瘦素与多囊卵巢综合征发病及体外受精结局的相关研究

目的探讨血清及卵泡液瘦素(leptin)水平与多囊卵巢综合征(PCOS)发病的关系和对体外受精-胚胎移植(IVF-ET)结局的影响。方法采用放射免疫法测定进行IVF-ET的20例PCOS患者(PCOS组)和20例非PCOS患者(对照组)卵泡液中leptin、胰岛素(INS)水平以及同期血清中leptin水平,PCOS患者经二甲双胍和口服避孕药(OC)预治疗三个月。结果PCOS组卵泡液及血清leptin水平均高于对照组(12.87±7.34 vs 10.10±5.15)、(13.65±7.75 vs 10.53±4.65),但差异无显著性,卵泡液及血清leptin水平均与卵泡液INS水平呈正相关(r=0.578、r=0.682,P均<0.01)。PCOS患者卵泡液低leptin组成熟卵细胞率高于高leptin组,差异有统计学意义(94%vs 86%,P<0.05),血清leptin水平与卵裂率呈负相关(r=-0.501,P<0.05)。结论PCOS患者体内leptin可能与卵泡液INS共同参与PCOS发生发展,leptin可能主要通过影响卵母细胞成熟、受精卵分裂而影响妊娠成功率。

The study of the relationship between leptin and the pathogenesis of PCOS and the impact of leptin levels on the outcome of in vitro fertilization-embryo transfer in patients with PCOS

Objective: To investigate the relationship between leptin and the pathogenesis of the polycystic ovarian syndrome(PCOS) and the impact of leptin levels on the outcome of in vitro fertilization-embryo transfer(IVF-ET) in PCOS women.Methods: Radioimmunoassay(RIA) was used to determine the levels of leptin in serum and leptin,(insulin)(INS) levels in follicular fluid obtained during oocyte retrieval in 20 PCOS infertility patients and in 20 non-PCOS infertility patients(as controls).PCOS women were pretreated with metformin and oral contraceptives(OC) for three months.Results: PCOS patients had slightly higher leptin levels in follicular fluid and serum than controls(12.87±7.34 vs 10.10±5.15 and 13.65±7.75 vs 10.53±4.65,respectively),but the differences were not statistically significant.Both follicular fluid and serum leptin levels were positively correlated with follicular fluid INS levels(P<0.01)in patients with PCOS.Higher maturation oocyte rate was observed in low follicular fluid leptin group when compared with that in high leptin group(94% vs 86%,(P<0.05))in patients with PCOS.Serum leptin levels in PCOS patients were inversely correlated with cleavage rate(r=-0.501,P<0.05). Conclusion: Both leptin and INS play an important role in the pathogenesis of PCOS.High levels of leptin could impact pregnancy rate through decreasing maturation oocyte rate and cleavage rate in patients with PCOS.