Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome

Purpose  To investigate the correlation between serum 25-hydroxyvitamin D (25-OH-VD) concentrations and metabolic parameters in obese and non-obese women with polycystic ovary syndrome (PCOS). Methods  One hundred women with PCOS were divided into two groups, obese and non-obese, according to their body mass index (BMI). Waist-to-hip ratio (WHR), Ferriman–Gallwey score, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol, triglycerides, calcium, 25-OH-VD, LH/FSH, total testosterone, and DHEAS were measured. Results  The serum 25-OH-VD mean levels were 56.31% lower in the obese PCOS patients. There was an association of increased HOMA-IR, BMI, WHR, triglycerides, total testosterone, and DHEAS with decreased 25-OH-VD concentrations in the obese PCOS patients. Conclusion  Low serum 25-OH-VD concentrations result from the presence of obesity and insulin resistance. However, the dependency between PCOS and hypovitaminosis D is questionable. Hypovitaminosis D should be kept in mind while managing obese women with PCOS.     

Screening for insulin resistance in women with polycystic ovarian syndrome

Introduction Insulin resistance is implicated in the pathogenesis of polycystic ovarian syndrome (PCOS). Insulin-sensitizing agents are increasingly used in the treatment of infertility and hirsutism in PCOS. However, not all women with PCOS are insulin-resistant.

Objective To assess the degree of insulin resistance within a clinic population of women referred for treatment of oligomenorrhoea or infertility.

Design We evaluated 25 consecutive PCOS outpatients referred for treatment of menstrual dysfunction/infertility and a matched control group. All underwent a standard oral glucose tolerance test (OGTT) with serial insulin measurements. Insulin sensitivity was calculated using homeostasis model assessment (HOMA).

Results Five of the 25 clinic patients had abnormal glucose handling (two had previously unknown type 2 diabetes and three had impaired glucose tolerance). Fasting and 2-h insulin levels were significantly higher in the PCOS women. Mean HOMA-S (insulin sensitivity) was even lower for PCOS women with normal GTT status (mean (95% confidence interval): 0.53 (0.34–0.72)) than for controls (0.94 (0.84–1.04)) (F?=?4.2, p?<?0.001). HOMA-B (pancreatic β-cell function) was nearly tripled for normal GTT status PCOS women at 273 (205–342) versus 105 (70–139) for controls (F?=?6.8, p?<?0.001).

Conclusions The results suggest a role for routine measurement of HOMA-S in identifying women with PCOS with insulin resistance with a view to targeting them with insulin-sensitizing agents.     

Association between serum adipocyte factor level and insulin resistance in polycystic ovarian syndrome

The relationship between serum adipocytokines level and insulin resistance (IR) in polycystic ovary syndrome (PCOS) is unclear. Sixty-one patients with PCOS were divided into an IR group (n?=?31) and a non-IR group (n?=?30) using homeostasis model assessment (HOMA). Serum levels of luteinizing hormone, follicle-stimulating hormone, estradiol, progesterone, total testosterone, insulin, glucose, and adipocytokines were measured by radioimmunoassay or enzyme-linked immunosorbent assay. The serum adiponectin level in women with PCOS and IR was lower than that of non-IR PCOS patients (P?<?0.05); however, there were no significant differences between the two groups with regard to resistin, leptin, and leptin receptor levels (P?>?0.05). And the levels of adipocytokines and IR are significantly correlated; consequently, adipocytokines may be involved in the development of IR in PCOS patients.     

Evaluation of insulin resistance and metabolic syndrome in patients with polycystic ovary syndrome

Aim.?Polycystic ovary syndrome (PCOS) is associated with the clustering of states including insulin resistance (IR), obesity, elevated blood pressure, and dyslipidemia that are termed as metabolic syndrome (MBS). This study was designed to assess the differences between homeostatic model assessment (HOMA) values in PCOS and healthy women.

