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Результаты применения комбинации миоинозитола и D-хироинозитола в соотношении 5:1 у женщин с синдромом поликистозных яичников
Обоскалова Т.А., Воронцова А.В., Звычайный М.А. и др. Результаты применения комбинации миоинозитола и D-хироинозитола в соотношении 5:1 у женщин с синдромом поликистозных яичников. Гинекология. 2020; 22 (6): 84–89. DOI: 10.26442/20795696.2020.6.200548
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Oboskalova T.A., Vorontsova A.V., Zvychainyi M.A. et al. Results of treatment with myo-Inositol and D-chiro inositol combination in ratio 5:1 in women with polycystic ovary syndrome. Gynecology. 2020; 22 (6): 84–89. DOI: 10.26442/20795696.2020.6.200548
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Аннотация
Нами проведено обсервационное описательное исследование оценки эффективности терапевтической модификации образа жизни с включением для нутритивной поддержки комбинации 1000 мг миоинозитола и 200 мг D-хироинозитола (соотношение 5:1) у 104 женщин репродуктивного возраста с синдромом поликистозных яичников (классический фенотип и неклассические фенотипы при наличии гиперандрогении) на протяжении 6 мес. Выявленные изменения антропометрических параметров (снижение индекса массы тела на 0,89 кг/м2; р<0,05 и окружности талии на 3,0 см; р<0,05), состояния кожных покровов (уменьшение частоты встречаемости акне с 96,2 до 58,6%; р<0,05 и себореи с 34,6 до 5,8%; р<0,05), гормонального фона (статистически значимое изменение всех исследуемых параметров; р<0,05: снижение общего тестостерона до 1,27 нмоль/л и индекса свободных андрогенов до 4,12% на фоне повышения глобулина, связывающего половые гормоны), углеводного обмена (нормализация толерантности к глюкозе без развития гипогликемии) и восстановление параметров менструального цикла – МЦ (регулярный МЦ у 76,9%; р<0,05, длительность МЦ 33,4 дня; р<0,05) свидетельствуют о значительной роли I этапа терапии пациенток с синдромом поликистозных яичников и возможных преимуществах комбинации 1000 мг мио- и 200 мг D-хироинозитола в качестве нутритивной поддержки.
Ключевые слова: синдром поликистозных яичников, миоинозитол, D-хироинозитол, Дикироген.
Ключевые слова: синдром поликистозных яичников, миоинозитол, D-хироинозитол, Дикироген.
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We conducted an observational descriptive study evaluating the effectiveness of therapeutic modification of lifestyle with adding of 1000 mg of myo-inositol and 200 mg of D-chiro inositol combination (ratio 5:1) for nutritional support in 104 women of reproductive age with polycystic ovary syndrome (classic phenotype and nonclassical phenotypes in the presence of hyperandrogenism) for 6 months. Revealed changes in anthropometric parameters (decrease in body mass index by 0.89 kg/m2; p<0.05 and waist circumference by 3.0 cm; p<0.05), skin status (decrease in the incidence of acne from 96.2 up to 58.6%; p<0.05 and seborrhea from 34.6 to 5.8%; p<0.05), hormonal profile (statistically significant change in all studied parameters; p<0.05: decrease in total testosterone to 1.27 nmol/L and a free androgen index up to 4.12% under an increase in globulin binding sex hormones), carbohydrate metabolism (normalization of glucose tolerance without the development of hypoglycemia) and restoration of menstrual cycle (MC) parameters (regular MC in 76.9 %; p<0.05, MC duration 33.4 days; p<0.05) indicate a significant role of stage I therapy in patients with polycystic ovary syndrome and the possible benefits of 1000 mg of myo-inositol and 200 mg of D-chiro inositol combination as a nutritional support.
Key words: polycystic ovary syndrome, myo-Inositol, D-chiro inositol, Dikirogen.
Полный текст
Список литературы
1. Barber TM, McCarthy MI, Wass JA, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 2006; 65 (2): 137–45.
2. Otta CF, Wior M, Iraci GS et al. Clinical, metabolic, and endocrine parameters in response to metformin and lifestyle intervention in women with polycystic ovary syndrome: a randomized, double-blind, and placebo control trial. Gynecol Endocrinol 2010; 26 (3): 173–8.
