多囊卵巢综合征患者血清脂肪细胞因子与胰岛素抵抗的相关性研究

Correlations between adipocytokines and insulin resistance in women with polycystic ovary syndrome

目的探讨PCOS患者血清脂肪细胞因子与胰岛素敏感性的相关性。方法将PCOS患者60例分为肥胖组PCOS36例、非肥胖组PCOS24例，将同期就诊的男方因素不孕症患者（正常体重）26例作对照组。进行内分泌代谢指标测定，采用空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）评估胰岛素敏感性；并应用酶联免疫吸附法测定血清游离脂肪酸（FFA）、瘦素及C反应蛋白（CRP），放射免疫法测定血清脂联素（APN）、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6。结果（1）肥胖组PCOS的血清APN为（10±7）mg／L，低于非肥胖组PCOS[（17±9）mg／L]和对照组，均P〈0．01；FFA为（548±105）μmol／L，高于非肥胖组PCOS[（427±67）μmol／L]和对照组，P〈0．01；血清瘦素水平为（42±21）μg／L，高于非肥胖组PCOS[（24±13）μg／L]和对照组，均P〈0．01。非肥胖组PCOS与对照组问APN、FFA和瘦素差异无统计学意义。血清IL-6肥胖组PCOS[（173±184）ng／L]和非肥胖组PCOS[（184±44）ng／L]均高于对照组（P〈0．05、P〈0．01）；血清TNF-α非肥胖组PCOS[（0．97±0．33）μg/L]和肥胖组PCOS[（0．82±0．21）μg/L]均高于对照组（P〈0．01，P〈0．05）；非肥胖组PCOSTNF。仪高于肥胖组（P〈0．05）。非肥胖组和肥胖组的PCOS患者血清中CRP高于对照组，但差异无统计学意义（P〉0．05）。（2）瘦素与人体质量指数（BMI）、腰臀比及HOMA-IR呈正相关（P〈0．01），APN与BMI、腰臀比及HOMA-IR呈负相关（P〈0．01）。（3）BMI和TNF-α是FINS的独立影响因素，APN是除FINS、空腹血葡萄糖、BMI外，对HOMA-R的独立影响因素。结论炎性因子可能参与了非肥胖型PCOS患者IR的发生；而肥胖型PCOSIR的进一步加重可能与其脂肪组织分泌瘦素、FFA增多及分泌APN减少相关。

Objective To investigate the correlations between adipocytokines and insulin resistance in women with polycystic ovary syndrome. Methods Sixty women with polycystic ovary syndrome aged 19-34 years old were divided into 2 groups： group A [n =36, BMI ≥ 25 kg/m-2 or WHR （waist height ratio） 〉 0. 85 ] and group B （ n = 24, BMI 〈 25 kg/m-2 and WHR≤0. 85 ）. Twenty-six healthy infertile women with amean age of 26±8 years old served as controls and they were named as group C （n=26, BMI 〈25 kg/m-2 and WHR ≤0. 85）. Anthropometrie measurements,hormonal profiles and metabolic profiles were compared between three groups. Plasma leptin, CRP and free fatty acid were measured by enzyme-linked immunosorbent assay （ELISA）. Adiponectin, interleukin-6 （IL-6） and tumor necrosis factor-alpha （TNF-α） were measured by radioimmunoassay. Insulin resistance was estimated by homeostasis model assessment （HOMA）. Results （ 1 ） Adiponectin and TNF-α levels were significantly higher in group B （ 17 ±9） mg/L and （ 1.0 ± 0. 3 ） mg/L respectively than in group A （ 10± 7 ） mg/L and （ 0. 8 ± 0. 2 ） mg/L respectively. Leptin was lower in group B （ 24 ± 13 ） μg/L and group C than in group A （ 42± 21 ）μg/L （ all P 〈 0. 01 ）. IL-6 was higher in group A （ 173 ± 184） ng/L and group B （ 184±44） ng/L than in group C （ P 〈 0. 05 and P 〈 0. 01respectively）. No significant difference of circulating level of CRP was found between these 3 groups. （2）Leptin was positively correlated with BMI, WHR and HOMA-IR （all P 〈 0.01 ） whereas adiponectin was negatively correlated with BMI, WHR and HOMA-IR （P 〈 0. 01 ; P 〈 0. 01, P 〈 0. 05 respectively）. Multivariate regression showed that adiponectin was the most significant predictor of HOMAIR and it explained 16. 5% of variance. Conclusion The higher levels of leptin and TNF-α, the lower level of adiponectin in obese PCOS and the higher level of TNF-α and IL-6 in non-obese PCOS suggested different adipocytokines play different roles of insulin resistance in PCOS. groups. （2）Leptin was positively correlated with BMI, WHR and HOMA-IR （all P 〈 0.01 ） whereas adiponectin was negatively correlated with BMI, WHR and HOMA-IR （P 〈 0. 01 ; P 〈 0. 01, P 〈 0. 05 respectively）. Multivariate regression showed that adiponectin was the most significant predictor of HOMAIR and it explained 16. 5% of variance. Conclusion The higher levels of leptin and TNF-α, the lower level of adiponectin in obese PCOS and the higher level of TNF-α and IL-6 in non-obese PCOS suggested different adipocytokines play different roles of insulin resistance in PCOS.