多囊卵巢综合征患者胰岛素抵抗的研究进展
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摘要
多囊卵巢综合征(PCOS)是一种常见的影响生育功能的妇科内分泌疾病,被认为与遗传、代谢、内分泌及环境等多因素相关。PCOS患者的胰岛素抵抗增加了2型糖尿病、高血压、脂质代谢异常等发生的风险,越来越多的研究开始关注PCOS患者的胰岛素抵抗,本文从胰岛素抵抗的发生机制、评估、治疗等方面阐述其在PCOS中的研究进展。
Polycystic ovary syndrome(PCOS)is a common gynecological endocrine disease affecting fertility.It is considered to be related to many factors such as heredity,metabolism,endocrine and environment.Insulin resistance increases the risk of developing type 2 diabetes,hypertension and abnormal lipid metabolism in patients with PCOS.More studies have paid attention to insulin resistance in patients with PCOS.This article expounds the latest research progress in the pathogenesis,evaluation and treatment of insulin resistance in the patients with PCOS.
Polycystic ovary syndrome(PCOS)is a common gynecological endocrine disease affecting fertility.It is considered to be related to many factors such as heredity,metabolism,endocrine and environment.Insulin resistance increases the risk of developing type 2 diabetes,hypertension and abnormal lipid metabolism in patients with PCOS.More studies have paid attention to insulin resistance in patients with PCOS.This article expounds the latest research progress in the pathogenesis,evaluation and treatment of insulin resistance in the patients with PCOS.
引文
[1]March WA,Moore VM,Willson KJ,et al.The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria[J].Hum Reprod,2010,25:544-551.
[2]蔡志明,李蓉,卢丽华,等.胰岛素抵抗与多囊卵巢综合征[J].生殖医学杂志,2005,14:189-192.
[3]Baillargeon JP,Nestler JE.Commentary:polycystic ovary syndrome:a syndrome of ovarian hypersensitivity to insulin?[J].Clin Endocrinol Metab,2006,91:22-24.
[4]Belani M,Deo A,Shah P,et al.Differential insulin and steroidogenic signaling in insulin resistant and non-insulin resistant human luteinized granulosa cells-A study in PCOSpatients[J].Steroid Biochem Mol Biol,2018,178:283-292.
[5]Ding Y,Xia BH,Zhang CJ.Mutations in mitochondrial tRNAgenes may be related to insulin resistance in women with polycystic ovary syndrome[J].Am J Transl Res,2017,9:2984-2996.
[6]Ding Y,Zhuo G,Zhang C.The mitochondrial tRNALeu(UUR)A3302G mutation may be associated with insulin resistance in woman with polycystic ovary syndrome[J].Reprod Sci,2016,23:228-233.
[7]Victor VM,Rovira-Llopis S,Ba1uls C,et al.Insulin resistance in PCOS patients enhances oxidative stress and leukocyte adhesion:role of myeloperoxidase[J].PLoS One,2016,11:e0151960.doi:10.1371/journal.pone.0151960.
[8]BruléH,Holmes WM,Keith G,et al.Effect of a mutation in the anticodon of human mitochondrial tRNAPro on its posttranscriptional modification pattern[J].Nucleic Acids Res,1998,26:537-543.
[9]Wallace DC.A mitochondrial paradigm of metabolic and degenerative diseases,aging,and cancer:a dawn for evolutionary medicine[J].Annu RevGenet,2005,39:359-407.
[10]Durmus U,Duran C.Visceral adiposity index levels in overweight and/or obese,and non-obese patients with polycystic ovary syndrome and its relationship with metabolic and inflammatory parameters[J].Endocrinol Invest,2017,40:487-497.
[11]Trujillo ME,Scherer PE.Adipose tissue-derived factors:impact on health and disease[J].Endocr Rev,2006,27:762-778.
[12]Koleva DI,Orbetzova MM,Nikolova JG,et al.Adipokines and soluble cell adhesion molecules in insulin resistant and non-insulin resistant women with polycystic ovary syndrome[J].Arch Physiol Biochem,2016,122:223-227.
[13]Zheng SH,Du DF,Li XL.Leptin levels in women with polycystic ovary syndrome:a systematic review and a metaanalysis[J].Reprod Sci,2017,24:656-670.
[14]Brandt B,Mazaki-Tovi S,Hemi R,et al.Omentin,an adipokine with insulin-sensitizing properties,is negatively associated with insulin resistance in normal gestation[J].Perinat Med,2015,43:325-331.
