性激素结合球蛋白检测在评价多囊卵巢综合征治疗中的意义

目的探讨性激素结合球蛋白(SHBG)检测在评价治疗多囊卵巢综合征(PCOS)不育患者中的意义。方法将533例PCOS不育患者按体重指数(BMI)分为非肥胖组(424例)和肥胖组(109例)并再按是否存在胰岛素抵抗(IR)分为四组。A组:非肥胖无IR组(162例)、B组:非肥胖IR组(262例)、C组:肥胖无IR组(42例)、D组:肥胖IR组(67例)。测定黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_2)、总睾酮(T)、泌乳素(PRL)、SHBG、血糖(FBG)和胰岛素(FINS)水平,计算游离雄激素指数(FAI)及稳态模型指数(HOMA-IR)。A组、C组予达英-35;B组、D组予达英-35+盐酸二甲双胍,均治疗3月后复查各指标。停药后给予枸橼酸氯米芬(克罗米芬,CC)+人绝经期促性腺激素(HMG)促排卵治疗。比较各组排卵及妊娠情况。结果四组治疗后FAI均较治疗前降低,SHBG较治疗前升高差异有显著性;四组治疗后LH、LH/FSH比值、T较治疗前降低差异有显著性;但A组HOMA-IR、FINS较治疗前升高差异有显著性,B、D组HOMA-IR、FINS较治疗前降低差异有显著性。促排卵结果显示治疗后排卵率非肥胖组高于肥胖组(85.60%vs 68.69%,P0.01),两组治疗后有排卵患者SHBG较无排卵患者升高,FAI较无排卵患者降低;非肥胖组LH、LH/FSH比值、FINS降低(P0.05),而肥胖组FINS、HOMA-IR则降低(P0.05)。妊娠结局比较:非肥胖组和肥胖组妊娠分娩患者治疗后T、FAI、FINS、HOMA-IR较自然流产患者降低,SHBG升高(P0.05);此外肥胖组妊娠分娩患者治疗后BMI较自然流产患者降低。结论无论肥胖还是非肥胖的PCOS患者,无论是否存在胰岛素抵抗,SHBG及FAI均可作为评价治疗是否有效的指标之一,可提示促排卵治疗及妊娠结局。因此在PCOS患者治疗中检测SHBG及FAI能指导临床用药,降低流产率,对优生优育有重要指导意义。

Significance of sex hormone-binding globulin examination in the treatment of women with polycystic ovarian syndrome

Objective ： To explore the significance of sex hormone-binding globulin examination in the treatment of women with polycystic ovarian syndrome （PCOS）. Methods： The data of body mass index （BMI）, serum levels of basal sexual hormones, sex hormone- binding globulin （SHBG）, fasting blood glucose （FBG） and fasting insulin （FINS） were collected from 533 women with PCOS, aged 20-39 years. The patients were divided into four groups according to BMI and homeostasis model assessment of insulin status （HOMA-IR） ： group A （non-obese without insulin resistance, n=162）, group B （non-obese with insulin resistance, n=262）, group C （obese without insulin resistance, n=42） and group D （obese with insulin resistance, n：67）. Patients in group A and B took Diane-35 alone, while those in group C and D took Diane-35 plus metformin （1000 mg daily） for 3 months. Then clomiphene citrate （CC） and human menopausal gonadotropin （HMG） were administered to induce ovulation. The ovulation rate and pregnancy outcomes were compared among groups.
Results： Free androgen index （FAI） decreased significantly and SHBG levels increased significantly in all groups after treatment. A significant decrease in serum LH levels, LH/FSH ratio and testosterone （T） levels was also found in all 4 groups after treatment （P〈0.05）. FINS and HOMA-IR increased significantly A＋ B） was higher than that in obese group （C-t-D） （85.60% vs. 68.69%, P〈0.01）. Compared with those in non-ovulation patients, SHBG levels increased significantly in the ovulation patients after treatment in both obese and non-obese groups. In the separate analysis of those ovulated, serum levels of LH, FINS, LH/FSH ratio and FAI decreased significantly in non-obese group, while FINS, HOMA-IR decreased significantly in obese group after treatment. The serum levels of SHBG, T, FINS, FAI and HOMA-IR after treatment were significantly higher in the patients with live birth than in those with spontaneous abortion （P〈0.05）. Conclusions： SHBG and FAI could be good predictors of treatment efficacy and pregnancy outcomes for the PCOS patients, regardless of the status of obesity or insulin resistance.