| BackgroundPolycystic ovary syndrome (PCOS) is the commonest endocrine disorder which is characterized by hyperandrogeneamia and anovulation. According to the recent studies, the definition of PCOS has beyond of the range of gynecological endocrine. It included a series of chronic endocrine disorders of many systems such as menstrual disorders, hirsutism, obesity, dyslipidaemia and hyperandrogeneamia, insulin resistance and infertility. More and more studies indicate that significantly increased risks of type 2 diabetes, hypertension, dyslipidaemia, cardiovascular diseases were oberserved in PCOS patients. PCOS affects 20% of women of childbearing age and often occurs in puberty girls. It is difficult to resolve the problem of low pregnancy rate in treating PCOS patients, so the study about the pathogenesis and effective therapy of PCOS is very important.Leptin and IGF-1 have been implicated in the pathogenesis of PCOS in recent studies, but the underlying mechanisms are not clear. The aim of study is to investigate the pathogenesis and therapy of PCOS. Part I Clinical study on serum leptin and IGF-1 levels in patientswith polycystic ovary syndromeObjective To determine whether PCOS is related to leptin, IGF-1 and IGFBP-1 dysregulation and to investigate the relationship between endocritic and metabolic disorders. Methods Thirty-six patients with PCOS and twenty-six control women were included in the study. In all patients, serum concentrations of leptin, IGF-1, IGFBP-1, fasting plasma glucose, fasting insulin, sex hormone binding globulin (SHBG) and sex hormone were measured in a basal sample. Insulin sensitivity index (ISI) and free androgen index (FAI) were calculated. Autropomethric parameters: weight, height, were measured and the BMI was calculated. Results Serum leptin, IGF-1, insulin in PCOS were significantly higher than in control group, serum IGFBP-1, SHBGlevels and ISI were significantly lower than in control group. When obese and non-obese women with PCOS were compared, we found serum LH level was significantly elevated in non-obese women with PCOS. Elevated leptin, insulin levels and decreased IGFBP-1 level were found in obese women with PCOS. Serum IGF-1 concentration did not differ significantly between obese and non-obese PCOS patients. PCOS patients with hyperinsulinemia had same endocritic characters with obese PCOS. Serum leptin was positively correlated with BMI and insulin, negatively correlated with T level. Serum insulin was negatively correlated with IGFBP-1 and SHBG in PCOS patients. Conclusions The leptin, IGF-1, IGFBP-1 concentrations are abnormal in PCOS women. Serum concentration and action of leptin, IGF-1 and IGFBP-1 are related tightly with high insulin level. So hyperinsulinemia have a crucial role in pathogenesis of PCOS. Treatment should be different because of the different endocritic characters. Part IIClinical study the effect of metformin on PCOSwith hyperinsulinemiaObjective To investigate whether metformin affected serum concentrations of leptin, IGF-1 and IGFBP-1 and to explore the mechanisms of therapy with metformin and it's clinical effects. Methods Twenty-four PCOS women with hyperinsulinemia participated in the study and were administered metformin at a dose of 500mg three times a day. Treatment was continued for 8-24 weeks. BMI, serum leptin, IGF-1, IGFBP-1, SHBG, insulin and sex hormone were evaluated before and again after 8 weeks metformin therapy. Assay effects of metformin on menstruration, ovulation and pregnancy. Results Metformin led to a significant decrease in serum leptin, insulin and testosterone levels. Decreased BMI and increased insulin sensitivity index were observed. A significant increase in serum IGFBP-1 level was observed after metformin, with no significant difference in serum IGF-1 and SHBG. 10 out of 24 had more regular menstrual cycles, 6 patients had ovulation and 3 patients conceived. After metformin therapy, CC or CC+FIMG induced ovulation 18 cycles,ovulation rate and pregnancy rate were 66.7% a... |
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