[15]Tang YL,Yu J,Zeng ZG,et al.Circulating omentin-1levels in women with polycystic ovary syndrome:a meta-analysis[J].Gynecol Endocrinol,2017,33:244-249.
[16]Fukuhara A,Matsuda M,Nishizawa M,et al.Visfatin:a protein secreted by visceral fat that mimics the effects of insulin[J].Science,2005,307:426-430.
[17]Schwartz DR.Human resistin:found in translation from mouse to man[J].Trends Endocrinol Metab,2011,22:259-265.
[18]Shorakae S,Ranasinha S,Abell S,et al.Inter-related effects of insulin resistance,hyperandrogenism,sympathetic dysfunction and chronic inflammation in PCOS[J].Clin Endocrinol(Oxf),2018:doi:10.1111/cen.13808.
[19]Brieger K,Schiavone S,Miller FJ Jr,et al.Reactive oxygen species:from health to disease[J].Swiss Med Wkly,2012,142:w13659.doi:10.4414/smw.2012.13659.
[20]González F,Rote NS,Minium J,et al.Reactive oxygen species-induced oxidative stress in the development of insulin resistance and hyperandrogenism in polycystic ovary syndrome[J].Clin Endocrinol Metab,2006,91:336-340.
[21]Arslan S,Akdevelioˇglu Y.The relationship between female reproductive functions and vitamin D[J].J Am Coll Nutr,2018,37:546-551.
[22]Gupta T,Rawat M,Gupta N,et al.Study of effect of vitamin D supplementation on the clinical,hormonal and metabolic profile of the PCOS women[J].Obstet Gynaecol India,2017,67:349-355.
[23]Sharifi F,Mazloomi S,Hajihosseini R,et al.Serum magnesium concentrations in polycystic ovary syndrome and its association with insulin resistance[J].Gynecol Endocrinol,2012,28:7-11.
[24]Chakraborty P,Ghosh S,Goswami SK,et al.Altered trace mineral milieu might play an aetiological role in the pathogenesis of polycystic ovary syndrome[J].Biol Trace Elem Res,2013,152:9-15.
[25]贾月月,刘洪彬,李婧博,等.多囊卵巢综合征患者颗粒细胞microRNA-200b的表达及影响[J].山东大学学报(医学版),2017,55:63-68.
[26]Shi L,Liu S,Zhao W,et al.miR-483-5p and miR-486-5p are down-regulated in cumulus cells of metaphase II oocytes from women with polycystic ovary syndrome[J/OL].Reprod Biomed Online,2015,31:565-572.
[27]DeFronzo RA,Tobin JD,Andres R.Glucose clamp technique:a method for quantifying insulin secretion and resistance[J].AmJ Physiol,1979,237:E214-223.
[28]Matthews DR,Hosker JP,Rudenski AS,et al.Homeostasis model assessment:insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J].Diabetologia,1985,28:412-419.
[29]Katz A,Nambi SS,Mather K,et al.Quantitative insulin sensitivity check index:a simple,accurate method for assessing insulin sensitivity in humans[J].Clin Endocrinol Metab,2000,85:2402-2410.
[30]Ducluzeau PH,Cousin P,Malvoisin E,et al.Glucose-toinsulin ratio rather than sex hormone-binding globulin and adiponectin levels is the best predictor of insulin resistance in nonobese women with polycystic ovary syndrome[J].Clin Endocrinol Metab,2003,88:3626-3631.
[31]Jin P,Xie Y.Treatment strategies for women with polycystic ovary syndrome[J].Gynecol Endocrinol,2018,34:272-277.
[32]Panidis D,Tziomalos K,Papadakis E,et al.Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome:impact on metabolism and fertility[J].Endocrine,2013,44:583-590.
[33]Kogure GS,Silva RC,Miranda-Furtado CL,et al.Hyperandrogenism enhances muscle strength after progressive resistance training,independent of body composition,in women with polycystic ovary syndrome[J].J Strength Cond Res,2018,32:2642-2651.
[34]Cheema BS,Vizza L,Swaraj S.Progressive resistance training in polycystic ovary syndrome:can pumping iron improve clinical outcomes?[J].Sports Med,2014,44:1197-1207.
[35]Kalem MN,Kalem Z,Gurgan T.Effect of metformin and oral contraceptives on polycystic ovary syndrome and IVF cycles[J].Endocrinol Invest,2017,40:745-752.