Methods.?In a case–control study, 55 women with PCOS and 59 women with normal cycles (control group) aged 15–40 years old were evaluated. In all the subjects (after obtaining written informed consent), blood pressure, body weight, height, body mass index (BMI), waist /hip ratio(WHR) and fasting blood glucose (FBG), triglycerides (TG), HDL, C-peptide, insulin, HOMA Index, and FGIR (fasting glucose to insulin ratio) were measured.

Results.?In this study, the prevalence of MBS was significantly higher in PCOS group compared with the control group (p = 0.028). There were no significant differences in age, waist/hip ratio, fasting glucose, insulin, and C-peptide levels between patients with PCOS and control group. Furthermore, the prevalence of impaired fasting glucose (IFG) and the mean of HOMA and FGIR did not differ significantly between PCOS and control group.

Conclusion.?Criteria of MBS are frequently present in young women with PCOS and may be more useful as a prognostic factor than IR indexes in this age group. We suggest evaluation of IR in older age women with PCOS.     

Follicular fluid 25-hydroxyvitamin D levels determine fertility outcome in patients with polycystic ovary syndrome

ObjectiveTo determine the possible relationship between follicular fluid 25-hydroxyvitamin D [25(OH)D] levels and fertility outcome of women who underwent IVF/ICSI with the diagnosis of lean polycystic ovary syndrome.Materials and methodsThirty patients who were diagnosed with PCOS according to the Rotterdam criteria and decided on IVF/ICSI were included in the study. Thirty patients who were scheduled for IVF/ICSI for reasons other than PCOS and matched in terms of age and BMI were taken as the control group (non-PCOS). According to BMI values, patients in both PCOS and non-PCOS groups were lean. Women in both groups were aged 21–35 years with a normal BMI (18.5–24.9 kg/m2) and first IVF/ICSI attempt. Both groups of patients were followed up using the antagonist protocol. Vit D levels were measured in serum and follicular fluid (FF) samples taken on the day of oocyte collection. The correlation between FF vit D levels, the number of total oocytes, MII oocytes and 2 PN zygotes, HOMA-IR, hormonal and demographic parameters, clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate were evaluated.ResultsAt the time of oocyte retrieval women with PCOS had similar serum Vitamin D compared to non-PCOS women (21.8 (12.6–24.8) ng/ml vs 22.3 (11.5–25.1) ng/ml, p < 0.54). In FF, assessed on the day of oocyte retrieval, the concentration of Vitamin D was similar in women with PCOS when compared to non-PCOS women (11.2 (9.2–14.4) ng/ml vs 13.3 (11.1–17.4) ng/ml, p < 0.06). For both groups, Vitamin D levels were lower in FF compared to serum vit D. A positive correlation was found between serum and FF Vitamin D concentrations in the full cohort. A positive and significant correlation was found between FF-vit D levels and the number of total oocyte (r = 0.344, p < 0.04) and MII oocyte (r = 0.404, p < 0.02) in the PCOS group. The number of total oocyte, MII oocyte and 2 PN zygotes of the PCOS group were significantly higher than the non-PCOS group. Positive pregnancy test rate, clinical pregnancy and live birth rates were similar in both groups. The miscarriage rates in the non-PCOS group were significantly higher than in the PCOS group. A positive and significant correlation was also found between FF vit D levels and positive pregnancy test (r = 0.566, p < 0.03) and CPR (r = 0.605, p < 0.02) in PCOS group. There was no correlation between FF-vit D levels and live birth and miscarriage rates in neither the PCOS nor the non-PCOS group.ConclusionsBoth serum and FF 25-hydroxyvitamin D level of women with PCOS at the time of oocyte retrieval are similar to non-PCOS controls. While FF 25-hydroxyvitamin D levels correlate with total and MII oocyte counts, positive pregnancy test and CPR, it does not correlate with miscarriage and live birth rates.     

Profile on personality types and cortisol in polycystic ovarian syndrome

Objective

To understand the profile of personality types and cortisol in patients with polycystic ovarian syndrome (PCOS).

