Meenakumari K J, Agarwal S, Krishna A, Pandey L K
Department of Zoology, Banaras Hindu University, Varanasi, India.
Braz J Med Biol Res. 2004 Nov;37(11):1637-44. doi: 10.1590/s0100-879x2004001100007. Epub 2004 Oct 26.
The causes of luteal phase progesterone deficiency in polycystic ovary syndrome (PCOS) are not known. To determine the possible involvement of hyperinsulinemia in luteal phase progesterone deficiency in women with PCOS, we examined the relationship between progesterone, luteinizing hormone (LH) and insulin during the luteal phase and studied the effect of metformin on luteal progesterone levels in PCOS. Patients with PCOS (19 women aged 18-35 years) were treated with metformin (500 mg three times daily) for 4 weeks prior to the test cycle and throughout the study period, and submitted to ovulation induction with clomiphene citrate. Blood samples were collected from control (N = 5, same age range as PCOS women) and PCOS women during the late follicular (one sample) and luteal (3 samples) phases and LH, insulin and progesterone concentrations were determined. Results were analyzed by one-way analysis of variance (ANOVA), Duncan's test and Karl Pearson's coefficient of correlation (r). The endocrine study showed low progesterone level (4.9 ng/ml) during luteal phase in the PCOS women as compared with control (21.6 ng/ml). A significant negative correlation was observed between insulin and progesterone (r = -0.60; P < 0.01) and between progesterone and LH (r = -0.56; P < 0.05) concentrations, and a positive correlation (r = 0.83; P < 0.001) was observed between LH and insulin. The study further demonstrated a significant enhancement in luteal progesterone concentration (16.97 ng/ml) in PCOS women treated with metformin. The results suggest that hyperinsulinemia/insulin resistance may be responsible for low progesterone levels during the luteal phase in PCOS. The luteal progesterone level may be enhanced in PCOS by decreasing insulin secretion with metformin.
多囊卵巢综合征（PCOS）中黄体期孕酮缺乏的原因尚不清楚。为了确定高胰岛素血症在PCOS女性黄体期孕酮缺乏中可能起到的作用，我们研究了黄体期孕酮、促黄体生成素（LH）和胰岛素之间的关系，并探讨了二甲双胍对PCOS患者黄体期孕酮水平的影响。PCOS患者（19名年龄在18 - 35岁之间的女性）在测试周期前4周及整个研究期间接受二甲双胍治疗（每日3次，每次500mg），并接受枸橼酸氯米芬促排卵治疗。在卵泡晚期（采集1次样本）和黄体期（采集3次样本）从对照组（N = 5，年龄范围与PCOS女性相同）和PCOS女性中采集血样，测定LH、胰岛素和孕酮浓度。结果采用单因素方差分析（ANOVA）、邓肯检验和卡尔·皮尔逊相关系数（r）进行分析。内分泌研究显示，PCOS女性黄体期孕酮水平（4.9 ng/ml）低于对照组（21.6 ng/ml）。胰岛素与孕酮浓度之间存在显著负相关（r = -0.60；P < 0.01），孕酮与LH浓度之间也存在显著负相关（r = -0.56；P < 0.05），而LH与胰岛素之间存在正相关（r = 0.83；P < 0.001）。该研究进一步表明，接受二甲双胍治疗的PCOS女性黄体期孕酮浓度显著升高（16.97 ng/ml）。结果提示，高胰岛素血症/胰岛素抵抗可能是PCOS女性黄体期孕酮水平降低的原因。通过二甲双胍降低胰岛素分泌，可提高PCOS患者的黄体期孕酮水平。
