胰岛素与类胰岛素生长因子 1 对多囊卵巢综合征患者雄激素产生的作用

目的研究胰岛素（ＩＮＳ）及胰岛素样生长因子－１（ＩＧＦ－１）在多囊卵巢综合征（ＰＣＯＳ）中对卵巢雄激素产生的促进作用。方法根据体重指数将４８例ＰＣＯＳ患者分为肥胖组和非肥胖组；正常对照组１０例。测定上述对象的血促卵泡生成素（ＦＳＨ）、促黄体生成素（ＬＨ）及睾酮（Ｔ）。对４８例ＰＣＯＳ患者中的４０例动态观察口服糖耐量实验后ＩＮＳ、ＩＧＦ－１及雄稀二酮（Ａ）的水平。并对１０例ＰＣＯＳ患者及５例对照者在高ＩＮＳ条件下做卵巢间质组织培养，测定培养液中ＩＧＦ－１及Ａ。结果ＰＣＯＳ患者均存在高胰岛素血症及高雄激素血症；ＰＣＯＳ非肥胖组较肥胖组血ＩＧＦ－１衡定增高（Ｐ＜０．０１）。高浓度ＩＮＳ能明显提高卵巢间质培养液中的ＩＧＦ－１浓度及Ａ浓度（均Ｐ＜０．０５），两者呈正相关（Ｐ＜０．０５）。结论ＰＣＯＳ患者均存在高胰岛素血症，ＩＮＳ在卵巢局部参与调节ＩＧＦ－１系统，在高雄激素血症形成中起重要作用。

The effects of hypereinsulinmia and insulin like growth factor 1 on hyperandrogenism in polycyctic ovarian syndrome

Objective To investigate the effects of insulin(INS) and insulin like growth factor 1 (IGF 1) on ovarian androgen production in women with polycystic ovarian syndrome (PCOS). Method 48 patients with PCOS were divided into two groups based on body mass index (BMI) (24 were obese BMI>25 and 24 nonobese) (BMI<25). 10 women with normal weight and menstruation were recruited as controls. The serum LH, FSH and testosterone (T) levels were determined. 40 cases were measured INS, IGF 1, androstenodine (A) and sex hormone binding globulin (SHBG) after a 3 hour oral glucose tolerance test (OGTT). Ovarian stroma obtained from 10 patients with PCOS and 5 healthy women were cultured in the medium with high INS concentration (30 ng/ml and 60 ng/ml). The IGF 1 and A levels were determined. Results Two groups of patients with PCOS demonstrated significant hyperinsulinmia (HI) and hyperandrogenism. Significantly higher IGF 1 level was observed in nonobese patients ( P <0.01). Insulin markedly stimulated release of IGF 1 (4 times, P <0.01) and A (6 times, P <0.05) in incubation of ovarian stroma obtained from PCOS patients. A positive correlation between IGF 1 and A was present in the culture medium ( r =0.679, P <0.05). The serum levels of SHBG were significantly lower in PCOS patients. Conclution The findings suggest that the women with PCOS have HI, since INS may plasy an important role in hyperandrogenism by upregulating IGF 1 system in ovary.