多囊卵巢综合征胰岛素抵抗与瘦素关系的探讨

目的　探讨多囊卵巢综合征 (PCOS)妇女血清瘦素 (leptin)水平与胰岛素抵抗 (IR)的关系 ,为研究PCOS的发病机制和治疗新途径提供理论依据。方法　 5 1例PCOS患者及 2 3例正常妇女均测定体重指数(BMI)、腰臀比 (WHR)、血清生殖激素及leptin水平 ,同期行口服糖耐量 (OGTT)及胰岛素 (Ins)释放试验 ,OGTT示IR者给予二甲双胍 (1 5 g/d)治疗 3个月后复测上述指标。 结果　PCOS患者血清leptin水平高于相应对照组 ,且IR组显著高于NIR组 ;PCOS患者经二甲双胍治疗后血清Ins水平显著下降 ,胰岛素敏感指数 (ISI)显著上升 ,同时leptin水平下降。相关分析表明 ,PCOS患者血清leptin与BMI、WHR及T显著正相关 ,与ISI负相关 (r=0 6 7,P <0 0 1) ,多元回归显示leptin中有BMI、ISI引入。结论　PCOS患者血清leptin水平升高与胰岛素敏感性相关 ;二甲双胍治疗PCOS患者可提高其胰岛素敏感性 ,降低血清leptin水平。     

Insulin resistance, dyslipidemia, and metabolic syndrome in women with polycystic ovary syndrome

Objective

To investigate the association of insulin resistance with dyslipidemia and metabolic syndrome (MBS) in women with polycystic ovary syndrome (PCOS).

Methods

Fasting glucose (G), insulin (I), and lipid levels were measured in 50 infertile women with PCOS. A fasting G/I ratio of 4.5 or less (n = 29) defined insulin resistance (IR).

Results

The mean levels of total cholesterol (P < 0.001), low-density lipoprotein (P = 0.02), and triglycerides (P < 0.001) were significantly higher and the mean levels of high-density lipoprotein were significantly lower (P < 0.001) in the IR group. The prevalence of MBS (P = 0.02) and obesity (P = 0.04), hypertension (P = 0.02), fasting hyperglycemia (P = 0.03), low high-density lipoprotein levels (P = 0.02), and hypertriglyceridemia (P = 0.02) were also significantly higher in the IR group.

Conclusion

Insulin resistance is associated with dyslipidemia and MBS in women with PCOS. Lifestyle modification and insulin-sensitizing agents should be part of the management plan.     

维生素D与多囊卵巢综合征相关性的初步研究

目的:研究多囊卵巢综合征(PCOS)患者血清维生素D的浓度与内分泌紊乱的相互关系。方法:收集55例初诊PCOS患者(PCOS组)和20例健康育龄期妇女(对照组),计算体重指数(BMI),测定血清睾酮(T)、雌二醇(E2)、LH、FSH及血清25-(OH)D3浓度,并行OGTT和胰岛素释放试验,计算QUICKI指数。结果:PCOS组25-(OH)D3浓度显著低于对照组(P0.01)。将PCOS组患者分为肥胖、超重及正常体重者分析,发现肥胖和超重者25-(OH)D3浓度显著低于正常体重者。PCOS组中,25-(OH)D3浓度与BMI、T、LH/FSH呈显著负相关(r=-0.446、-0.390、-0.411,P0.01),与QUICKI值呈正相关(r=0.423,P0.01)。结论:维生素D缺乏与PCOS内分泌紊乱密切相关。     

