多囊卵巢综合征患者外周血RAS与胰岛素抵抗及脂代谢的关系
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摘要
目的探讨多囊卵巢综合征患者外周血肾素-血管紧张素系统(RAS)与胰岛素抵抗及脂代谢的关系。方法选择2015年1月～2017年12月厦门市儿童医院(以下简称"我院")收治的多囊卵巢综合征患者116例,根据胰岛素抵抗指数(HOMA-IR)水平分为胰岛素抵抗组(HOMA-IR≥2.69,n=47)和非胰岛素抵抗组(HOMA-IR<2.69,n=69);选择同期我院体检健康女性60名作为对照组。比较各组外周血肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、空腹胰岛素(FINS)、性激素、血脂和超声学特征,并分析各指标与PRA、AngⅡ的相关性。结果胰岛素抵抗组外周血PRA、AngⅡ、FINS、HOMA-IR、黄体生成素(LH)、黄体生成素/卵泡刺激素(LH/FSH)、睾酮(T)水平显著高于非胰岛素抵抗组和对照组,非胰岛素抵抗组外周血PRA、AngⅡ、LH、LH/FSH、T水平显著高于对照组(均P <0.05)。胰岛素抵抗组外周血三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平显著高于非胰岛素抵抗组和对照组(均P <0.05)。非胰岛素抵抗组与对照组比较,外周血TG、TC、LDL-C、高密度脂蛋白胆固醇(HDL-C)、体重指数(BMI)差异无统计学意义(均P> 0.05)。胰岛素抵抗组卵巢卵泡数、子宫动脉阻力指数(RI)显著高于非胰岛素抵抗组和对照组,卵巢间质动脉RI显著低于非胰岛素抵抗组和对照组(均P <0.05),非胰岛素抵抗组卵巢体积、卵巢卵泡数、子宫动脉RI显著高于对照组,卵巢间质动脉RI显著低于对照组(均P <0.05)。多囊卵巢综合征患者外周血PRA、AngⅡ与FINS、HOMA-IR、LH、LH/FSH、T、LDL-C、TG、TC、卵巢卵泡数、子宫动脉RI呈正相关(均P <0.05),与卵巢间质动脉RI呈负相关(均P <0.05)。结论多囊卵巢综合征患者存在外周血RAS的亢进,PRA、AngⅡ水平可以影响患者胰岛素抵抗、脂代谢及卵泡生成。
Objective To investigate the relationship between the renin angiotensin system(RAS) in peripheral blood and insulin resistance and lipid metabolism in patients with polycystic ovary syndrome. Methods A total of 116 cases of patients with polycystic ovary syndrome from January 2015 to December 2017 treated in Xiamen Children′s Hospital( "our hospital" for short) were selected, which were divided into the insulin resistance group(HOMA-IR≥2.69, n = 47)and the non insulin resistance group(HOMA-IR<2.69, n = 69) according to insulin resistance index(HOMA-IR), and60 cases of healthy women in our hospital were selected as the control group. Plasma renin activity(PRA), angiotensinⅡ(AngⅡ), fasting insulin(FINS), sex hormone, blood lipid and ultrasonic features were compared between the groups,and the correlation between each index and PRA, Ang Ⅱ were analyzed. Results The insulin resistance group of peripheral blood PRA, AngⅡ, FINS, HOMA-IR, luteinizing hormone(LH), luteinizing hormone/follicle stimulating hormone(LH/FSH), testosterone(T) level were significantly higher than that in the non insulin resistance group and the control group, the peripheral blood PRA, Ang Ⅱ, LH,LH/FSH, T level in the non insulin resistance group were significantly higher than the control group(all P <0.05). The levels of peripheral blood triglyceride(TG),total cholesterol(TC), low density lipoprotein cholesterol(LDL-C) in the insulin resistance group were significantly higher than that of the non insulin resistance group and the control group(all P < 0.05), peripheral blood TG, TC,LDL-C, high density lipoprotein cholesterol(HDL-C) and BMI in the non insulin resistance group were not significantly different from those in the control group(all P > 0.05). The number of follicles and the resistant index of uterus artery(RI) in the insulin resistance group were significantly higher than those in the non insulin resistance group and the control group, RI of ovarian stromal artery was significantly lower than that in the non insulin resistance group and the control group(all P < 0.05), ovarian volume, follicle number and RI of uterine artery in the insulin resistance group were significantly higher than the control group, RI of ovarian stromal artery was significantly lower than the control group(all P < 0.05). PRA and AngⅡ in peripheral blood of patients with polycystic ovary syndrome were positively correlated with FINS, HOMA-IR, LH, LH/FSH, T, LDL-C, TG, TC, ovarian follicle number and RI of uterine artery(all P < 0.05), and negatively correlated with RI of ovarian interstitial artery(all P < 0.05). Conclusion Patients with polycystic ovary syndrome have hyperactivity of RAS in peripheral blood. The levels of PRA and AngⅡ can affect insulin resistance, lipid metabolism and follicle formation.
