高胰岛素血症在多囊卵巢综合征发病中的作用及抗胰岛素的治疗

目的探讨高胰岛素（ＩＮＳ）血症在多囊卵巢综合征（ＰＣＯＳ）发病中的作用及二甲双胍对ＰＣＯＳ的治疗效果。方法将２３例ＰＣＯＳ病人分为肥胖组（１２例）和非肥胖组（１１例）,于服二甲双胍前及服二甲双胍８～１２周后,应用放射免疫法测定基础状态下雄激素、黄体生成素（ＬＨ）、性激素结合球蛋白及促性腺激素释放激素激动剂（ＧｎＲＨａ）刺激后,血１７α羟孕酮（１７ＯＨＰ）和ＬＨ的水平、口服糖耐量试验（ＯＧＴＴ）中血ＩＮＳ水平。结果用药后肥胖组空腹血ＩＮＳ水平和非肥胖组ＯＧＴＴ时血ＩＮＳ反应曲线下面积均明显下降;两组基础状态下的血１７ＯＨＰ、雄烯二酮（Ａ）、睾酮（Ｔ）水平均显著下降、性激素结合蛋白水平显著增加;ＬＨ基值及ＧｎＲＨａ刺激后的ＯＨＰ和ＬＨ值均无明显变化。结论高ＩＮＳ血症在ＰＣＯＳ的高雄激素血症起重要作用,二甲双胍可用于ＰＣＯＳ的治疗

Role of hyperinsulinemia in pathogenesis of polycystic ovary syndrome and treatment by reduction of insulin secretion

OBJECTIVE: To investigate the role of insulin in the polycystic ovary syndrome (PCOS) pathogenesis and application of Metformin in the treatment of PCOS. METHODS: Serum androgen, luteinizing hormone (LH) and sex hormone-binding globulin(SHBG) concentration during fasting and serum 17 alpha-hydroxyprogesterone (17-OHP), LH level in response to gonadotropin-releasing hormone agonist (GnRH-a) stimulation were determined. Oral glucose-tolerance tests(OGTT) before and after oral administration of metoformin for 8-12 weeks were performed in 12 obese and 11 lean women with PCOS. RESULTS: After oral administration of metformin for 8-12 weeks, fasting insulin concentration in obese group and area under curve (AUC) after OGTT in lean group decreased significantly. There were significant decrease in basal 17 alpha-hydroprogesterone, androstenedione, testosterone concentration, and increase in serum SHBG concentration in obese and lean groups. Basal LH and the response of serum 17-OHP, LH to GnRHa were not significantly changed. CONCLUSIONS: Hyperinsulinemia may play an important role in hyperandrogenism GnRH-a of PCOS, and metformin may be used in the treatment of PCOS.