多囊卵巢综合征胰岛素抵抗与卵巢局部IGF-I系统的相关性研究

Relationship between insulin resistance and IGF-I system of ovary in polycystic ovary syndrome

目的探讨卵巢局部胰岛素样生长因子-I(IGF-I)系统在PCOS胰岛素抵抗发病机制中的作用。方法选择30例PCOS胰岛素抵抗患者为研究组,30例输卵管性不孕患者为对照组。测定并比较两组的血清、小卵泡液中IGF-I、胰岛素样生长因子结合球蛋白-1(IGFBP-1)及各项性激素、糖代谢及卵巢超声指标,分析其与各项指标之间的相关性。结果研究组小卵泡液IGF-I高于对照组和其血清水平(P<0.01),血清和小卵泡液的IGFBP-1低于对照组(P<0.05,P<0.01),小卵泡液IGFBP-1水平低于血清(P<0.05)。研究组小卵泡液IGF-I与总睾酮(T0)、雌二醇(E2)及卵巢体积(OV)、卵巢总面积(TA)、卵泡数(FN)、空腹胰岛素(FI)和口服葡萄糖后2h胰岛素(2h胰岛素)呈正相关(r分别为0.94、0.51、0.52、0.49、0.65、0.76和0.58,P值均<0.05);血清IGF-I与胰岛素敏感指数(ISI)、体重指数(BMI)和腰臀比(WHR)呈正相关(r分别为0.47、0.61和0.58,P<0.05),与定量胰岛素敏感指数(QUICKI)呈负相关(r=-0.34,P<0.05);研究组小卵泡液及血清IGFBP-1与FINS、2h胰岛素呈负相关(r=-0.48,P<0.001;r=-0.39,P<0.05;r=0.54,P<0.05;r=-0.52,P<0.05)。结论 PCOS患者的外周胰岛素抵抗可能通过影响卵巢局部IGF-I系统,刺激卵巢组织产生大量雄激素,导致排卵障碍。

Objective To study the effects of ovarian insulin-like growth factor-I（IGF-I）system on PCOS with insulin resistance（IR）.Methods 30 insulin-resistant PCOS patients and 30 tubal infertility women were enrolled.IGF-I and insulin-like growth factor binding protein-1（IGFBP-1）in follicular fluid and serum,reproductive hormones,insulin sensitivity indexes,ovarian ultrasound parameters were measured and compared between the two groups.Correlation of IGF-I system with other parameters was analysed.Results Follicular fluid IGF-I in PCOS group was significantly lower than that in control group（P0.01）.Both serum and follicular fluid level of IGFBP-1 in PCOS group were all significant lower than that in control group（P0.05,P0.01）.In PCOS group,IGF-I in follicular fluid was significantly higher than that in serum（P0.01）,and IGFBP-1 in follicular fluid was significantly lower than that in serum（P0.05）.In PCOS group,follicular fluid IGF-I positively correlated with T0,E2,ovary volume（OV）,total area（TA）,follicle number（FN）,free insulin（FI）and 2 h I（P0.05）.Serum IGF-I positively correlated with insulin sensitivity index（ISI）,body mass index（BMI）and waist/hip ratio（WHR）（P0.05）,negatively correlated with QUICK I（P0.05）.Both follicular fluid and serum IGFBP-1 negatively correlated with FINS,2 h I（P0.05）.Conclusions These results raise the possibility that IR is likely contributes to hyperandrogenism and anovulation in PCOS by affecting ovarian IGF-I system.