Kiddy D S, Hamilton-Fairley D, Bush A, Short F, Anyaoku V, Reed M J, Franks S
Department of Obstetrics and Gynaecology, Imperial College of Science, Technology and Medicine, St Mary's Hospital Medical School, London, UK.
Clin Endocrinol (Oxf). 1992 Jan;36(1):105-11. doi: 10.1111/j.1365-2265.1992.tb02909.x.
Obese women with polycystic ovary syndrome have a greater frequency of menstrual disturbance and of hirsutism than lean women with the syndrome. Initial studies have demonstrated a marked improvement in endocrine function following a short-term, very low calorie diet. The purpose of this study was to examine the effect of long-term calorie restriction on clinical as well as biochemical abnormalities in obese women with polycystic ovary syndrome.
We performed a within-group comparison of clinical and biochemical indices before and during dietary treatment.
Twenty-four obese women with polycystic ovary syndrome (mean weight 91.5 (SD 14.7) kg) were scheduled for treatment for 6-7 months with a 1000 kcal, low fat diet. Nineteen of the 24 had menstrual disturbances, 12 had infertility and 19 were hirsute.
Thirteen subjects lost more than 5% of their starting weight (range 5.9-22%). In this group there was no significant change in gonadotrophin or total serum testosterone levels but there was a marked increase in concentrations of sex hormone-binding globulin (pretreatment: 23.6 (9.5); post-treatment 36.3 (11.8) nmol/l, P = 0.002) and a reciprocal change in free testosterone levels (77 (26) vs 53 (21) pmol/l, P = 0.009). These changes were accompanied by a reduction in fasting serum insulin levels (median (range) 11.2 (5.2-32) vs 2.3 (0.1-13.8) mU/l, P = 0.018) and the insulin response to 75 g oral glucose. There were no significant changes in these indices in the group who lost less than 5% of their initial body weight. Of the 13 women who lost greater than 5% of their pretreatment weight, 11 had menstrual dysfunction. Amongst these women, nine of 11 showed an improvement in reproductive function, i.e. they either conceived (five) or experienced a more regular menstrual pattern. There was a reduction in hirsutism in 40% of the women in this group. By contrast, in the group who lost less than 5% of their initial weight, only one of the eight with menstrual disturbances noted an improvement in reproductive function and none had a significant reduction in hirsutism.
These data indicate that moderate weight loss during long-term calorie restriction is associated with a marked clinical improvement which reflects the reduction in insulin concentrations and reciprocal changes in SHBG. The improvement in menstrual function and fertility may therefore be consequent upon an increase in insulin sensitivity which, directly or indirectly, affects ovarian function.
患有多囊卵巢综合征的肥胖女性比患有该综合征的瘦女性出现月经紊乱和多毛症的频率更高。初步研究表明，短期极低热量饮食后内分泌功能有显著改善。本研究的目的是探讨长期热量限制对患有多囊卵巢综合征的肥胖女性临床及生化异常的影响。
我们对饮食治疗前后的临床和生化指标进行了组内比较。
24名患有多囊卵巢综合征的肥胖女性（平均体重91.5（标准差14.7）千克）计划接受为期6 - 七个月的1000千卡低脂饮食治疗。24名患者中有19名有月经紊乱，12名不孕，19名多毛。
13名受试者体重减轻超过起始体重的5%（范围5.9 - 22%）。在该组中，促性腺激素或总血清睾酮水平无显著变化，但性激素结合球蛋白浓度显著升高（治疗前：23.6（9.5）；治疗后36.3（11.8）nmol/l，P = 0.002），游离睾酮水平呈相反变化（77（26）对53（21）pmol/l，P = 0.009）。这些变化伴随着空腹血清胰岛素水平降低（中位数（范围）11.2（5.2 - 32）对2.3（0.1 - 13.8）mU/l，P = 0.018）以及对75克口服葡萄糖的胰岛素反应降低。体重减轻少于初始体重5%的组中，这些指标无显著变化。在体重减轻超过治疗前体重5%的13名女性中，11名有月经功能障碍。在这些女性中，11名中有9名生殖功能改善，即她们要么怀孕（5名）要么月经周期更规律。该组40%的女性多毛症减轻。相比之下，在体重减轻少于初始体重5%的组中，8名有月经紊乱的女性中只有1名生殖功能改善，且无人多毛症显著减轻。
这些数据表明，长期热量限制期间适度体重减轻与显著的临床改善相关，这反映了胰岛素浓度降低以及性激素结合球蛋白的相应变化。月经功能和生育能力改善可能因此是胰岛素敏感性增加的结果，胰岛素敏感性直接或间接影响卵巢功能。
