卵巢局部IGF-I系统与多囊卵巢综合征胰岛素抵抗的相关性研究

目的：研究卵巢局部胰岛素样生长因子-I系统（IGF-I系统）在伴有胰岛素抵抗多囊卵巢综合征中的作用机制。方法选择30例合并胰岛素抵抗的PCOS（polycystic ovary syndrome）患者为试验组,30例患有卵巢良性肿瘤需手术探查的患者为对照组。检测并对比血清、小卵泡液中IGF-I、胰岛素样生长因子结合球蛋白-1（IGFBP-1）与各项性激素,FI,2hI,ISI,QUICK I,卵巢超声指标,研究其与各种指标间的相关性。结果试验组小卵泡液IGF-I高于对照组（P〈0.01）,小卵泡液及血清IGFBP-1低于对照组（P〈0.05,P〈0.01）。试验组小卵泡液IGF-I水平高于血清（P〈0.01）,小卵泡液IGFBP-1水平低于血清（P〈0.05）。试验组小卵泡液IGF-I与T0、E2及卵巢体积（OV）,卵巢总面积（TA）,卵泡数（FN）,空腹胰岛素（FI）,服糖后2h胰岛素（2hI）呈正相关（P〈0.05）;血清IGF-I与胰岛素敏感指数（ISI）,体重指数（BMI）,腰臀比（WHR）呈正相关（P〈0.05）,与定量胰岛素敏感指数（QUICK I）呈负相关（P〈0.05）;试验组小卵泡液及血清IGFBP-1与FI,2hI呈负相关（P〈0.05）。结论 IR可能通过影响卵巢局部IGF-I系统,刺激卵巢分泌雄激素,引发排卵障碍,在PCOS的发病机制中起到重要作用。

Study of the relationship between the IGF-I system in ovary and the polycystic ovary syndrome combined withinsulin resistanceI

Objective：To study effects of ovarian insulin-like growth factor-I（IGF-I）system on PCOS with insulin resistance（IR）. Methods：30 insulin-resistant PCOS patients and 30 patients with gynecology benign disease were enrolled. IGF-I and insulin-like growth factor binding protein-1（IGFBP-1）in follicular fluid and serum,reproductive hormones,insulin sensitivity indexs,ovarian ultrasound parameters were measured and compared between two groups.Correlation of IGF-I system with other parameters were analysed. Results：Follicular fluid IGF-I in PCOS group was significantly lower than in control group（P0.01）. Both serum and follicular fluid level of IGFBP-1 in PCOS group were all markedly lower than in control group（P0.05,P0.01）. In PCOS group,IGF-I in follicular fluid was significantly higher than in serum（P0.01）,and IGFBP-1 in follicular fluid was significantly lower than in serum（P0.05）.In PCOS group,follicular fluid IGF-I positively correlated with T0,E2,ovary volume（OV）,total area（TA）,follicle number（FN）,free insulin（FI）,2hI（P0.05）. Serum IGF-I positively correlated with insulin sensitivity index（ISI）,body mass index（BMI）,waist/hip ratio（WHR）（P0.05）,negatively correlated with QUICK I（P0.05）.Both follicular fluid and serum IGFBP-1 negatively correlated with FINS,2hI（P0.05）. Conclusion：These results raise the possibility that IR likely contributes to hyperandrogenism and anovulatiaon in PCOS by effecting ovarian IGF-I system.