吻素与多囊卵巢综合征的相关性研究

Study on the correlation between kisspeptin and polycystic ovary syndrome

目的 探讨血清吻素(kisspeptin)水平与多囊卵巢综合征(polycystic ovary syndrome,PCOS)的相关性,为PCOS的诊断与治疗提供新思路。方法 选取2018年1月至2018年12月在山东第一医科大学第二附属医院生殖医学门诊就诊的40例PCOS患者作为研究对象,选取同期就诊的因输卵管因素或男方因素导致不孕的非PCOS患者40例作为对照组。测量患者身高、体质量、腰围、臀围等基本指标,并计算腰臀比(waist-to-hip ratio,WHR)与体质量指数;检测患者血液性激素六项及相关生化指标;应用酶联免疫吸附法检测患者血清中吻素水平。结果 PCOS组患者WHR显著高于对照组,差异有统计学意义(P <0.05)。PCOS组血清黄体生成素(luteinizing hormone,LH)水平、黄体生成素/卵泡刺激素(follicle-stimulating hormone,FSH)、吻素及抗苗勒管激素(anti-Mullerian hormone,AMH)较对照组显著增高(P <0.05),而卵泡刺激素水平较对照组偏低,差异均有统计学意义(P <0.05)。PCOS组空腹胰岛素(fasting insulin,FINS)、空腹血糖(fasting blood glucose,FBG)、稳态模型胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)均高于对照组,差异有统计学意义(P <0.05)。Pearson相关分析显示,吻素和AMH、LH、HOMA-IR水平呈正相关,差异有统计学意义(r=0.804,0.907,0.023;P <0.001,P <0.001,P=0.030)。受试者工作特征(receiver operating characteristic,ROC)曲线分析血清吻素水平对PCOS诊断的影响,结果显示,ROC曲线下面积为0.621,95%CI:0.570~0.704,灵敏度为68.8%,特异度为80.9%,吻素用于预测PCOS的截断值为0.470。结论 血清吻素水平升高与PCOS具有相关性,吻素/吻素1受体(kisspeptin 1 receptor,KISS1R)系统过度活跃可能参与了PCOS的病理生理过程。

Objective:To investigate the correlation between kisspeptin level and polycystic ovary syndrome(PCOS).Methods:Forty PCOS patients and forty non-PCOS patients were selected as the study subjects,and six sex hormones,biochemical indexes and kisspeptin levels were measured.The differences were compared between pcos and control groups.Results:The waist-to-hip ratio(WHR)of the PCOS group was higher than that of the control group,and the difference was statistically significant(P<0.05).The levels of LH,LH/FSH,Kisspetin and AMH in PCOS group were higher than those in control group(P<0.05),but the levels of FSH in PCOS group were lower than those in the control group(P<0.05),there was no significant difference in E2,P,total-T and PRL between the two groups(P>0.05).The levels of fasting insulin(FINS),fasting blood glucose(FBG),glycated hemoglobin and insulin resistance index(HOMA-IR)in PCOS group were significantly higher than those in control group(P<0.05).Kisspeptin was correlated with AMH,LH and HOMA-IR in the PCOS group,and there was positive correlation between kisspeptin and Amh,Lh and HOMA-IR(r=0.580,P<0.001).There was no significant difference between them and WHR,BMI,FSH,E2,P,total-T,PRL,FBG and FINS.ROC was used to analyze the influence of kisspeptin level on PCOS diagnosis of the study subjects.AUC was 0.621(95%CI:0.570-0.704,sensitivity was 68.8%,specificity was 80.9%,and cut-off value was 0.470).Conclusion:Elevated serum kisspeptin levels are associated with the development of PCOS,and abnormal serum kisspeptin may be involved in the pathophysiological mechanisms of PCOS.