Correlation Between Cystathionine Beta-synthase And Homeostasis Model Assessment Of Insulin Resistance In Patients Of Polycystic Ovary Syndrome

Objective:By studying the correlation between cystathionine beta-synthase（CBS）and homocysteine（HCY）and homeostasis model of insulin resistance（HOMA-IR）in patients with polycystic ovary syndrome（PCOS）,we will provide a new way of diagnosis and treatment to improve insulin resistance in patients with PCOS and a theoretical basis for the health management of PCOS patients.Methods:We randomly selected women aged 20 to 40 who attended the specialist gynecological clinic of Wuyi district of Shanxi Maternal and Child Health Hospital from February 2021 to December 2021 as the research objects,we definded 50 patients with PCOS as the case group and 50 normal prepregnancy women as the control group.According to HOMA-IR≥2.69,25 PCOS patients with insulin resistance and 25 PCOS patients without insulin resistance were divided into two groups.The inclusion criteria of the control group were as follows:women of reproductive age with normal physical examination indexes and normal menstrual cycle,the immune disease history of woman were excluded.The inclusion criteria for the case group were:1)No estrogen drugs or immunosuppressant drugs were used within 3 months;2)No abnormality of liver or kidney function,immune system,gynecological organic disease or surgical history;3)No history of smoking,taking drugs or drinking;4)Willing to participate in the study and sign informed consent;5)Meet the requirements of the ethics committee.The exclusion criteria for the case group were:1)Pregnancy or breastfeeding within the past6 months or less than 3 years after menarche;2)Menopause（defined as amenorrhea≥3years or amenorrhea≥1 year but<3 years and follicle-stimulating hormone concentration increased to the range of postmenopause range）;3)Confirmed endocrine diseases（congenital adrenal hyperplasia,androgen secreting tumors,Cushing’s syndrome,thyroid dysfunction and adrenal diseases）;4)pre-existing general or psychiatric conditions and the use of medications that affect carbohydrate or lipid metabolism;5)A specific nutritional regimen or low-calorie diet for the past three months,including a vegan or vegetarian diet or supplements of antioxidants,folic acid,vitamins.The expression levels of CBS in serum of control group and case group were compared,to investigate the correlation between CBS expression and HOMA-IR in PCOS patients.Results:1.Compared with the normal female control group,both ovarian volumes of PCOS patients increased,the difference was statistically significant（P<0.05）.The uterine volume of PCOS patients decreased significantly,the difference was statistically significant（P<0.05）.Body mass index,waist-hip ratio and body fat percentage of human body composition of PCOS patients were significantly increased,with statistical significance（P<0.05）.2.Compared with the control group,the lipid metabolism of PCOS patients was significantly abnormal,with uric acid,total cholesterol,triglyceride and low density lipoprotein significantly increased（P<0.05）,and high density lipoprotein significantly decreased（P<0.05）.3.The levels of sex hormones in PCOS patients were significantly different from those in normal healthy women,AMH level was significantly increased,LH/FSH ratio was significantly higher than that in normal female control group,the difference was statistically significant（P<0.05）,and the levels of LH and T in sex hormones were significantly higher than that in control group,the difference was statistically significant（P<0.05）.There was no statistical difference in the levels of E₂and P between the case group and the control group.There were no significant differences in serum levels of TSH,FT₃and FT₄between the case group and the control group.4.The serum HOMA-IR and HCY level of PCOS patients was significantly higher than that of the control group,the difference was statistically significant（P<0.05）.The expression level of the CBS was significantly lower than that of the control group,the difference was statistically significant（P<0.05）.There was no significant difference in MTHFR expression and glycated hemoglobin level between case group and control group.5.Compared with the PCOS group without insulin resistance,the serum HCY level in the PCOS group with insulin resistance was significantly increased（P<0.05）,the expression level of the CBS was significantly decreased（P<0.05）,and the expression level of the MTHFR was not significantly different.6.The age of PCOS patients in reproductive age was positively correlated with uterine volume（r=0.288,P<0.05）,and was negatively correlated with bilateral ovarian volume（r=-3.13,P<0.05;r=-0.292,P<0.05）,was positively correlated with serum FSH level（r=0.284,P<0.05）,and had no correlation with CBS,MTHFR,HOMA-IR and HCY（r=0.074,P=0.610;r=0.157,P=0.278;r=0.133,P=0.433;r=-0.051,P=0.726）.There was no correlation between age and serum AMH level in PCOS patients（r=-0.189,P=0.188）.7.In the case group,triglyceride was positively correlated with uric acid and HOMA-IR,and the differences were statistically significant（r=0.319,P<0.05;r=0.482,P<0.001）,triglyceride was negatively correlated with CBS and MTHFR in PCOS patients,with statistical significance（r=-0.286,P<0.05;r=-0.311,P<0.05）,uric acid was positively correlated with T（r=0.297,P<0.05）.8.In the case group,HOMA-IR was positively correlated with serum HCY level（r=0.547,P<0.001）,and was negatively correlated with serum CBS expression level（r=-0.807,P<0.001）,and was no correlation with MTHFR expression level in serum（r=-0.074,P=0.608）.Serum HCY level in PCOS patients was negatively correlated with CBS（r=-0.565,P<0.001）,but not with MTHFR（r=-0.143,P=0.321）.Conclusion:1.The level of AMH in PCOS patients increased.Obesity parameters in human body include body mass index,waist-hip ratio and body fat percentage,they increased significantly in PCOS women,and triglyceride was correlated with uric acid and HOMA-IR.2.HCY metabolism in normal women mainly depends on the expression levels of rate-limiting enzyme CBS and MTHFR.The proportion of CBS factor is significantly higher than that of MTHFR.The level of HOMA-IR and HCY in PCOS is obviously higher than that in normal healthy women,and the expression level of CBS is obviously lower,there was no significant difference in the expression of MTHFR.The serum HCY level in PCOS subjects with elevated HOMA-IR was higher than that in PCOS subjects with decreased HOMA-IR,and the expression of CBS was significantly lower.The expression of HOMA-IR and increased HCY in patients with PCOS was significantly correlated the suppression of the rate-limiting enzyme CBS,and HOMA-IR was negatively correlated with CBS.