Objective To investigate the relationship between the renin angiotensin system(RAS) in peripheral blood and insulin resistance and lipid metabolism in patients with polycystic ovary syndrome. Methods A total of 116 cases of patients with polycystic ovary syndrome from January 2015 to December 2017 treated in Xiamen Children′s Hospital( "our hospital" for short) were selected, which were divided into the insulin resistance group(HOMA-IR≥2.69, n = 47)and the non insulin resistance group(HOMA-IR<2.69, n = 69) according to insulin resistance index(HOMA-IR), and60 cases of healthy women in our hospital were selected as the control group. Plasma renin activity(PRA), angiotensinⅡ(AngⅡ), fasting insulin(FINS), sex hormone, blood lipid and ultrasonic features were compared between the groups,and the correlation between each index and PRA, Ang Ⅱ were analyzed. Results The insulin resistance group of peripheral blood PRA, AngⅡ, FINS, HOMA-IR, luteinizing hormone(LH), luteinizing hormone/follicle stimulating hormone(LH/FSH), testosterone(T) level were significantly higher than that in the non insulin resistance group and the control group, the peripheral blood PRA, Ang Ⅱ, LH,LH/FSH, T level in the non insulin resistance group were significantly higher than the control group(all P <0.05). The levels of peripheral blood triglyceride(TG),total cholesterol(TC), low density lipoprotein cholesterol(LDL-C) in the insulin resistance group were significantly higher than that of the non insulin resistance group and the control group(all P < 0.05), peripheral blood TG, TC,LDL-C, high density lipoprotein cholesterol(HDL-C) and BMI in the non insulin resistance group were not significantly different from those in the control group(all P > 0.05). The number of follicles and the resistant index of uterus artery(RI) in the insulin resistance group were significantly higher than those in the non insulin resistance group and the control group, RI of ovarian stromal artery was significantly lower than that in the non insulin resistance group and the control group(all P < 0.05), ovarian volume, follicle number and RI of uterine artery in the insulin resistance group were significantly higher than the control group, RI of ovarian stromal artery was significantly lower than the control group(all P < 0.05). PRA and AngⅡ in peripheral blood of patients with polycystic ovary syndrome were positively correlated with FINS, HOMA-IR, LH, LH/FSH, T, LDL-C, TG, TC, ovarian follicle number and RI of uterine artery(all P < 0.05), and negatively correlated with RI of ovarian interstitial artery(all P < 0.05). Conclusion Patients with polycystic ovary syndrome have hyperactivity of RAS in peripheral blood. The levels of PRA and AngⅡ can affect insulin resistance, lipid metabolism and follicle formation.
引文
[1]刘聪,殷秀荣,李丽玮,等.血浆内脂素与多囊卵巢综合征患者糖脂代谢的相关性研究[J].生殖医学杂志,2018,27(6):579-581.
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[6]Enjezab B,Eftekhar M,Ghadiri-Anari A,et al.Association between severity of depression and clinico-biochemical markers of polycystic ovary syndrome[J].Electron Physician,2017,9(11):5820-5825.
[7]麻海英,刘复权,张英奎,等.多囊卵巢综合征患者性激素水平与肾素血管紧张素系统及IGF-1、IGFBP-1相关性分析[J].河北医药,2010,32(21):2967-2969.
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[9]刘艳美,刘新雄,林春莲,等.多囊卵巢综合征患者早孕期促性腺激素水平与体重指数的相关性研究[J].中国性科学,2015,24(6):31-33.
[10]刘玮,赵文娜,李伟.血浆肾素-血管紧张素系统与原发性高血压的关系分析[J].临床医学研究与实践,2017,2(24):15-16.
[11]刘耀泽.多囊卵巢综合征患者高雄激素血症与肥胖及胰岛素抵抗的相关性[J].实用妇科内分泌电子杂志,2016,3(13):87,89.
[12]金玉杰,刘圣君,赵自刚.肾素-血管紧张素系统在急慢性肾损伤发病机制中作用的研究进展[J].中国全科医学,2018,21(2):203-206.
[13]Saleem F,Rizvi SW.New Therapeutic Approaches in Obesity and Metabolic Syndrome Associated with Polycystic Ovary Syndrome[J].Cureus,2017,9(11):e1844.
[14]陈丽华,王秀丽,陈静,等.血管紧张素Ⅱ和血管紧张素1-7及其受体在多囊卵巢综合征患者中的表达研究[J].中国全科医学,2017,20(24):2978-2983.
[15]殷冬梅,阮祥燕,田玄玄,等.亚临床甲减对多囊卵巢综合征患者胰岛素抵抗及脂代谢的影响[J].中国医药导报,2018,15(17):68-71.
[16]左宏玲,李晓冬,杜彦芳,等.多囊卵巢综合征患者外周血Ang-(1-7)、AngⅡ/Ang-(1-7)比值与胰岛素抵抗及脂代谢的相关性研究[J].中华生殖与避孕杂志,2017,37(5):366-370.