[36]Du Q,Yang S,Wang YJ,et al.Effects of thiazolidinediones on polycystic ovary syndrome:a meta-analysis of randomized placebo-controlled trials[J].Adv Ther,2012,29:763-774.
[37]Sathyapalan T,Coady AM,Kilpatrick ES,et al.The effect of atorvastatin on pancreatic beta cell requirement in women with polycystic ovary syndrome[J].Endocr Connect,2017,6:811-816.
[38]Kamenov Z,Kolarov G,Gateva A,et al.Ovulation induction with myo-inositol alone and in combination with clomiphene citrate in polycystic ovarian syndrome patients with insulin resistance[J].Gynecol Endocrinol,2015,31:131-135.
[39]Zeng L,Yang K.Effectiveness of myoinositol for polycystic ovary syndrome:a systematic review and meta-analysis[J].Endocrine,2018,59:30-38.
[40]Kumar P,Arora S.Orlistat in polycystic ovarian syndrome reduces weight with improvement in lipid profile and pregnancy rates[J].J Hum Reprod Sci,2014,7:255-261.
[41]Panidis D,Tziomalos K,Papadakis E,et al.Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome:impact on metabolism and fertility[J].Endocrine,2013,44:583-590.
[42]Tao T,Wu P,Wang Y.Comparison of glycemic control andβ-cell function in new onset T2DM patients with PCOS of metformin and saxagliptin monotherapy or combination treatment[J].BMC Endocr Disord,2018,18:14.
[43]Wu Y,Li P,Zhang D,et al.Metformin and pioglitazone combination therapy ameliorate polycystic ovary syndrome through AMPK/PI3K/JNK pathway[J].Exp Ther Med,2018,15:2120-2127.
[44]Matsuzaki T,Tungalagsuvd A,Iwasa T,et al.Clinical outcome of various metformin treatments for women with polycystic ovary syndrome[J].Reprod Med Biol,2017,16:179-187.
[45]Jamilian M,Maktabi M,Asemi Z.A trial on the effects of magnesium-zinc-calcium-vitamin D co-supplementation on glycemic control and markers of cardio-metabolic risk in women with polycystic ovary syndrome[J].Arch Iran Med,2017,20:640-645.
[46]Liang F,Koya D.Acupuncture:is it effective for treatment of insulin resistance?[J].Diabetes Obes Metab,2010,12:555-569.
[47]Mohammadi S,Karimzadeh Bardei L,Hojati V,et al.Antiinflammatory effects of curcumin on insulin eesistance index,levels of interleukin-6,C-reactive protein,and liver histology in polycystic ovary syndrome-induced rats[J].Cell J,2017,19:425-433.
[48]Li Y,Ma H,Zhang Y,et al.Effect of berberine on insulin resistance in women with polycystic ovary syndrome:study protocol for a randomized multicenter controlled trial[J].Trials,2013,14:226.doi:10.1186/1745-6215-14-226.
[2]蔡志明,李蓉,卢丽华,等.胰岛素抵抗与多囊卵巢综合征[J].生殖医学杂志,2005,14:189-192.
[3]Baillargeon JP,Nestler JE.Commentary:polycystic ovary syndrome:a syndrome of ovarian hypersensitivity to insulin?[J].Clin Endocrinol Metab,2006,91:22-24.
[4]Belani M,Deo A,Shah P,et al.Differential insulin and steroidogenic signaling in insulin resistant and non-insulin resistant human luteinized granulosa cells-A study in PCOSpatients[J].Steroid Biochem Mol Biol,2018,178:283-292.
[5]Ding Y,Xia BH,Zhang CJ.Mutations in mitochondrial tRNAgenes may be related to insulin resistance in women with polycystic ovary syndrome[J].Am J Transl Res,2017,9:2984-2996.
[6]Ding Y,Zhuo G,Zhang C.The mitochondrial tRNALeu(UUR)A3302G mutation may be associated with insulin resistance in woman with polycystic ovary syndrome[J].Reprod Sci,2016,23:228-233.
[7]Victor VM,Rovira-Llopis S,Ba1uls C,et al.Insulin resistance in PCOS patients enhances oxidative stress and leukocyte adhesion:role of myeloperoxidase[J].PLoS One,2016,11:e0151960.doi:10.1371/journal.pone.0151960.