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5. Dinicola S, Minini M, Unfer V et al. Nutritional and Acquired Deficiencies in Inositol Bioavailability. Correlations with Metabolic Disorders. Int J Mol Sci 2017; 18 (10): 2187. DOI: 10.3390/ijms18102187
6. Brown LD, Cheung A, Harwood JE, Battaglia FC. Inositol and mannose utilization rates in term and late-preterm infants exceed nutritional intakes. J Nutr 2009; 139: 1648–52.
7. Larner J, Brautigan DL, Thorner MO. D-chiro-inositol glycans in insulin signaling and insulin resistance. Mol Med 2010; 16 (11–2): 543–52. DOI: 10.2119/molmed.2010.00107
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[Torshin I.Iu., Maiorova L.A., Uvarova E.V. et al. Khemoreaktomnyi analiz stereoizomerov inozitola: razlichnye profili farmakologicheskogo deistviia mioinozitola i D-khiroinozitola pri narusheniiakh zhenskoi reproduktivnoi sistemy. Vopr. akusherstva, ginekologii i perinatologii. 2020; 5 (19). DOI: 10.20953/1726-1678-2020-5 (in Russian).]
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10. Nordio M, Proietti E. The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone. Eur Rev Med Pharmacol Sci 2012; 16 (5): 575–81.
11. Bizzarri M, Carlomagno G. Inositol: history of an effective therapy for Polycystic Ovary Syndrome. Eur Rev Med Pharmacol Sci 2014;18 (13): 1896–903. PMID: 25010620
12. Laganà AS, Garzon S, Casarin J et al. Inositol in Polycystic Ovary Syndrome: Restoring Fertility through a Pathophysiology-Based Approach. Trends Endocrinol Metab 2018; 29 (11): 768–80. DOI: 10.1016/j.tem.2018.09.001. PMID: 30270194
13. Pintaudi B, Di Vieste G, Bonomo M. The Effectiveness of Myo-Inositol and D-Chiro Inositol Treatment in Type 2 Diabetes. Int J Endocrinol 2016; 2016: 9132052. DOI: 10.1155/2016/9132052
14. Клинические рекомендации «Синдром поликистозных яичников в репродуктивном возрасте (современные подходы к диагностике и лечению)». М., 2015.
[Clinical guidelines “Polycystic ovary syndrome in reproductive age (modern approaches to diagnosis and treatment)”. Moscow, 2015 (in Russian).]
15. Лабораторная диагностика. Под ред. Е.А. Кондрашевой, А.Ю. Островского. 4-е изд., перераб. и доп. М.: Медиздат, 2018.
[Laboratory diagnostics. Ed. E.A. Kondrasheva, A.Yu. Ostrovsky. 4th ed., rev. and add. Moscow: Medizdat, 2018 (in Russian).]
16. Chalasani N et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67 (1): 328–57.
17. Sarkar M, Terrault N, Chan W et al. Polycystic Ovary Syndrome (PCOS) Is Associated With NASH Severity and Advanced Fibrosis. Liver Int 2020; 40 (2): 355–9.
18. Успенская Ю.Б., Кузнецова И.В. Желчнокаменная болезнь как коморбидное синдрому поликистозных яичников заболевание. Consilium Medicum. 2015; 17 (6): 45–8.
[Uspenskaya Yu.B., Kuznetsova I.V. Cholelithiasis as a comorbid disease with polycystic ovary syndrome. Consilium Medicum. 2015; 17 (6): 45–8 (in Russian).]
19. Sie KK, Li J, Ly A et al. Effect of maternal and postweaning folic acid supplementation on global and gene-specific DNA methylation in the liver of the rat offspring. Mol Nutr Food Res 2013; 57 (4): 677–85. DOI: 10.1002/mnfr.201200186; PMID: 23463647
20. Bian A, Ma Y, Zhou X et al. Association between sarcopenia and levels of growth hormone and insulin-like growth factor-1 in the elderly. BMC Musculoskelet Disord 2020; 21 (1): 214. DOI: 10.1186/s12891-020-03236-y; PMID: 32264885
21. Mendoza N, Diaz-Ropero MP, Aragon M et al. Comparison of the effect of two combinations of myo-inositol and D-chiro-inositol in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial. Gynecol Endocrinol 2019; 35 (8): 695–700. DOI: 10.1080/09513590.2019.1576620
22. La Marca A, Grisendi V, Dondi G et al. The menstrual cycle regularization following D-chiro-inositol treatment in PCOS women: A retrospective study. Gynecol Endocrinol 2015; 31: 52–6.
