吡格列酮对胰岛素抵抗型多囊卵巢综合征患者脂肪细胞因子的影响

Effects of pioglitazone on serum adipocytokines in polycystic ovary syndrome patients with insulin resistance

目的探讨胰岛素增敏剂吡格列酮在治疗胰岛素抵抗型多囊卵巢综合征(PCOS)时脂肪细胞因子瘦素、抵抗素及脂联素的变化。方法35例胰岛素抵抗型PCOS患者用吡格列酮治疗12周,监测治疗前、后患者的临床指标,检测治疗前、后患者血清脂肪因子、空腹血糖、胰岛素、性激素水平和血脂情况。结果35例患者中88.5%月经和排卵功能改善,腰臀比和F-G评分与治疗前比较显著下降(P<0.05),体重指数也有下降,但差异无统计学意义(P>0.05);治疗后黄体生成素(LH)和睾酮(T)水平显著下降(P<0.01),卵泡刺激素(FSH)水平无显著变化(P>0.05);空腹血清胰岛素和胰岛素抵抗指数(HOMA-IR)较治疗前显著下降(P<0.01),空腹血糖在治疗后略有下降,但差异无统计学意义(P>0.05);治疗后总胆固醇、甘油三脂和低密度脂蛋白较前显著下降(P<0.01,P<0.05),高密度脂蛋白较前显著升高(P<0.01);瘦素和抵抗素较治疗前显著下降(P<0.05),脂联素较前显著升高(P<0.05)。结论胰岛素增敏剂吡格列酮可有效改善胰岛素抵抗型PCOS患者的临床体征、胰岛素敏感性和糖、脂代谢状况;脂肪细胞因子瘦素、抵抗素和脂联素可能参与PCOS的胰岛素抵抗(IR)的发生、发展,且吡格列酮可能通过改善血清脂肪细胞因子而发挥其治疗PCOS、改善IR的疗效。

Objective To investigate the effects of pioglitazone on serum adipocytokines（leptin,resistin and adiponectin） in polycystic ovary syndrome（PCOS） patients with insulin resistance（IR）.Methods Thirty-five PCOS patients with IR were treated with pioglitazone 15mg/d for 12 weeks.The results of ovulation induction were observed.The changes of fasting plasma glucose（FPG）,fasting serum insulin（FINS）,serum levels of leptin,resistin and adiponectin,follicle-stimulating hormone（FSH）,luteinizing hormone（LH）,testosterone（T）,and blood fat were examined at the baseline and after the therapy by enzyme-linked immunosorbentassay（ELISA） and radioimmunoassay（RIA）.Results After 12 weeks＇ treatment,menstruation and rate of ovulation per cycle were improved in 35（88.5%） PCOS patients with IR.Waist/hip ratio and F-G score were significantly decreased（P〈0.05）,and BMI declined with no significant difference（P〉0.05）.The levels of LH,T,FINS,HOMA-IR,total cholesterol,triglyceride and low density lipoprotein-cholesterol were significantly decreased（P〈0.01,P〈0.05） after treatment;high density lipoprotein-cholesterol level was significantly increased（P〈0.01） after treatment.However,there were no significant differences in FSH and FPG（P〉0.05）.The levels of serum leptin and resistin were decrease than before（P〈0.05）,and the level of serum adiponectin was increased（P〈0.05）.Conclusion Pioglitazone can effectively improve clinical syndromes,insulin sensitivity,glucose and lipid metabolism of PCOS patients with IR.Adipocytokines（leptin,adiponectin and resistin） as regulators of insulin metabolism are involved in the pathogenesis of insulin resistance in PCOS.Pioglitazone treatment can decrease plasma glucose level and improve insulin sensitivity at least partly through improving the profiles of adipocytokines.