The Study Of Fructose Levels In Women With Polycystic Ovary Syndrome In Serum And Follicular Fluid

Objective: To estimate the levels of fructose in serum and follicular fluid in patients with polycystic ovary syndrome(PCOS),and to explore its relationship with PCOS and its predictive value for PCOS.Methods: A total of 157 Chinese Han subjects(90 PCOS patients and 67 controls)were recruited at Shengjing Hospital of China Medical University.PCOS was defined according to the Rotterdam criteria(Rotterdam,2004).According to the body mass index(BMI)and fasting serum insulin(FSI),the study population of control subjects and PCOS patients was divided into overweight/obese and lean subgroups,and hyper-FSI and normal-FSI subgroups,respectively.Serum samples were collected and detected for lipid profiles,fasting insulin and glucose levels,luteinizing hormone(LH),follicle-stimulating hormone(FSH),estradiol,total testosterone,prolactin and thyroid-stimulating hormone(TSH)levels.And the concentrations of SHBG,free testosterone,DHEAS and fructose in serum and follicular fluid were measured using commercial enzyme-linked immunosorbent assay kits.Statistical analyses were used to assess the comparisons between PCOS patients and controls,to test the relationship between two quantitative variables and evaluate the diagnostic performance of fructose and hormonal parameters.Results:(1)Serum fructose levels were increased in overweight/obese and hyper-FSI PCOS patients as compared with the control subjects.(2)Furthermore,fructose levels were significantly higher in follicular fluids from PCOS patients as compared with control subjects,regardless of whether the follicles were mature or immature.(3)Fructose had an area under the curve(AUC)of 79.7% at a cutoff value of 10.13 pmol/μl,with a sensitivity of 91.7% and a specificity of 59.3% for the prediction of PCOS in overweight/obese patients.(4)In hyper-FSI group,fructose had an AUC of 72% at a cutoff value of 10.49 pmol/μl,with a sensitivity of 71.1% and a specificity of 64.4% for the prediction of PCOS.(5)There were no differences between fructose,total testosterone,free testosterone,or dehydroepiandrosterone sulfate levels with respect to the reliability of predicting PCOS in the overweight/obese or hyper-FSI groups using the method outlined by Hanley and Mc Neil.(6)Notably,the combination of fructose and total testosterone levels resulted in the highest AUC of 86.0% and a high sensitivity(85.4%)and specificity(83.1%)for the prediction of PCOS in overweight/obese patients.The PPV and NPV were 80.4% and 87.5%,respectively.Similarly,the combination of fructose and total testosterone levels also resulted in a high AUC of 80.2% and a moderate sensitivity(73.3%)and high specificity(84.7%)for the prediction of PCOS in hyper-FSI patients.The PPV and NPV were 78.6% and 80.6%,respectively.Conclusion: Elevated serum fructose levels are associated with PCOS in Chinese Han women with obesity and hyperinsulinemia,and fructose levels are higher in follicular fluids from PCOS patients as compared with control subjects.