纤溶酶原激活系统与多囊卵巢综合征的相关性研究

Relationship between plasminogen activator system and PCOS

目的观察多囊卵巢综合征(PCOS)患者外周血纤溶酶原激活抑制物1(PAI-1)、组织纤溶酶原激活物(t-PA)和尿激酶型纤溶酶原激活物(uPA)的水平,探讨其与肥胖及胰岛素抵抗的相关性。方法PCOS组分为肥胖组和正常体重组,用酶联免疫吸附法(ELISA)测定并比较PCOS组与对照组、PCOS肥胖组与非肥胖组之间的血浆PAI-1及血清t-PA、uPA水平的差异,测定体重指数(BMI)、腰臀比(WHR)、空腹血糖(FPG)、空腹胰岛素及胰岛素释放试验(IRT),以稳态模型(Homa Model)公式评估胰岛素抵抗(IR)。结果PCOS组与正常对照组相比,黄体生成素/卵泡刺激素(LH/FSH)、睾酮(T)、空腹血糖、HOMA指数及PAI-1含量均显著升高,t-PA含量下降(P<0.05)。其中,PCOS肥胖组与非肥胖组相比,HOMA指数及PAI-1含量显著升高(P<0.05)。在相关性分析中,PAI-1与HOMA指数、BMI均呈明显正相关(P<0.0001);HOMA指数与BMI之间也明显正相关;t-PA、HOMA指数之间相关性显著(P<0.0001)。结论PAI-1升高可能是高胰岛素血症等代谢紊乱共同作用的结果,是肥胖与胰岛素抵抗的桥梁,PAI-1可作为胰岛素抵抗的评价指标之一。抗PAI-1的研究可能提供一个新的治疗PCOS胰岛素抵抗的方法。

Objective To detect the plasma plasminogen activator inhibitor 1 （ PAI-1 ）, tissue-type plasminogen activator（t-PA） and urokinase-type plasminogen activator（uPA） levels in PCOS and explore the correlation between them and insulin resistance, obesity. Methods Plasma PAI-1 and serum t-PA, uPA of PCOS and normal control were assayed with enzyme-linked immunosurbent assay （ELISA） , and body mass index （BMI） , waist hip ratio（WHR） , blood glucose, fasting insulin and IRT were meassured. Insulin resistance was evaluated with Homa Model. Results The plasma level of LH/FSH, T, blood glucose, HOMA-IR and PAI-1 were significantly increased in PCOS compared with normal control （P 〈 0. 05 ） , but t-PA level decreased. The plasma level of PAI-1 was significantly increased in obesity compared with non-obesity of PCOS （P 〈 0. 05 ）. In the Spearman bivariate correlation analysis, PAI-1 had obvious positive correlation with HOMA-IR and BMI. Significant correlation were found between t-PA and HOMA-IR. Conclusion The increase of PAI-1 is the result of metabolism disorder with hyperinsu-linism and obesity. PAI-1 is the bridge between obesity and insulin resistance. PAI-1 is one of evalution marker of insulin resistance. Anti-PAI-1 study maybe a new way to prevent obesity and insulin resistance.