[8]BruléH,Holmes WM,Keith G,et al.Effect of a mutation in the anticodon of human mitochondrial tRNAPro on its posttranscriptional modification pattern[J].Nucleic Acids Res,1998,26:537-543.
[9]Wallace DC.A mitochondrial paradigm of metabolic and degenerative diseases,aging,and cancer:a dawn for evolutionary medicine[J].Annu RevGenet,2005,39:359-407.
[10]Durmus U,Duran C.Visceral adiposity index levels in overweight and/or obese,and non-obese patients with polycystic ovary syndrome and its relationship with metabolic and inflammatory parameters[J].Endocrinol Invest,2017,40:487-497.
[11]Trujillo ME,Scherer PE.Adipose tissue-derived factors:impact on health and disease[J].Endocr Rev,2006,27:762-778.
[12]Koleva DI,Orbetzova MM,Nikolova JG,et al.Adipokines and soluble cell adhesion molecules in insulin resistant and non-insulin resistant women with polycystic ovary syndrome[J].Arch Physiol Biochem,2016,122:223-227.
[13]Zheng SH,Du DF,Li XL.Leptin levels in women with polycystic ovary syndrome:a systematic review and a metaanalysis[J].Reprod Sci,2017,24:656-670.
[14]Brandt B,Mazaki-Tovi S,Hemi R,et al.Omentin,an adipokine with insulin-sensitizing properties,is negatively associated with insulin resistance in normal gestation[J].Perinat Med,2015,43:325-331.
[15]Tang YL,Yu J,Zeng ZG,et al.Circulating omentin-1levels in women with polycystic ovary syndrome:a meta-analysis[J].Gynecol Endocrinol,2017,33:244-249.
[16]Fukuhara A,Matsuda M,Nishizawa M,et al.Visfatin:a protein secreted by visceral fat that mimics the effects of insulin[J].Science,2005,307:426-430.
[17]Schwartz DR.Human resistin:found in translation from mouse to man[J].Trends Endocrinol Metab,2011,22:259-265.
[18]Shorakae S,Ranasinha S,Abell S,et al.Inter-related effects of insulin resistance,hyperandrogenism,sympathetic dysfunction and chronic inflammation in PCOS[J].Clin Endocrinol(Oxf),2018:doi:10.1111/cen.13808.
[19]Brieger K,Schiavone S,Miller FJ Jr,et al.Reactive oxygen species:from health to disease[J].Swiss Med Wkly,2012,142:w13659.doi:10.4414/smw.2012.13659.
[20]González F,Rote NS,Minium J,et al.Reactive oxygen species-induced oxidative stress in the development of insulin resistance and hyperandrogenism in polycystic ovary syndrome[J].Clin Endocrinol Metab,2006,91:336-340.
[21]Arslan S,Akdevelioˇglu Y.The relationship between female reproductive functions and vitamin D[J].J Am Coll Nutr,2018,37:546-551.
[22]Gupta T,Rawat M,Gupta N,et al.Study of effect of vitamin D supplementation on the clinical,hormonal and metabolic profile of the PCOS women[J].Obstet Gynaecol India,2017,67:349-355.
[23]Sharifi F,Mazloomi S,Hajihosseini R,et al.Serum magnesium concentrations in polycystic ovary syndrome and its association with insulin resistance[J].Gynecol Endocrinol,2012,28:7-11.
[24]Chakraborty P,Ghosh S,Goswami SK,et al.Altered trace mineral milieu might play an aetiological role in the pathogenesis of polycystic ovary syndrome[J].Biol Trace Elem Res,2013,152:9-15.
[25]贾月月,刘洪彬,李婧博,等.多囊卵巢综合征患者颗粒细胞microRNA-200b的表达及影响[J].山东大学学报(医学版),2017,55:63-68.
[26]Shi L,Liu S,Zhao W,et al.miR-483-5p and miR-486-5p are down-regulated in cumulus cells of metaphase II oocytes from women with polycystic ovary syndrome[J/OL].Reprod Biomed Online,2015,31:565-572.
[27]DeFronzo RA,Tobin JD,Andres R.Glucose clamp technique:a method for quantifying insulin secretion and resistance[J].AmJ Physiol,1979,237:E214-223.
[28]Matthews DR,Hosker JP,Rudenski AS,et al.Homeostasis model assessment:insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J].Diabetologia,1985,28:412-419.
