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目的:研究卵巢局部胰岛素样生长因子-I系统(IGF-I系统)在伴有胰岛素抵抗多囊卵巢综合征中的作用机制。方法选择30例合并胰岛素抵抗的PCOS(polycystic ovary syndrome)患者为试验组,30例患有卵巢良性肿瘤需手术探查的患者为对照组。检测并对比血清、小卵泡液中IGF-I、胰岛素样生长因子结合球蛋白-1(IGFBP-1)与各项性激素,FI,2hI,ISI,QUICK I,卵巢超声指标,研究其与各种指标间的相关性。结果试验组小卵泡液IGF-I高于对照组(P<0.01),小卵泡液及血清IGFBP-1低于对照组(P<0.05,P<0.01)。试验组小卵泡液IGF-I水平高于血清(P<0.01),小卵泡液IGFBP-1水平低于血清(P<0.05)。试验组小卵泡液IGF-I与T0、E2及卵巢体积(OV),卵巢总面积(TA),卵泡数(FN),空腹胰岛素(FI),服糖后2h胰岛素(2hI)呈正相关(P<0.05);血清IGF-I与胰岛素敏感指数(ISI),体重指数(BMI),腰臀比(WHR)呈正相关(P<0.05),与定量胰岛素敏感指数(QUICK I)呈负相关(P<0.05);试验组小卵泡液及血清IGFBP-1与FI,2hI呈负相关(P<0.05)。结论 IR可能通过影响卵巢局部IGF-I系统,刺激卵巢分泌雄激素,引发排卵障碍,在PCOS的发病机制中起到重要作用。
AIM: To investigate the mechanism of ovarian IGF-I (IGF-I system) in insulin resistance polycystic ovary syndrome. Methods Thirty patients with PCOS (polycystic ovary syndrome) with insulin resistance were selected as the experimental group. Thirty patients with benign ovarian tumors who underwent surgical exploration were selected as the control group. The levels of IGF-I, IGFBP-1, sex hormones, FI, 2hI, ISI and QUICK I in serum and small follicular fluid were detected and compared. Correlation between indicators. Results The level of IGF-I in small follicular fluid in experimental group was significantly higher than that in control group (P <0.01). The level of IGFBP-1 in small follicular fluid and serum was lower than that in control group (P <0.05, P <0.01). The level of IGF-I in small follicular fluid of experimental group was higher than that of serum (P <0.01), while the level of IGFBP-1 in small follicular fluid was lower than that of serum (P <0.05). IGF-I in follicular fluid of test group was positively correlated with T0, E2, ovarian volume (OV), total ovarian area (TA), number of follicles (FN), fasting insulin (FI) and insulin at 2h <0.05). Serum IGF-I was positively correlated with insulin sensitivity index (ISI), body mass index (BMI) and WHR (P <0.05), and negatively correlated with QUICK I <0.05). There was a negative correlation between IGFBP-1 in small follicular fluid and serum FI and 2hI (P <0.05). Conclusion IR may play an important role in the pathogenesis of PCOS by affecting the local ovarian IGF-I system, stimulating the secretion of androgen in the ovary, triggering ovulation disorders.