2. Otta CF, Wior M, Iraci GS et al. Clinical, metabolic, and endocrine parameters in response to metformin and lifestyle intervention in women with polycystic ovary syndrome: a randomized, double-blind, and placebo control trial. Gynecol Endocrinol 2010; 26 (3): 173–8.
3. Teede HJ, Misso ML, Costello MF et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018; 110 (3): 364–79.
4. Wojciechowska A, Osowski A, Jóźwik M et al. Inositols' Importance in the Improvement of the Endocrine-Metabolic Profile in PCOS. Int J Mol Sci 2019; 20 (22): 5787. DOI: 10.3390/ijms20225787
5. Dinicola S, Minini M, Unfer V et al. Nutritional and Acquired Deficiencies in Inositol Bioavailability. Correlations with Metabolic Disorders. Int J Mol Sci 2017; 18 (10): 2187. DOI: 10.3390/ijms18102187
6. Brown LD, Cheung A, Harwood JE, Battaglia FC. Inositol and mannose utilization rates in term and late-preterm infants exceed nutritional intakes. J Nutr 2009; 139: 1648–52.
7. Larner J, Brautigan DL, Thorner MO. D-chiro-inositol glycans in insulin signaling and insulin resistance. Mol Med 2010; 16 (11–2): 543–52. DOI: 10.2119/molmed.2010.00107
8. Торшин И.Ю., Майорова Л.А., Уварова Е.В. и др. Хемореактомный анализ стереоизомеров инозитола: различные профили фармакологического действия миоинозитола и D-хироинозитола при нарушениях женской репродуктивной системы. Вопр. акушерства, гинекологии и перинатологии. 2020; 5 (19). DOI: 10.20953/1726-1678-2020-5
[Torshin I.Iu., Maiorova L.A., Uvarova E.V. et al. Khemoreaktomnyi analiz stereoizomerov inozitola: razlichnye profili farmakologicheskogo deistviia mioinozitola i D-khiroinozitola pri narusheniiakh zhenskoi reproduktivnoi sistemy. Vopr. akusherstva, ginekologii i perinatologii. 2020; 5 (19). DOI: 10.20953/1726-1678-2020-5 (in Russian).]
9. Baillargeon J-P, Diamanti-Kandarakis E, Ostlund R et al. Altered D-Chiro-Inositol Urinary Clearance in Women With Polycystic Ovary Syndrome. Diabetes Care 2006; 29 (2): 300–5. DOI: 10.2337/diacare.29.02.06.dc05-1070
10. Nordio M, Proietti E. The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone. Eur Rev Med Pharmacol Sci 2012; 16 (5): 575–81.
11. Bizzarri M, Carlomagno G. Inositol: history of an effective therapy for Polycystic Ovary Syndrome. Eur Rev Med Pharmacol Sci 2014;18 (13): 1896–903. PMID: 25010620
12. Laganà AS, Garzon S, Casarin J et al. Inositol in Polycystic Ovary Syndrome: Restoring Fertility through a Pathophysiology-Based Approach. Trends Endocrinol Metab 2018; 29 (11): 768–80. DOI: 10.1016/j.tem.2018.09.001. PMID: 30270194
13. Pintaudi B, Di Vieste G, Bonomo M. The Effectiveness of Myo-Inositol and D-Chiro Inositol Treatment in Type 2 Diabetes. Int J Endocrinol 2016; 2016: 9132052. DOI: 10.1155/2016/9132052
14. Клинические рекомендации «Синдром поликистозных яичников в репродуктивном возрасте (современные подходы к диагностике и лечению)». М., 2015.
