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Effects of exenatide combined with clomifene citrate on insulin resistance and Angiotensin II/Angiotensin-(1-7) in peripheral blood in patients with polycystic ovary syndrome

Objective: To study the effects of exenatide combined with clomifene citrate on the levels of Angiotensin (Ang) II/Angiotensin-(1-7) and insulin resistance in patients with polycystic ovary syndrome (PCOS).

Methods: A total of 78 patients with PCOS who were treated in our department from January 2015 to January 2017 were included in the study. Patients were randomly divided into observation group (n=45) and control group (n=33). Patients in the observation group were treated with exenatide combined with clomifene citrate. Patients in the control group were treated with metformin combined with clomifene citrate. Serum levels of Ang II, Ang (1-7) and serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), sex hormone binding globulin (SHBG) and dehydroepiandrosterone sulfate (DHEAS) levels were measured before and after treatment. Fasting plasma glucose (FPG) and fasting serum insulin (FINS) were measured. Homeostasis model assessmentinsulin resistance (HOMA-IR) was calculated. The ovulation rate and pregnancy rate was recorded.

Results: After treatment, the levels of Ang II, Ang (1-7) and Ang II/Ang (1-7) in the observation group were lower than those before treatment (P<0.05). The ratio of Ang II, Ang (1-7) and Ang II/Ang (1-7) in the observation group was lower than that in the control group (P<0.05). The levels of LH, T and DHEAS in the two groups were lower than those before treatment (P<0.05). And the level of the observation group was lower than that of the control group, the difference was statistically significant (P<0.05). The levels of FSH, E2 and SHBG were statistically significant compared with before treatment in the two groups (P<0.05), and the level of the observation group was higher than that of the control group (P<0.05). After treatment, the levels of FPG, FINS and HOMA-IR in the observation group and the control group were significantly lower than those before treatment (P<0.05). The levels of FPG, FINS and HOMA-IR in the observation group were lower than those in the control group (P<0.05). The ovulation rate and pregnancy rate of the observation group were higher than those of the control group, the difference was statistically significant (P<0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group (P>0.05).

Conclusion: Exenatide combined with clomifene citrate is effective in the treatment of PCOS, and can reduce the activity of renin-angiotensin system (RAS) in patients, reduce the level of insulin resistance in patients, promote ovarian ovulation. It is safe and reliable, which should be further expanded and followed-up to detect the long-term efficacy and safety in the treatment of PCOS patients.

Author(s): Juan Wang, Xiangyan Ruan, Fengyu Jin, Yuandong Sun, Junshi Wang