肥胖与非肥胖型多囊卵巢综合征患者血清胃促生长素分泌特点与发病机制探讨*

【摘要】目的 比较肥胖与非肥胖型多囊卵巢综合征（PCOS）患者血清胃促生长素(Ghrelin)分泌特点及其与代谢紊乱机制的关系。方法 以体质量指数（BMI）为标准，将60例PCOS患者分为肥胖组（BMI≥25 kg/m2）30例和非肥胖组（BMI＜25 kg/m2）30例，以30例月经正常的输卵管性不孕患者为对照组。3组患者均采用全自动化学发光法测定血清生殖激素，并进行糖耐量和胰岛素释放试验；采用酶联免疫吸附试验（ELISA）测定血清Ghrelin水平，并分析其水平与黄体生成素(LH)、卵泡刺激素（FSH）、雌二醇（E2）、睾酮（T）及其他代谢指标间的关系。结果 （1）肥胖与非肥胖组空腹血清Ghrelin水平低于对照组（2.52±0.78），且肥胖组（1.84±0.46）低于非肥胖组（2.13±0.52），差异有统计学意义（P < 0.05）。（2）肥胖组空腹胰岛素(FIN)、稳态模型胰岛素抵抗指数（HOMA-IR）、服糖后2 h及3 h血清胰岛素水平高于非肥胖组和对照组，非肥胖组血清LH及LH/FSH高于肥胖组和对照组（均P < 0.05）。（3）肥胖组血清Ghrelin水平与FIN、HOMA-IR呈负相关（r 分别为-0.542、-0.503，P < 0.05）；非肥胖组血清Ghrelin水平与睾酮呈负相关（r=-0.568，P < 0.05）。结论 血清Ghrelin水平分泌紊乱可能在PCOS患者特别是肥胖型PCOS患者发病中起重要作用。

Characteristics of serum Ghrelin secretion and pathogenesis mechanisms in obese and non-obese patients with polycystic ovarian syndrome

[Abstract] Objective To compare the relationship between secretory characteristics of serum ghrelin and mechanism of metabolic syndrome in obese and non-obese patients with polycystic ovarian syndrome (PCOS). Methods Based onthe body mass index (BMI), 60 PCOS patients were divided into two groups, 30 cases in obese group（BMI≥25 kg/m2）and 30 cases in non-obese group (BMI＜25 kg/m2). Thirty infertile patients with tubal factor and normal menstruation were the control group. The serum levels of ovarian sex steroid hormones were detected by fully automatic chemiluminescence method,and the experiment of sugar metabolism was carried out in three groups. The serum ghrelin level was detected by enzyme linked immunosorbent assay (ELISA). The correlation between ghrelin level and biochemical metabolic indexes was analyzed by simple correlation analysis. Results(1) The serum ghrelin level was significantly lower in obese group (1.84±0.46) and non-obese group (2.13±0.52) than that of control group (2.52±0.78，P < 0.05)，and the level was significantly lower in obese group than that of non-obese group. (2) The values of fasting insulin (FIN), homeostasis model assessment insulin resistance index (HOMA-IR), and serum INS levels of 2 h and 3 h oral glucose tolerance test (OGTT) were significantly higher in obese group than those of non-obese group and control group (P < 0.05). In non-obese group, the serum values of LH and LH/FSH were markedly higher than those of obese group and control group. (3) The serum ghrelin level was negatively correlated with FIN and HOMA-IR (r=-0.542 and -0.503,P < 0.05). In non-obese group, the serum ghrelin level was negatively correlated with testosterone (r=-0.568，P <0.05). Conclusion The serum ghrelin levels may play a significant role in pathogenesis mechanisms in PCOS patients，especially in obese ones.