腹腔镜下卵巢打孔术对耐药多囊卵巢综合征妇女生长激素轴的影响

Effects of laparoscopic ovarian drilling on growth hormone/insulin-like growth factor-1 axis in women with refractory P COS

目的:观察腹腔镜下卵巢打孔术对多囊卵巢综合征(PCOS)患者GH IGF I轴的影响,并探讨其机制.方法:选 择30名耐药PCOS患者及30名正常妇女作为对照,比较两组 血清指标的差异.PCOS组实行腹腔镜下卵巢打孔术,观察术 前和术后3mo血清指标的变化,并了解生长激素(GH)是否 与其他血清指标具有相关性.结果:PCOS组治疗前与对照组 相比具有较低的基础GH水平和较高IGF I水平(P<0.01), 治疗前后GH和IGF Ⅰ水平变化有统计学意义(P<0.01). 术前基础GH仅与T呈负相关(r=-0.58,P<0.01),而术后 与T和A都有显著相关性(PT<0.01;PA<0.05).结论:腹腔 镜下卵巢打孔术能够显著改善PCOS患者GH IGF Ⅰ轴功能, 其机制主要归因于术后雄激素水平的降低,另外一些卵巢源 性的生长因子、细胞因子也可能起到一定影响.

AIM: To assess the effect of ovarian drilling under laparoscopy on the growth hormone/insulin-like growth factor-1 axis in women with refractory polycystic ovary syndrom (PCOS) and its main clinical mechanism.METHODS: We chose 30 women with PCOS with clomiphene resistance as PCOS group and 30 women with regular cycles as control group, who matched in age and body mass index.We compared the serum hormone level between PCOS group and control group.Laparoscopic ovarian drilling was performed in PCOS group.The serum was obtained before and 3 months after intervention and the hormone level was compared to determine whether the growth hormone (GH) levels was associated with other serum indices.RESULTS: The PCOS group had lower GH levels and higher IGF-Ⅰ levels compared with those of conrol group (P<0.01).The surgical treatment in PCOS group obviously increased the GH and reduced the IGF-Ⅰ (P<0.01).The basal GH was correlated positively only with testosterone before operation (r = -0.58,P<0.01),but after operation it was correlated positively with testosterone and androstenedione (P T<0.01,P A<0.05).CONCLUSION: The GH-IGF-Ⅰ axis of women with PCOS reverses after laparoscopic ovarian drilling,which attributes mainly to the decreased androgens levels.Some ovarian cytokines and growth factors may also play some important roles.