[Clinical guidelines “Polycystic ovary syndrome in reproductive age (modern approaches to diagnosis and treatment)”. Moscow, 2015 (in Russian).]
15. Лабораторная диагностика. Под ред. Е.А. Кондрашевой, А.Ю. Островского. 4-е изд., перераб. и доп. М.: Медиздат, 2018.
[Laboratory diagnostics. Ed. E.A. Kondrasheva, A.Yu. Ostrovsky. 4th ed., rev. and add. Moscow: Medizdat, 2018 (in Russian).]
16. Chalasani N et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67 (1): 328–57.
17. Sarkar M, Terrault N, Chan W et al. Polycystic Ovary Syndrome (PCOS) Is Associated With NASH Severity and Advanced Fibrosis. Liver Int 2020; 40 (2): 355–9.
18. Успенская Ю.Б., Кузнецова И.В. Желчнокаменная болезнь как коморбидное синдрому поликистозных яичников заболевание. Consilium Medicum. 2015; 17 (6): 45–8.
[Uspenskaya Yu.B., Kuznetsova I.V. Cholelithiasis as a comorbid disease with polycystic ovary syndrome. Consilium Medicum. 2015; 17 (6): 45–8 (in Russian).]
19. Sie KK, Li J, Ly A et al. Effect of maternal and postweaning folic acid supplementation on global and gene-specific DNA methylation in the liver of the rat offspring. Mol Nutr Food Res 2013; 57 (4): 677–85. DOI: 10.1002/mnfr.201200186; PMID: 23463647
20. Bian A, Ma Y, Zhou X et al. Association between sarcopenia and levels of growth hormone and insulin-like growth factor-1 in the elderly. BMC Musculoskelet Disord 2020; 21 (1): 214. DOI: 10.1186/s12891-020-03236-y; PMID: 32264885
21. Mendoza N, Diaz-Ropero MP, Aragon M et al. Comparison of the effect of two combinations of myo-inositol and D-chiro-inositol in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial. Gynecol Endocrinol 2019; 35 (8): 695–700. DOI: 10.1080/09513590.2019.1576620
22. La Marca A, Grisendi V, Dondi G et al. The menstrual cycle regularization following D-chiro-inositol treatment in PCOS women: A retrospective study. Gynecol Endocrinol 2015; 31: 52–6.
________________________________________________
1. Barber TM, McCarthy MI, Wass JA, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 2006; 65 (2): 137–45.
2. Otta CF, Wior M, Iraci GS et al. Clinical, metabolic, and endocrine parameters in response to metformin and lifestyle intervention in women with polycystic ovary syndrome: a randomized, double-blind, and placebo control trial. Gynecol Endocrinol 2010; 26 (3): 173–8.
3. Teede HJ, Misso ML, Costello MF et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018; 110 (3): 364–79.
4. Wojciechowska A, Osowski A, Jóźwik M et al. Inositols' Importance in the Improvement of the Endocrine-Metabolic Profile in PCOS. Int J Mol Sci 2019; 20 (22): 5787. DOI: 10.3390/ijms20225787
5. Dinicola S, Minini M, Unfer V et al. Nutritional and Acquired Deficiencies in Inositol Bioavailability. Correlations with Metabolic Disorders. Int J Mol Sci 2017; 18 (10): 2187. DOI: 10.3390/ijms18102187
6. Brown LD, Cheung A, Harwood JE, Battaglia FC. Inositol and mannose utilization rates in term and late-preterm infants exceed nutritional intakes. J Nutr 2009; 139: 1648–52.
7. Larner J, Brautigan DL, Thorner MO. D-chiro-inositol glycans in insulin signaling and insulin resistance. Mol Med 2010; 16 (11–2): 543–52. DOI: 10.2119/molmed.2010.00107
8. Torshin I.Iu., Maiorova L.A., Uvarova E.V. et al. Khemoreaktomnyi analiz stereoizomerov inozitola: razlichnye profili farmakologicheskogo deistviia mioinozitola i D-khiroinozitola pri narusheniiakh zhenskoi reproduktivnoi sistemy. Vopr. akusherstva, ginekologii i perinatologii. 2020; 5 (19). DOI: 10.20953/1726-1678-2020-5 (in Russian).