达英-35联合不同胰岛素增敏剂对PCOS伴IR患者的临床疗效比较

目的:比较吡格列酮和二甲双胍分别配伍达英-35治疗多囊卵巢综合征(P-COS)的内分泌异常以及对卵巢生殖功能恢复的疗效。方法:随机将91例PCOS合并胰岛素抵抗(IR)患者分为两组,吡格列酮配伍组47例口服达英-35和盐酸吡格列酮,二甲双胍配伍组44例口服达英-35和盐酸二甲双胍,两组均于治疗3个月后进行诱导排卵治疗3个周期。检测治疗前后性激素、IR程度、血脂水平以及观察诱导排卵的效果。结果:二甲双胍配伍组治疗后BM I明显降低(P<0.05)。两组治疗后F-G评分均显著降低(P<0.05),卵泡总数及卵巢体积均显著降低(P<0.01),LH、LH/FSH、A2均显著降低(P<0.01)。两组治疗后IR明显改善(P<0.01),吡格列酮配伍组FIN水平降低的更为显著(P<0.05)。吡格列酮配伍组治疗后TC显著下降(P<0.05),TG、LDL-C显著下降(P<0.01),HDL-C显著升高(P<0.05),二甲双胍配伍组治疗前后血脂无明显改变(P>0.05)。两组的周期排卵率、单卵泡发育率、妊娠结局无明显差异(P>0.05)。结论:达英-35与吡格列酮配伍或与二甲双胍联合应用,均能改善PCOS患者的IR和高雄激素症状,对于异常的糖脂代谢,吡格列酮的疗效要优于二甲双胍。     

罗格列酮对多囊卵巢综合征胰岛素抵抗及高雄激素血症的治疗研究

目的　探讨胰岛素增敏剂罗格列酮对多囊卵巢综合征 (PCOS)的胰岛素抵抗及高雄激素血症的治疗效果。方法　对 30例PCOS患者给予每天早餐前口服 4mg罗格列酮 ,共 1 2周 ,比较治疗前后体重指数、胰岛素、血糖和血脂、瘦素和神经肽Y以及生殖激素水平与排卵率的变化。结果治疗 1 2周后 ,基础胰岛素水平从 (1 8± 8)mIU/L降至 (1 2± 7)mIU/L(P <0 0 1 ) ,胰岛素抵抗指数从4 3± 1 2降至 2 6± 0 7(P <0 0 1 )。黄体生成素从 (1 5 4± 4 4)U/L降至 (7 9± 2 1 )U/L ,游离睾酮从(1 2 5± 1 9)pmol/L降至 (8 9± 1 4)pmol/L ,雄烯二酮从 (9 8± 1 7)nmol/L降至 (7 4± 1 2 )nmol/L ,差异均有极显著性 (P均 <0 0 1 ) ;硫酸脱氢表雄酮从 (8 7± 3 5) μmol/L降至 (6 9± 2 1 ) μmol/L(P<0 0 5) ;性激素结合球蛋白从 (39± 3)nmol/L升至 (58± 5)nmol/L(P <0 0 1 )。血浆瘦素水平从 (1 8±4) μg/L降至 (1 3± 3) μg/L(P <0 0 1 )。 30例月经稀发的患者 ,2 5例恢复排卵 ,排卵率 50 %。 结论　罗格列酮可降低PCOS患者血浆瘦素水平 ,改善胰岛素敏感性 ,进而改善高雄激素血症等内分泌紊乱 ,恢复有排卵月经     

Adiponectin as serum biomarker of insulin resistance in patients with polycystic ovarian syndrome

Abstract

Objective: To examine the role of adiponectin as a biomarker of insulin resistance in polycystic ovary syndrome (PCOS).

Background: PCOS is associated with metabolic syndrome, which correlates to increased cardiovascular risk in these patients. Adiponectin is decreased in obese individuals.

Methods: Ninety women with PCOS (45 with and 45 without metabolic syndrome) were enrolled in this study. Anthropometric variables, serum concentrations of fasting glucose, insulin, triglycerides, lipoproteins, cholesterol, testosterone and adiponectin were measured in all patients. Insulin sensitivity was examined in all patients. Numerical values were analyzed by t-tests and categorical data were analyzed by Chi-square test. Multiple regression analyses were performed to detect the factors that contributed to insulin resistance.

Results: Metabolic syndrome predicted insulin resistance in PCOS patients. Serum adiponectin levels were suppressed in insulin resistant compared to insulin sensitive patients (10.7?±?4.3?µg/mL, p?<?0.001). Multiple linear regression analysis revealed for every 1?µg increase in adiponectin, insulin sensitivity index increases by 0.1 (p?=?0.016). Serum testosterone failed to correlate with insulin sensitivity.

