gained restored regular menstruation, and a further 5 conceived (a drug response rate of 66.7%). There were no significant clinical differences between responders and nonresponders. Twelve weeks after taking the drugs, the insulin sensitivity was significantly improved (M-value 4.7±0.2 vs. 5.5±0.4mg/kg/min, P<0.05), and the free testosterone levels(72.5±39.9 vs. 45.8 ±3.8pmol/L, P<0.05) were significantly decreased, without significant weight reduction. Conclusion: Metformin and rosiglitazone restored menstruation in 66.1% of women with PCOS. Hyperandrogenemia and insulin sensitivity were significantly improved with the use of the two drugs. However, metabolic or hormonal markers for predicting the drug response could not be found

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