Huber-Buchholz M M, Carey D G, Norman R J
Reproductive Medicine Unit, University of Adelaide, Queen Elizabeth Hospital, Woodville, South Australia, Australia.
J Clin Endocrinol Metab. 1999 Apr;84(4):1470-4. doi: 10.1210/jcem.84.4.5596.
Weight reduction and exercise have been shown to help with menstrual disturbance and infertility in obese women with polycystic ovary syndrome. We studied the relationship between insulin sensitivity and ovulation patterns in 18 infertile anovulatory obese polycystic ovary syndrome (PCOS) women (NO) with normal glucose tolerance, aged between 22-39 yr with a body mass index of 27-45 kg/m2, before and after a 6-month diet and exercise program. This program promotes healthy lifestyle factors, but does not lead to rapid weight loss. The anthropometric, metabolic, and endocrine factors of these subjects were compared to those of 10 age- and weight-matched PCOS women with regular monthly ovulation (RO). Before lifestyle modification, the anovulatory subjects had greater central obesity than regular ovulators, as assessed by percent central fat (NO, 45.7 +/- 0.8%; RO, 42.2 +/- 1.6%; P < 0.05), higher glucose increment after glucose challenge (NO, 10.1 +/- 1.0 mmol/L; RO, 6.4 +/- 1.1 mmol/L; P < 0.02), lower insulin sensitivity index (NO, 1.2 +/- 0.2; RO, 2.8 +/- 0.6 micromol/kg x min/pmol/L; P < 0.005), higher plasma LH (NO, 8.9 +/- 0.9; RO, 4.6 +/- 0.9 IU/L; P < 0.005), and lower plasma sex hormone-binding globulin (NO, 18.0 +/- 2.5; RO, 27.8 +/- 5.7 nmol/L; P < 0.05]. Anovulatory subjects were classified as responders (R) to the intervention if they regained ovulation during the study. As a result of intervention, R showed an 11% reduction in central fat, a 71% improvement in insulin sensitivity index, a 33% fall in fasting insulin levels, and a 39% reduction in LH levels. None of these parameters changed significantly in nonresponders (NR). At the end of the study, R had lower fasting insulin (R, 13.6 +/- 1.7; NR, 23.0 +/- 3.5 mU/L) and LH levels (R, 5.0 +/- 1.7; NR, 7.4 +/- 1.4 IU/L), but similar androgen levels compared to NR. We conclude that lifestyle modification without rapid weight loss leads to a reduction of central fat and improved insulin sensitivity, which restores ovulation in overweight infertile women with PCOS. Lifestyle modification is the best initial management for obese women seeking to improve their reproductive function.
体重减轻和运动已被证明有助于改善患有多囊卵巢综合征的肥胖女性的月经紊乱和不孕症。我们研究了18名糖耐量正常、年龄在22 - 39岁、体重指数为27 - 45kg/m²的不育无排卵肥胖多囊卵巢综合征（PCOS）女性（NO组）在进行为期6个月的饮食和运动计划前后胰岛素敏感性与排卵模式之间的关系。该计划促进健康的生活方式因素，但不会导致快速体重减轻。将这些受试者的人体测量、代谢和内分泌因素与10名年龄和体重匹配、月经周期规律有排卵的PCOS女性（RO组）进行比较。在生活方式改变之前，通过中心脂肪百分比评估，无排卵受试者的中心性肥胖程度高于规律排卵者（NO组，45.7±0.8%；RO组，42.2±1.6%；P<0.05），葡萄糖耐量试验后血糖升高幅度更大（NO组，10.1±1.0mmol/L；RO组，6.4±1.1mmol/L；P<0.02），胰岛素敏感性指数更低（NO组，1.2±0.2；RO组，2.8±0.6μmol/kg·min/pmol/L；P<0.005），血浆促黄体生成素（LH）水平更高（NO组，8.9±0.9；RO组，4.6±0.9IU/L；P<0.005），血浆性激素结合球蛋白水平更低（NO组，18.0±2.5；RO组，27.8±5.7nmol/L；P<0.05）。如果无排卵受试者在研究期间恢复排卵，则将其分类为对干预有反应者（R组）。干预的结果是，R组中心脂肪减少11%，胰岛素敏感性指数提高71%，空腹胰岛素水平下降33%，LH水平下降39%。无反应者（NR组）的这些参数均无显著变化。在研究结束时，R组的空腹胰岛素（R组，13.6±1.7；NR组，23.0±3.5mU/L）和LH水平（R组，5.0±1.7；NR组，7.4±1.4IU/L）更低，但与NR组的雄激素水平相似。我们得出结论，不快速减重的生活方式改变可导致中心脂肪减少和胰岛素敏感性改善，从而使超重的PCOS不育女性恢复排卵。生活方式改变是寻求改善生殖功能的肥胖女性的最佳初始治疗方法。