Conclusion: Serum adiponectin levels were suppressed in patients with both metabolic syndrome and insulin resistance. This protein could be used as a biomarker to distinguish the patients at a higher risk of diabetes and cardiovascular morbidity.     

多囊卵巢综合征患者血浆中不同结合状态的血小板活化因子乙酰水解酶活性与胰岛素抵抗的关系

目的 探讨多囊卵巢综合征(PCOS)患者血浆中不同结合状态的血小板活化因子乙酰水解酶(PAF-AH)活性与胰岛素抵抗(IR)的关系.方法 选择2006年10月-2008年1月在四川大学华西第二医院妇产科就诊的105例PCOS患者,其中稳态模型胰岛素抵抗指数(HOMA-IR)≥2.77者53例(IR-PCOS组),<2.77者52例(非IR-PCOS组).选择同期因输卵管因素或男性因素于本院就诊的53例不孕患者作为对照组.检测并比较3组患者的血浆PAF-AH、高密度脂蛋白结合PAF-AH(H-PAF-AH)、低密度脂蛋白结合PAF-AH(L-PAF-AH)活性及L-PAF-AH/H-PAF-AH活性比值.采用Pearson相关分析法及多重线性回归法分析PCOS患者血浆中L-PAF-AH/H-PAF-AH活性比值与生殖激素水平、糖脂代谢水平之间的相关性.结果 (1)IR-PCOS组患者血浆PAF-AH活性[(0.055±0.012)mmol·L~(-1)·min~(-1)]、L-PAF-AH活性[(0.052±0.012)mmol·L~(-1)·min~(-1)]及L-PAF-AH/H-PAF-AH活性比值(23±6)均分别高于对照组[(0.050±0.009)mmol·L~(-1)·min~(-1)、(0.047±0.009) mmol·L~(-1)·min~(-1)及18±4]与非IR-PCOS组[(0.050±0.012)mmol·L~(-1)·min~(-1)、(0.048±0.012)mmol·L~(-1)·min~(-1)及(18±5)],差异均有统计学意义(P<0.05);在校正体质指数后,IR-PCOS组血浆L-PAF-AH/H-PAF-AH活性比值仍然高于对照组和非IR-PCOS组,差异均有统计学意义(P<0.01).(2)相关性分析结果显示,PCOS患者血浆中L-PAF-AH/H-PAF-AH活性比值分别与动脉硬化指数、年龄、体质指数、腰围臀围比值、HOMA-IR及甘油三酯、空腹胰岛素、空腹血糖、低密度脂蛋白胆固醇、总胆固醇水平呈正相关关系(r=0.644、0.247、0.296、0.212、0.356、0.587、0.377、0.375、0.292、0.199,P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈负相关关系(r=-0.510,P<0.01).多重线形回归法分析显示,动脉硬化指数和甘油三酯水平是L-PAF-PAH/H-PAF-AH活性比值有意义的预测因子[标准化系数(β)分别为0.515和0.201,P<0.05].结论 PCOS患者血浆中L-PAF-AH活性升高可能与IR相关,L-PAF-AH/H-PAF-AH活性比值增加可能成为IR-PCOS患者慢性炎症状态的一个新指标.     

Agreement among insulin sensitivity indexes on the diagnosis of insulin resistance in polycystic ovary syndrome and ovulatory women