[17]张仁浇,刘宏伟,白怀,等.氧化应激与多囊卵巢综合征雄激素增多症关系的研究现状[J].中华妇幼临床医学杂志:电子版,2017,13(6):633-639.
[18]Codony-Servat J,Cuatrecasas M,Asensio E,et al.Nuclear IGF-1R predicts chemotherapy and targeted therapy resistance in metastatic colorectal cancer[J].Br J Cancer,2017,117(12):1777-1786.
[19]戴加乐,徐惠娟,詹小兰.多囊卵巢综合征患者的血脂代谢异常与胰岛素抵抗的关系[J].中国妇幼保健,2016,31(13):2604-2605.
[20]卢天孟,赖鸿鹄,李琼,等.多囊卵巢综合征合并代谢综合征与脂质蓄积指数的相关性分析[J].疑难病杂志,2017,16(8):801-804.
[21]Yandrapalli S,Aronow WS.Cardiovascular benefits of the newer medications for treating type 2 diabetes mellitus[J].J Thorac Dis,2017,9(7):2124-2134.
[2]刘新艳,贾爱华,王荣,等.达英-35联合二甲双胍治疗多囊卵巢综合征对内分泌及脂代谢指标的影响[J].检验医学与临床,2018,15(11):1685-1688.
[3]张琳,李敬,王泽,等.多囊卵巢综合征患者促甲状腺激素对血糖、血脂的影响[J].山东大学学报:医学版,2017,55(1):80-84.
[4]郭金强,李欠娇.经阴道超声检查与激素检测在多囊卵巢综合征诊断中的价值分析[J].生物医学工程学进展,2016,37(3):165-167.
[5]喻宝中.多囊卵巢综合征患者内分泌代谢临床特点分析[J]深圳中西医结合杂志,2016,26(16):27-28.
[6]Enjezab B,Eftekhar M,Ghadiri-Anari A,et al.Association between severity of depression and clinico-biochemical markers of polycystic ovary syndrome[J].Electron Physician,2017,9(11):5820-5825.
[7]麻海英,刘复权,张英奎,等.多囊卵巢综合征患者性激素水平与肾素血管紧张素系统及IGF-1、IGFBP-1相关性分析[J].河北医药,2010,32(21):2967-2969.
[8]陈子江,刘嘉茵.多囊卵巢综合征-基础与临床[M].北京:人民卫生出版社,2009:58.
[9]刘艳美,刘新雄,林春莲,等.多囊卵巢综合征患者早孕期促性腺激素水平与体重指数的相关性研究[J].中国性科学,2015,24(6):31-33.
[10]刘玮,赵文娜,李伟.血浆肾素-血管紧张素系统与原发性高血压的关系分析[J].临床医学研究与实践,2017,2(24):15-16.
[11]刘耀泽.多囊卵巢综合征患者高雄激素血症与肥胖及胰岛素抵抗的相关性[J].实用妇科内分泌电子杂志,2016,3(13):87,89.
[12]金玉杰,刘圣君,赵自刚.肾素-血管紧张素系统在急慢性肾损伤发病机制中作用的研究进展[J].中国全科医学,2018,21(2):203-206.
[13]Saleem F,Rizvi SW.New Therapeutic Approaches in Obesity and Metabolic Syndrome Associated with Polycystic Ovary Syndrome[J].Cureus,2017,9(11):e1844.
[14]陈丽华,王秀丽,陈静,等.血管紧张素Ⅱ和血管紧张素1-7及其受体在多囊卵巢综合征患者中的表达研究[J].中国全科医学,2017,20(24):2978-2983.
[15]殷冬梅,阮祥燕,田玄玄,等.亚临床甲减对多囊卵巢综合征患者胰岛素抵抗及脂代谢的影响[J].中国医药导报,2018,15(17):68-71.
[16]左宏玲,李晓冬,杜彦芳,等.多囊卵巢综合征患者外周血Ang-(1-7)、AngⅡ/Ang-(1-7)比值与胰岛素抵抗及脂代谢的相关性研究[J].中华生殖与避孕杂志,2017,37(5):366-370.
[17]张仁浇,刘宏伟,白怀,等.氧化应激与多囊卵巢综合征雄激素增多症关系的研究现状[J].中华妇幼临床医学杂志:电子版,2017,13(6):633-639.
[18]Codony-Servat J,Cuatrecasas M,Asensio E,et al.Nuclear IGF-1R predicts chemotherapy and targeted therapy resistance in metastatic colorectal cancer[J].Br J Cancer,2017,117(12):1777-1786.
[19]戴加乐,徐惠娟,詹小兰.多囊卵巢综合征患者的血脂代谢异常与胰岛素抵抗的关系[J].中国妇幼保健,2016,31(13):2604-2605.
[20]卢天孟,赖鸿鹄,李琼,等.多囊卵巢综合征合并代谢综合征与脂质蓄积指数的相关性分析[J].疑难病杂志,2017,16(8):801-804.
[21]Yandrapalli S,Aronow WS.Cardiovascular benefits of the newer medications for treating type 2 diabetes mellitus[J].J Thorac Dis,2017,9(7):2124-2134.