多囊卵巢综合征患者肾素-血管紧张素系统的改变

Renin Angiotensin System: Involvement in Polycystic Ovarian Syndrome

目的：探讨肾素－血管紧张素系统（ＲＡＳ）在多囊卵巢综合征（ＰＣＯＳ）的病理生理学和临床并发症中的作用。方法：对黄体生成素（ＬＨ）／卵泡刺激素（ＦＳＨ）≥３的１５例患者（Ⅰ型组）、ＬＨ／ＦＳＨ＜３的１５例患者（Ⅱ型组）以及２０例正常妇女（对照组），进行黄体生成素释放激素（ＬＲＨ，１００μｇ）兴奋垂体－卵巢轴功能试验，观察３组ＲＡＳ中血肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡＴⅡ）和醛固酮（ＡＬＤ）浓度的变化。结果：基础状态下，整个患者组的睾酮（Ｔ）与ＡＴⅡ呈显著性相关（Ｐ＜０．０５）；ＬＲＨ兴奋试验后ＬＨ、ＰＲＡ、ＡＴⅡ和ＡＬＤ的反应浓度是Ⅰ型组＞Ⅱ型组＞对照组，且患者组的ＬＨ和ＡＴⅡ的峰值浓度呈显著性相关（Ｐ＜０．０１）。结论：ＰＣＯＳ有ＲＡＳ功能亢进现象，尤其是Ⅰ型组患者；ＲＡＳ参与ＰＣＯＳ的雄激素过多和生殖功能障碍，并与卵巢过度刺激综合征的发生有关。

Objective: To investigate the relationship between renin angiotensin system (RAS) and polycystic ovarian syndrome (PCOS). Methods: A pituitary stimulating test with luteinizing hormone releasing hormone (LRH, 100 μg) was performed in two PCOS groups with similar mean testosteron (T) levels of luteinizing hormone/follicular stimulating hormone (LH/FSH)(LH/FSH≥3, group l, n =15; LH/FSH<3, group 2, n =15) and the controls ( n =20) of matched body mass index with group 1. The basal level and LRH-evoked responses of LH, plasma renin activity (PRA), angiotensin Ⅱ (AT Ⅱ) and aldosterone (ALD) were measured by RIA with commercially available kits. Results: In the basal state, a positive correlation was found between T and AT Ⅱ levels ( r =0.49, P <0.05) in all PCOS subjects. After LRH administration, susceptible individuals, especially of group1 had exaggerated responses of LH, PRA, AT Ⅱ and ALD as compared with the controls, and a positive correlation was also found between peak levels of LH and AT Ⅱ ( r =0.54, P <0.01). Conclusion: There is enhanced RAS function in PCOS especially in group 1. This may contribute to the excess androgen production and high incidence of ovarian hyperstimulation syndrome in this disorder.