多囊卵巢综合征患者血浆中不同结合状态的血小板活化因子乙酰水解酶活性与胰岛素抵抗的关系

Activity and distribution of plasma platelet-activating factor acetylhydrolase in polycystic ovary syndrome patients with insulin resistance

目的 探讨多囊卵巢综合征（PCOS）患者血浆中不同结合状态的血小板活化因子乙酰水解酶（PAF—AH）活性与胰岛素抵抗（IR）的关系。方法选择2006年10月-2008年1月在四川大学华西第二医院妇产科就诊的105例PCOS患者，其中稳态模型胰岛素抵抗指数（HOMA—IR）≥2．77者53例（IR—PCOS组），〈2．77者52例（非IR—PCOS组）。选择同期因输卵管因素或男性因素于本院就诊的53例不孕患者作为对照组。检测并比较3组患者的血浆PAF-AH、高密度脂蛋白结合PAF—AH（H—PAF—AH）、低密度脂蛋白结合PAF—AH（L-PAF—AH）活性及L—PAF—AH／H—PAF—AH活性比值。采用Pearson相关分析法及多重线性回归法分析PCOS患者血浆中L—PAF—AH／H-PAF—AH活性比值与生殖激素水平、糖脂代谢水平之间的相关性。结果（1）IR—PCOS组患者血浆PAF—AH活性[（0．055±0．012）mmd·L^-1·min^-1]、L-PAF—AH活性[（0．052±0．012）mmd·L^-1·min^-1及L—PAF—AH／H—PAF-AH活性比值（23±6）均分别高于对照组[（0．050±0．009）mmol·L^-1·min、（0．047±0．009）mmol·L^-1·min^-1及18±4]与非IR—PCOS组[（0．050±0．012）mmol·L^-1·min^-1（0．048±0．012）mmol·L^-1·min^-1及（18±5）]，差异均有统计学意义（P〈0．05）；在校正体质指数后，IR—PCOS组血浆L—PAF．AH／H—PAF—AH活性比值仍然高于对照组和非IR—PCOS组，差异均有统计学意义（P〈0．01）。（2）相关性分析结果显示，PCOS患者血浆中L—PAF—AH／H-PAF—AH活性比值分别与动脉硬化指数、年龄、体质指数、腰围臀围比值、HOMA—IR及甘油三酯、空腹胰岛素、空腹血糖、低密度脂蛋白胆固醇、总胆固醇水平呈正相关关系（r=0．644、0．247、0．296、0．212、0．356、0．587、0．377、0．375、0．292、0．199，P〈0．05），与高密度脂蛋白胆固醇（HDL—C）呈负相关关系（r=-0．510，P〈0．01）。多重线形回归法分析显示，动脉硬化指数和甘油三酯水平是L—PAF—PAH／H—PAF—AH活性比值有意义的预测因子[标准化系数（B）分别为0．515和0．201，P〈0．05]。结论PCOS患者血浆中L—PAF—AH活性升高可能与IR相关，L—PAF—AH／H-PAF—AH活性比值增加可能成为IR-PCOS患者慢性炎症状态的一个新指标。

Objective To investigate the relationship between activity of plasma platelet-activating factor acetylhydrolase （PAF-AH）and insulin resistance （IR） in patients with polycystic ovary syndrome （PCOS）. Methods From Oct. 2006 to Jan. 2008, 105 PCOS patients undergoing treatment in Department of Obstetrics and Gynecology of Second Hospital affiliated to West China University were enrolled in the study, among 53 cases with homeostatic model assessment IR （HOMA-IR） exceed or equal 2.77 as IR-PCOS group and 52 cases with HOMA-IR less than 2. 77 as non IR-PCOS group. In the mean time, 53 infertile women due to fallopian tube or husband factors were chosen as control group. Plasma PAF-AH activity, high-density lipoprotein-associated PAF-AH （H-PAF-AH） activity, low-density lipoproteinassociated PAF-AH （L-PAF-AH） activity, the ratio of L-PAF-AH to H-PAF-AH activity were measured and compared among three groups. The method of Pearson correlation analysis and stepwise multiple regression analysis were used to study the relationship between the ratio of L-PAF-AH to H-PAF-AH activities and hormonal and metabolic parameters. Results （ 1 ） Plasma PAF-AH activity [ （0. 055 ±0. 012） mmol·L^-1·min^-1], L-PAF-AH activity [ （0. 052±0. 012） mmol·L^-1·min^-1 ], and the ratio of L-PAF-AH to H-PAF-AH activity （23 ± 6） in the IR-PCOS group were significantly higher than those at control group [ （0. 050 ±0. 009） mmol·L^-1·min^-1, （0. 047 ±0. 009） mmol·L^-1·min^-1and （ 18±4） ] and non- IR-PCOS group [（0.050±0.0012） mmol·L^-1·min^-1 （0.048±0.012） mmol·L^-1·min^-1 and （18 ± 5）, P 〈0. 05]. The ratio of L-PAF-AH to H-PAF-AH activities at IR-PCOS group was also significantly higher than those at Non IR-PCOS and control group after correction for body mass index （P 〈0. 01 ）. （2） Pearson correlation analysis showed that the ratio of L-PAF-AH to H-PAF-AH in PCOS patients was positively correlated with atherogenic index, age, body mass index, waist-to-hip ratio, HOMA-IR, triglyceride levels, fasting insulin levels, fasting glucose levels,low density lipoprotein cholesterol and total cholesterol （r = 0. 644, 0. 247, 0.296, 0.212, 0.356, 0.587, 0. 377, 0. 375, 0. 292 and 0. 199, respectively, P 〈 0. 05）, and negatively correlated with high density lipoprotein cholesterol （r = -0. 510, P 〈0. 05）. The nmltiple stepwise regression analysis showed that atherogenic index and triglyceride were significant variables for the ratio of I.-PAF-AH to H-PAF-AH activity （ standardized coefficient, β = 0. 515 and 0. 201, respectively, P 〈0. 05）. Conclusion The elvated L-PAF-AH activity may be associated with IR in PCOS patients, and the increased ratio of L-PAF-AH to H-PAF-AH activities may be a potential marker of inflammation in the patients.