OBJECTIVE: The objective was to compare agreement on the diagnosis of insulin resistance (IR) among insulin sensitivity indexes in both ovulatory women and those with polycystic ovary syndrome (PCOS). STUDY DESIGN: In an observational study, the 75-g oral glucose tolerance test was performed in 105 women with PCOS and 51 ovulatory women. The insulin sensitivity indexes used were insulin quantitative sensitivity check index (QUICKI), 1/homeostasis model assessment-insulin resistance (1/HOMA-IR), area under curve for insulin (AUC-I), and the Matsuda insulin sensitivity index (COMP). For the IR diagnosis we used cut-off values described in recent publications (insulin >12 microIU/ml, 1/HOMA-IR <0.47, QUICKI < or =0.333, AUC-I > or =7000 microIU/ml 120 min, and COMP <4.75. RESULTS: Excellent agreement was assessed among insulin, QUICKI, and 1/HOMA-IR. However, the rate of IR detected by these indexes in the PCOS group (44.8-51.4%) was lower than expected. New cut-offs were then determined based on COMP results. Using these values, 1/HOMA-IR and QUICKI showed excellent agreement (kappa=0.83) with COMP. CONCLUSION: The observed agreements among insulin, QUICKI and 1/HOMA-IR were higher than 93%. Therefore, clinicians may choose any of those obtaining similar results. For clinicians who prefer COMP, but are looking for a simpler test to detect IR in PCOS women, the use of QUICKI and 1/HOMA-IR with the new cut-offs seems reasonable.     

非肥胖型多囊卵巢综合征患者体脂分布与胰岛素抵抗的研究

目的:研究非肥胖型多囊卵巢综合征(non-obese polycystic ovary syndrome,Nob-PCOS)患者体脂分布与胰岛素抵抗的关系。方法:非肥胖型多囊卵巢综合征(Nob-P-COS组)40例,以年龄、体重指数相匹配健康育龄妇女45例为对照组,采用双能X线吸收仪(DXA)测量全身和局部身体脂肪含量,化学发光法检测生殖内分泌,全自动生化分析仪检测糖、脂代谢指标。结果:Nob-PCOS组空腹胰岛素(INS)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、睾酮(T)分别为9.90±4.40μIU/ml、4.62±0.65mmol/L、2.98±1.02mmol/L、1.72±0.81nmol/L,均显著高于对照组的7.39±4.45μIU/ml、4.37±0.73mmol/L、2.63±0.65mmol/L、1.20±0.62nmol/L,差异均有统计学意义(P<0.05);Nob-PCOS组胰岛素敏感指数(ISI)为0.026±0.016,低于对照组的0.050±0.034,差异有统计学意义(P<0.01);Nob-PCOS组躯干脂肪量9081.38±2726.81g,高于对照组的7878.69±1187.41g,差异有统计学意义(P<0.01);Nob-PCOS组躯干/大腿脂肪比为1.51±0.31,高于对照组的1.33±0.24,差异有统计学意义(P<0.01)。躯干/大腿脂肪比与ISI呈负相关(r=-0.307,P<0.05)。结论:Nob-PCOS患者糖、脂代谢存在异常和胰岛素抵抗;Nob-PCOS组脂肪分布呈男性脂肪分布模式,向心性脂肪分布与胰岛素抵抗呈正相关。     

胰岛素增敏剂对多囊卵巢综合征患者卵巢局部胰岛素抵抗的影响

目的探讨多囊卵巢综合征(PCOS)患者卵巢局部胰岛素抵抗状态及胰岛素增敏剂——曲格列酮(troglitazone)对改善卵巢局部胰岛素抵抗的作用。方法收集11例PCOS患者(PCOS组)和排卵功能正常的33例输卵管性不孕患者(对照组)促排卵后卵巢黄素化颗粒细胞(卵巢细胞),进行体外培养,并经不同浓度的胰岛素及胰岛素样生长因子1(IGF-1)作用后,观察卵巢细胞糖原和DNA合成的变化,同时观察卵巢细胞胰岛素受体(IR)、IGT-1受体(IGF-1R)、胰岛素受体底物(IRS)的表达。结果(1)不同浓度IGE-1作用后,PCOS组卵巢细胞的DNA合成增加约为对照组的2倍,曲格列酮可抑制IGF-1的这一作用。(2)胰岛素作用后,PCOS组卵巢细胞的糖原合成量与对照组比较,明显降低;而曲格列酮作用后,两组卵巢细胞中胰岛素促糖原合成作用均增加。(3)与对照组比较,PCOS组卵巢细胞：[RS-1的表达(相对灰度,下同)升高,IRS-2表达降低。曲格列酮可降低IRS-1的表达水平,升高IRS-2的表达水平。结论(1)PCOS患者存在卵巢局部的胰岛素抵抗现象。(2)卵巢局部胰岛素抵抗与PCOS患者卵巢高反应状态相关。(3)曲格列酮可增加卵巢细胞对胰岛素的敏感性。     