9. Baillargeon J-P, Diamanti-Kandarakis E, Ostlund R et al. Altered D-Chiro-Inositol Urinary Clearance in Women With Polycystic Ovary Syndrome. Diabetes Care 2006; 29 (2): 300–5. DOI: 10.2337/diacare.29.02.06.dc05-1070
10. Nordio M, Proietti E. The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone. Eur Rev Med Pharmacol Sci 2012; 16 (5): 575–81.
11. Bizzarri M, Carlomagno G. Inositol: history of an effective therapy for Polycystic Ovary Syndrome. Eur Rev Med Pharmacol Sci 2014;18 (13): 1896–903. PMID: 25010620
12. Laganà AS, Garzon S, Casarin J et al. Inositol in Polycystic Ovary Syndrome: Restoring Fertility through a Pathophysiology-Based Approach. Trends Endocrinol Metab 2018; 29 (11): 768–80. DOI: 10.1016/j.tem.2018.09.001. PMID: 30270194
13. Pintaudi B, Di Vieste G, Bonomo M. The Effectiveness of Myo-Inositol and D-Chiro Inositol Treatment in Type 2 Diabetes. Int J Endocrinol 2016; 2016: 9132052. DOI: 10.1155/2016/9132052
14. Clinical guidelines “Polycystic ovary syndrome in reproductive age (modern approaches to diagnosis and treatment)”. Moscow, 2015 (in Russian).
15. Laboratory diagnostics. Ed. E.A. Kondrasheva, A.Yu. Ostrovsky. 4th ed., rev. and add. Moscow: Medizdat, 2018 (in Russian).
16. Chalasani N et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67 (1): 328–57.
17. Sarkar M, Terrault N, Chan W et al. Polycystic Ovary Syndrome (PCOS) Is Associated With NASH Severity and Advanced Fibrosis. Liver Int 2020; 40 (2): 355–9.
18. Uspenskaya Yu.B., Kuznetsova I.V. Cholelithiasis as a comorbid disease with polycystic ovary syndrome. Consilium Medicum. 2015; 17 (6): 45–8 (in Russian).
19. Sie KK, Li J, Ly A et al. Effect of maternal and postweaning folic acid supplementation on global and gene-specific DNA methylation in the liver of the rat offspring. Mol Nutr Food Res 2013; 57 (4): 677–85. DOI: 10.1002/mnfr.201200186; PMID: 23463647
20. Bian A, Ma Y, Zhou X et al. Association between sarcopenia and levels of growth hormone and insulin-like growth factor-1 in the elderly. BMC Musculoskelet Disord 2020; 21 (1): 214. DOI: 10.1186/s12891-020-03236-y; PMID: 32264885
21. Mendoza N, Diaz-Ropero MP, Aragon M et al. Comparison of the effect of two combinations of myo-inositol and D-chiro-inositol in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial. Gynecol Endocrinol 2019; 35 (8): 695–700. DOI: 10.1080/09513590.2019.1576620
22. La Marca A, Grisendi V, Dondi G et al. The menstrual cycle regularization following D-chiro-inositol treatment in PCOS women: A retrospective study. Gynecol Endocrinol 2015; 31: 52–6.
Авторы
Т.А. Обоскалова*1,2, А.В. Воронцова1,2, М.А. Звычайный1,2, К.Г. Гущина2, М.М. Майтесян1
1 ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России, Екатеринбург, Россия;
2 МАУЗ «Городская клиническая больница №40», Екатеринбург, Россия
*oboskalova.tat@yandex.ru
1 ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России, Екатеринбург, Россия;
2 МАУЗ «Городская клиническая больница №40», Екатеринбург, Россия
*oboskalova.tat@yandex.ru
________________________________________________
Tatiana A. Oboskalova*1,2, Anna V. Vorontsova1,2, Maksim A. Zvychainyi1,2, Karina G. Gushchina2, Marietta M. Maitesian1
1 Ural State Medical University, Ekaterinburg, Russia;
2 City Clinical Hospital №40, Ekaterinburg, Russia
*oboskalova.tat@yandex.ru
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