PCOS患者PAF-AH活性及其与糖脂代谢相关性的研究

目的 探讨多囊卵巢综合征(PCOS)患者血小板活化因子乙酰水解酶(PAF-AH)活性及其与糖脂代谢的关系.方法 按照鹿特丹标准筛选PCOS患者87例,同时选取年龄匹配的健康妇女83名作为对照.① 用化学发光法检测血清雌二醇(E2)、总睾酮(TT)、黄体生成素(LH)、促卵泡激素(FSH)、空腹胰岛素(FINS);② 用酶法试剂盒测定空腹血糖(FGLU)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C);③ 用[3H-acelty] PAF示踪三氯醋酸沉淀法检测血浆PAF-AH活性.结果 ① PCOS组体重指数(BMI)、腰臀比(WHR)、F-G评分、血清TT水平、LH/FSH比值高于对照组(P<0.01).② PCOS组血清FINS、胰岛素抵抗指数(HOMA-IR)、TG、TC、LDL-C、非高密度脂蛋白胆固醇(non-HDL-C)和致动脉粥样硬化指数(AI)高于对照组(P<0.01),而HDL-C水平低于对照组(P<0.01).但血浆PAF-AH活性两组间差异无统计学意义(P>0.05).③ 非肥胖PCOS患者(BMI＜25 kg/m2)FINS、HOMA-IR、LDL-C、non-HDL-C、AI高于非肥胖对照妇女(P<0.05).肥胖PCOS患者(BMI≥25 kg/m2)除了更严重的上述代谢异常外,FGLU、TG、TC、BMI、WHR、收缩压(SBP)、舒张压(DBP)也明显升高(P<0.05),HDL-C水平明显降低(P<0.05).然而非肥胖对照、非肥胖PCOS与肥胖PCOS三亚组间血浆PAF-AH活性差异无统计学意义(P>0.05).④ Person相关分析表明:PCOS组血浆PAF-AH活性分别与non-HDL-C、LDL-C、AI、TG、TG、WHR呈正相关,与HDL-C呈负相关(P<0.05).多重线性回归表明:non-HDL-C与SBP是PCOS组血浆PAF-AH活性有意义的预测因子(P<0.05).结论 PCOS组血浆PAF-AH活性与对照组比较无明显改变,血脂特别是胆固醇与血浆PAF-AH活性相关联.肥胖PCOS患者比非肥胖PCOS患者表现出更严重的脂代谢异常与胰岛素抵抗.

The Activity of Platelet Activating Factor Acetylhydrolase and Its Metabolic Profile in Patients with Polycystic Ovary Syndrome

Objective To investigate the association between plasma platelet activating factor (PAF)-acetylhydrolase (PAF-AH) activity and polycystic ovary syndrome(PCOS). Methods A total of 87 patients with PCOS were recruited in this study. Eighty three age-matched women with healthy ovulation served as controls. Plasma PAF-AH activity was measured by the trichloroacetic acid precipitation procedure using [3 H-acetyl] PAF as a substrate. Fasting insulin (FINS), estradiol (E2),total testosterone (TT), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were determined by chemiluminescent method. The metabolic profile was investigated by measuring FINS, fasting glucose (FGLU) . total cholesterol (TO , triglycerides (TG) , high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C). Results The patients with PCOS had higher BMI, WHR, F-G score, serum TT and LH/FSH radio than the controls (P<0. 05). The patients with PCSO had higher serum FINS, HOMA-IR, TG, TC, LDL-C, non-HDL-C and atherogenic index (AD, and lower HDL-C level than the controls (P<0. 05). No significant difference in plasma PAF-AH activity was found between the patients with PCOS and the controls (P>0.05). A progressive increase in FINS, HOMA-IR, TC, LDL-C, non-HDL-C and AI, and decrease in HDL-C level were found from non-obese healthy women (BMK25 kg/m~2) to non-obese patients, and to obese patients (BMI≥25 kg/m~2) with PCOS (P<0. 05). In addition, the obese patients with PCOS had higher BMI, WHR, SBP, DBP than the controls and the non-obese patients with PCOS. But no significant difference in plasma PAF-AH activity was found between the three groups of women (P>0. 05). The plasma PAF-AH activity was positively correlated with AI, non-HDL-C, LDL-C, TC, TG, and WHR, and negatively correlated with HDL-C level (P<0. 05). Non-HDL-C and SBP were predictors for plasma PAF-AH activity in patients with PCOS. Conclusions Patients with PCOS have similar total plasma PAF-AH activity as healthy women. Patients with PCOS present more atherogenic metabolic profilet especially in those with obesity.