[29]Katz A,Nambi SS,Mather K,et al.Quantitative insulin sensitivity check index:a simple,accurate method for assessing insulin sensitivity in humans[J].Clin Endocrinol Metab,2000,85:2402-2410.
[30]Ducluzeau PH,Cousin P,Malvoisin E,et al.Glucose-toinsulin ratio rather than sex hormone-binding globulin and adiponectin levels is the best predictor of insulin resistance in nonobese women with polycystic ovary syndrome[J].Clin Endocrinol Metab,2003,88:3626-3631.
[31]Jin P,Xie Y.Treatment strategies for women with polycystic ovary syndrome[J].Gynecol Endocrinol,2018,34:272-277.
[32]Panidis D,Tziomalos K,Papadakis E,et al.Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome:impact on metabolism and fertility[J].Endocrine,2013,44:583-590.
[33]Kogure GS,Silva RC,Miranda-Furtado CL,et al.Hyperandrogenism enhances muscle strength after progressive resistance training,independent of body composition,in women with polycystic ovary syndrome[J].J Strength Cond Res,2018,32:2642-2651.
[34]Cheema BS,Vizza L,Swaraj S.Progressive resistance training in polycystic ovary syndrome:can pumping iron improve clinical outcomes?[J].Sports Med,2014,44:1197-1207.
[35]Kalem MN,Kalem Z,Gurgan T.Effect of metformin and oral contraceptives on polycystic ovary syndrome and IVF cycles[J].Endocrinol Invest,2017,40:745-752.
[36]Du Q,Yang S,Wang YJ,et al.Effects of thiazolidinediones on polycystic ovary syndrome:a meta-analysis of randomized placebo-controlled trials[J].Adv Ther,2012,29:763-774.
[37]Sathyapalan T,Coady AM,Kilpatrick ES,et al.The effect of atorvastatin on pancreatic beta cell requirement in women with polycystic ovary syndrome[J].Endocr Connect,2017,6:811-816.
[38]Kamenov Z,Kolarov G,Gateva A,et al.Ovulation induction with myo-inositol alone and in combination with clomiphene citrate in polycystic ovarian syndrome patients with insulin resistance[J].Gynecol Endocrinol,2015,31:131-135.
[39]Zeng L,Yang K.Effectiveness of myoinositol for polycystic ovary syndrome:a systematic review and meta-analysis[J].Endocrine,2018,59:30-38.
[40]Kumar P,Arora S.Orlistat in polycystic ovarian syndrome reduces weight with improvement in lipid profile and pregnancy rates[J].J Hum Reprod Sci,2014,7:255-261.
[41]Panidis D,Tziomalos K,Papadakis E,et al.Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome:impact on metabolism and fertility[J].Endocrine,2013,44:583-590.
[42]Tao T,Wu P,Wang Y.Comparison of glycemic control andβ-cell function in new onset T2DM patients with PCOS of metformin and saxagliptin monotherapy or combination treatment[J].BMC Endocr Disord,2018,18:14.
[43]Wu Y,Li P,Zhang D,et al.Metformin and pioglitazone combination therapy ameliorate polycystic ovary syndrome through AMPK/PI3K/JNK pathway[J].Exp Ther Med,2018,15:2120-2127.
[44]Matsuzaki T,Tungalagsuvd A,Iwasa T,et al.Clinical outcome of various metformin treatments for women with polycystic ovary syndrome[J].Reprod Med Biol,2017,16:179-187.
[45]Jamilian M,Maktabi M,Asemi Z.A trial on the effects of magnesium-zinc-calcium-vitamin D co-supplementation on glycemic control and markers of cardio-metabolic risk in women with polycystic ovary syndrome[J].Arch Iran Med,2017,20:640-645.
[46]Liang F,Koya D.Acupuncture:is it effective for treatment of insulin resistance?[J].Diabetes Obes Metab,2010,12:555-569.
[47]Mohammadi S,Karimzadeh Bardei L,Hojati V,et al.Antiinflammatory effects of curcumin on insulin eesistance index,levels of interleukin-6,C-reactive protein,and liver histology in polycystic ovary syndrome-induced rats[J].Cell J,2017,19:425-433.
[48]Li Y,Ma H,Zhang Y,et al.Effect of berberine on insulin resistance in women with polycystic ovary syndrome:study protocol for a randomized multicenter controlled trial[J].Trials,2013,14:226.doi:10.1186/1745-6215-14-226.