Role of Insulin Resistance in Anovulation

胰岛素抵抗在无排卵中的作用

基本信息

批准号：
07671792
负责人：
KITAGAWA Hiroyuki
金额：
$ 1.34万
依托单位：
EHIME UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1995
资助国家：
日本
起止时间：
1995 至 1996
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-07671792/
关键词：
Insulin Anovulation Obesity PCO 多襄胞性卵巣 Insulin resistance PCO obese Mouse Anovulation

项目摘要

(1) The correlation between obesity and anovulation has been widely recognized. Recently some reports indicated the association between increased insulin resistance and polycystic ovary syndrome. To investigate the role of increased insulin secretion in anovulation, hormone analysis and insulin secretion in anovulation with clomiphene resistance was studied. Subjects were 32 anovulatory patients with clomiphene resistance. (19 patients had obesity greater than 24 in BMI : anovulatory obese group, and 13 had normal body weight : anovulatory normal weight group.) As a control, 4 simple obese women with normal ovulation cycles : ovulatory obese group. Hormonal analysis (LH,FSH,PRL,Androgens, Estrogens) was performed. Blood glucose concentrations and immuno-reactive insulin levels were measured in 75g OGTT.Results : Anovulatory obese group and anovulatory normal weight group had hyperandrogenism and high E1/E2 ratio similarly. Anovulatory normal weight group indicated higher LH levels and … More higher LH/FSH ratio than anovulatory obese group significantly. In anovulatory obese group, the mean basal level and response of insulin in 75g OGTT were significantly higher than those of control group. Though anovulatory normal weight group showed insulin resistance, anovulatory obese group showed significantly severe insulin resistance. Discussion : Increased insulin secretion following insulin resistance could be one of the direct cause of anovulation in obese women. Some reports indicated that insulin augments ovarian androgen production in normal women and androgen production in cultured human thecal cells. High LH/FSH ratio may be another direct cause of the vicious cycle in some PCOS patients. Polycystic ovary syndrome may consist of insulin resistance dominant group and high LH/FSH dominant group.(2) Recently some reports indicated weight loss in anovulatory obese women results in improvement in ovulation rate. To investigate the role of increased insulin secretion in anovulation with insulin resistance, clinical effect of diet therapy for anovulation with obesity was studied. Subjects : 7 anovulatory patients with obesity greater than 24 in BMI.As a control, 4 simple obese women with normal ovulation cycles. Methods : Hormonal analysis was performed before and after the diet therapy. The diet therapy of 1600 kcal/day was recommended until patients had weight loss more than 5 in BMI.Results : 6/7 patients had high LH levels and high LH/FSH ratios. All patients had hyperandrogenism and high E1/E2 ratios. Three patients showed normal glucose concentrations during 75g OGTT and the others showed latent diabetic patterns. In anovulatory patients, the mean basal insulin level was significantly higher than that in control group. In response to 75g OGTT,the mean rise of circulating insulin level was greater in anovulatory patients than in control group. Five patients could have weight loss more than 5. Three of 5 acquired spontaneous ovulatory cycles, and 2 got ovulatory cycles by clomiphene citrate. Hyperandrogenism, high E1/E2 ratio and increased insulin secretion returned to almost normal range after the diet therapy. Discussion : In anovulatory women with obesity, vicious cycle between insulin resistance and obesity could be established. The diet therapy could destroy the vicious cycle, and be useful for improvement of ovulation. Less

(1)肥胖与无排卵之间的相关性已得到广泛认可，最近一些报道表明胰岛素抵抗增加与多囊卵巢综合征之间的关联，以探讨胰岛素分泌增加在无排卵中的作用、激素分析以及克罗米芬抵抗性无排卵中的胰岛素分泌。研究对象为 32 名克罗米芬耐药的无排卵患者（BMI 大于 24 的患者有 19 名，无排卵肥胖组有 13 名患者体重正常。无排卵正常体重组。）作为对照，对 4 名具有正常排卵周期的单纯肥胖女性：排卵肥胖组进行了激素分析（LH、FSH、PRL、雄激素、雌激素）。 75g OGTT。结果：无排卵肥胖组和无排卵正常体重组具有相似的高雄激素血症和高E1/E2比值。与无排卵肥胖组相比，无排卵肥胖组的 LH 水平和 LH/FSH 比值显着升高。在无排卵肥胖组中，75g OGTT 中胰岛素的平均基础水平和反应显着高于对照组。胰岛素抵抗，无排卵肥胖组表现出严重的胰岛素抵抗。讨论：胰岛素抵抗后胰岛素分泌增加可能是肥胖女性无排卵的直接原因之一。正常女性的雄激素产生和培养的人膜细胞中的雄激素产生可能是某些PCOS患者恶性循环的另一个直接原因，多囊卵巢综合征可能由胰岛素抵抗主导型和高LH/FSH主导型组成。 (2)最近有报道指出无排卵肥胖女性体重减轻可提高排卵率。为了探讨胰岛素分泌增加在无排卵和胰岛素抵抗中的作用以及饮食治疗无排卵的临床效果。研究对象：7 名BMI 大于24 的无排卵患者。作为对照，4 名排卵周期正常的单纯肥胖女性。方法：在1600 kcal 饮食治疗之前和之后进行激素分析。建议每天一次，直到患者体重减轻超过 BMI 5。结果：6/7 患者具有高 LH 水平和高 LH/FSH 比率。 3 名患者在 75g OGTT 期间显示出正常的血糖浓度，而其他患者则显示出潜在的糖尿病模式。在无排卵患者中，平均基础胰岛素水平显着高于对照组。无排卵患者的循环胰岛素水平平均上升幅度高于对照组，其中 5 名患者的体重减轻超过 5。5 名患者中有 3 名获得了自发排卵周期，另外 2 名患者获得了自发排卵周期。克罗米芬柠檬酸盐的排卵周期高雄激素血症、高 E1/E2 比率和增加的胰岛素分泌在饮食治疗后恢复到几乎正常范围。讨论：在患有肥胖症的无排卵女性中，可以建立胰岛素抵抗和肥胖之间的恶性循环。破坏恶性循环，有利于改善排卵。