【摘要】 目的探讨性激素结合球蛋白（SHBG）检测在评价治疗多囊卵巢综合征（PCOS）不育患者中的意义。方法将533例PCOS不育患者按体重指数（BMI）分为非肥胖组（424例）和肥胖组（109例）并再按是否存在胰岛素抵抗（IR）分为四组。A组:非肥胖无IR组（162例）、B组:非肥胖IR组（262例）、C组:肥胖无IR组（42例）、D组:肥胖IR组（67例）。测定黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇（E₂）、总睾酮（T）、泌乳素（PRL）、SHBG、血糖（FBG）和胰岛素（FINS）水平,计算游离雄激素指数（FAI）及稳态模型指数（HOMA-IR）。A组、C组予达英-35;B组、D组予达英-35+盐酸二甲双胍,均治疗3月后复查各指标。停药后给予枸橼酸氯米芬（克罗米芬,CC）+人绝经期促性腺激素（HMG）促排卵治疗。比较各组排卵及妊娠情况。结果四组治疗后FAI均较治疗前降低,SHBG较治疗前升高差异有显著性;四组治疗后LH、LH/FSH比值、T较治疗前降低差异有显著性;但A组HOMA-IR、FINS较治疗前升高差异有显著性,B、D组HOMA-IR、FINS较治疗前降低差异有显著性。促排卵结果显示治疗后排卵率非肥胖组高于肥胖组（85.60%vs 68.69%,P<0.01）,两组治疗后有排卵患者SHBG较无排卵患者升高,FAI较无排卵患者降低;非肥胖组LH、LH/FSH比值、FINS降低（P<0.05）,而肥胖组FINS、HOMA-IR则降低（P<0.05）。妊娠结局比较:非肥胖组和肥胖组妊娠分娩患者治疗后T、FAI、FINS、HOMA-IR较自然流产患者降低,SHBG升高（P<0.05）;此外肥胖组妊娠分娩患者治疗后BMI较自然流产患者降低。结论无论肥胖还是非肥胖的PCOS患者,无论是否存在胰岛素抵抗,SHBG及FAI均可作为评价治疗是否有效的指标之一,可提示促排卵治疗及妊娠结局。因此在PCOS患者治疗中检测SHBG及FAI能指导临床用药,降低流产率,对优生优育有重要指导意义。更多还原

【Abstract】 Objective:To explore the significance of sex hormone-binding globulin examination in the treatment of women with polycystic ovarian syndrome(PCOS). Methods:The data of body mass index(BMI),serum levels of basal sexual hormones,sex hormone-binding globulin(SHBG),fasting blood glucose(FBG) and fasting insulin(FINS) were collected from 533 women with PCOS,aged 20-39 years.The patients were divided into four groups according to BMI and homeostasis model assessment of insulin status(HOMA-IR):group A(non-obese without insulin resistance, n=162),group B(non-obese with insulin resistance,n = 262),group C(obese without insulin resistance,n = 42) and group D(obese with insulin resistance,n = 67).Patients in group A and B took Diane -35 alone,while those in group C and D took Diane-35 plus metformin(1000 mg daily) for 3 months. Then clomiphene citrate(CC) and human menopausal gonadotropin(HMG) were administered to induce ovulation.The ovulation rate and pregnancy outcomes were compared among groups. Results:Free androgen index(FAI) decreased significantly and SHBG levels increased significantly in all groups after treatment.A significant decrease in serum LH levels,LH/FSH ratio and testosterone(T) levels was also found in all 4 groups after treatment(P<0.05).FINS and HOMA-IR increased significantly in group A(P<0.05),while both decreased significantly in group B and D(P<0.05) after treatment. The ovulation rate in non-obese group(A + B) was higher than that in obese group(C + D) (85.60%vs.68.69%,P<0.01).Compared with those in non-ovulation patients,SHBG levels increased significantly in the ovulation patients after treatment in both obese and non-obese groups.In the separate analysis of those ovulated,serum levels of LH,FINS,LH/FSH ratio and FAI decreased significantly in non-obese group,while FINS,HOMA-IR decreased significantly in obese group after treatment.The serum levels of SHBG,T,FINS,FAI and HOMA-IR after treatment were significantly higher in the patients with live birth than in those with spontaneous abortion(P<0.05). Conclusions:SHBG and FAI could be good predictors of treatment efficacy and pregnancy outcomes for the PCOS patients,regardless of the status of obesity or insulin resistance.更多还原