Сравнение эффективности применения инозитолов и комбинированных оральных контрацептивов для коррекции метаболических, эндокринных и клинических параметров пациенток с синдромом поликистозных яичников

Abstract

The use of a combination of myoinositol and D-chiroinositol in a ratio of 5:1 (MI/DCI 5:1), manganese and folic acid appears promising for the correction of androgen-dependent dermopathy, regulation of the menstrual cycle, restoration of ovulation in patients planning pregnancy, as well as for improving endocrine and metabolic parameters, carbohydrate and lipid metabolism in patients with polycystic ovary syndrome (PCOS). Objective. To compare the effects of combined oral contraceptives (COCs) and combination of MI/DCI 5:1, manganese and folic acid on endocrine, metabolic and clinical parameters in patients with PCOS. Patients and methods. A prospective open-label clinical trial included 129 patients with PCOS. Patients in group 1 (A, n = 63) were prescribed COCs with antiandrogenic activity containing ethinyl estradiol 20 μg/drospirenone 3 mg; patients in group 2 (B, n = 66) were prescribed the combination of MI/DCI 5:1, manganese and folic acid for 6 months. Lifestyle modifications were also recommended for all patients: physical activity and diet therapy. Results. Low serum androgen levels were observed in both groups. The use of COCs resulted in a more significant reduction in hirsutism according to the Ferriman-Gallwey score and clinical manifestations of acne. Administration of the combination of MI/DCI 5:1 showed good results in improving carbohydrate and lipid metabolism in patients with PCOS. Thus, in group B there was a significant reduction in glucose levels (4.9 ± 0.3 vs. 5.2 ± 0.5 mmol/L, p < 0.01) and fasting insulin (12.1 ± 5.3 vs. 22.2 ± 4.9 mmol/L, p < 0.01), HOMA and CARO indices. No changes in carbohydrate metabolism were observed during COCs administration, but there was an increase in cholesterol levels (6.0 ± 0.7 vs. 5.7 ± 0.5 mmol/L, p < 0.05), low-density lipoproteins (LDL) (3.9 ± 0.4 vs. 3.5 ± 0.6 mmol/L, p < 0.05), and atherogenic coefficient (AC). Lipid profile parameters in group B improved significantly from baseline by reducing cholesterol (5.1 ± 0.6 vs. 5.6 ± 0.6 mmol/L, p < 0.05), triglycerides (1.5 ± 0.4 vs. 1.8 ± 0.3 mmol/L, p < 0.05), and LDL (2.7 ± 0.5 vs. 3.6 ± 0.8 mmol/L, p < 0.01). Diet therapy and administration of the combination of MI/DCI 5:1, manganese and folic acid resulted in a 4.4% decrease in waist circumference and a 4.8% decrease in body mass index (BMI). In contrast, the COCs group showed a 2.1% increase in waist circumference and a 4.7% increase in BMI, which may be related to an increased appetite. In group B, the regularity of menstrual cycle in patients with PCOS was also analyzed. After 6 months of therapy, a regular cycle was observed in 40% of patients vs. 11% of patients at baseline with a mean duration of 33.3 ± 9.4 days (p < 0.05). Conclusion. Lifestyle modification with the combination of MI/DCI 5:1, manganese and folic acid is effective for the correction of endocrine, metabolic, and clinical profile in patients with PCOS and appears to be a promising new alternative to COCs regardless of reproductive planning. Key words: polycystic ovary syndrome, myoinositol, D-chiroinositol, hyperandrogenism, insulin resistance, hirsutism, acne