多囊卵巢综合征患者血清脂联素水平及与胰岛素抵抗相关性的研究

目的:检测多囊卵巢综合征(PCOS)患者血清脂联素(APN)水平,探讨APN与胰岛素抵抗(IR)的相关性。方法:研究对象于月经周期第3~5天行75g糖耐量实验(OGTT实验),分别测定0h、1h、2h的血糖(FPG、PG1h、PG2h)、胰岛素(FINS、INS1h、INS2h)和脂联素(FAPN、APN1h、APN2h)。PCOS患者给予达英-353个周期联合二甲双胍治疗3个月后复查上述指标,比较治疗前后的变化。结果:(1)PCOS组与对照组均表现为肥胖组APN水平低于非肥胖组,且PCOS组中肥胖组与非肥胖组的APN水平均低于对照组(P<0.05);(2)PCOS组中肥胖组与非肥胖组的FINS、INS1h、INS2h、AUCins及HOMA-IR均高于对照组,且肥胖PCOS组高于非肥胖PCOS组(P<0.05);(3)PCOS组经二甲双胍联合达英-35治疗后FINS、INS1h、INS2h、AUCins、HOMA-IR均降低(P<0.05),而APN水平明显升高;(4)相关性分析表明,PCOS患者APN水平与FINS、INS1h、INS2h、FPG、AUCins、HOMA-IR和BMI均呈负相关。多元逐步回归分析显示,APN与FINS、HOMA-IR的相关性最显著。结论:PCOS患者APN水平显著降低与IR密切相关。     

Effect of folic acid in women with and without insulin resistance who have hyperhomocysteinemic polycystic ovary syndrome.

OBJECTIVE: To study the effect of folic acid on homocysteine (Hcy) levels in women with insulin resistance and polycystic ovary syndrome (PCOS) in a prospective clinical trial. METHOD: Of 210 women with PCOS, 70 were hyperhomocysteinemic; and of these, 32 were insulin resistant and 38 were not. The 70 women were treated with folic acid for 3 months. Baseline and serum levels of Hcy and insulin were measured in both groups. RESULTS: In both groups Hcy concentrations were significantly decreased following folic acid supplementation. The mean+/-SD levels before and after treatment were 14.03+/-1.5 micromol/L and 12.53+/-1.72 micromol/L in group 1 (P<0.001), and they were 12.07+/-0.87 micromol/L and 8.83+/-0.78 micromol/L in group 2 (P<0.001). CONCLUSION: The Hcy levels of hyperhomocysteinemic women with PCOS were reduced after 3 months of folic acid supplementation, and the rate of reduction was higher among women without insulin resistance. No change was found in fasting insulin levels.     

Metformin versus laparoscopic ovarian drilling in clomiphene- and insulin-resistant women with polycystic ovary syndrome

Objective

To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistant patients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling.

Methods

A total of 110 eligible participants were randomly allocated to diagnostic laparoscopy plus metformin therapy (group 1, n = 55) or laparoscopic ovarian drilling (group 2, n = 55). The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment. The χ² test was used for comparisons of ovulation, pregnancy, and abortion rates.

Results

Groups 1 and 2 showed a significant decline in testosterone, insulin-like growth factor-1 (P < 0.001 vs P < 0.001), and luteinizing hormone (P < 0.05 vs P < 0.001), while the glucose to insulin ratio was significantly increased (P < 0.001 vs P < 0.05) compared with baseline. Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1: 76.4% [42/55] vs 58.2% [32/55], P < 0.04; 50.8% [131/258] vs 33.5% [94/281], P < 0.001; and 38.2% [21/55] vs 20.0% [11/55], P < 0.03, respectively. The difference in the early abortion rate between the groups was not statistically significant.

Conclusion

Although metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy.