Luque-Ramírez Manuel, Alvarez-Blasco Francisco, Botella-Carretero José I, Sanchón Raul, San Millán José L, Escobar-Morreale Héctor F
Department of Endocrinology and Molecular Genetics, Hospital Universitario Ramón y Cajal and Universidad de Alcalá, Madrid, Spain.
Diabetes Care. 2007 Sep;30(9):2309-13. doi: 10.2337/dc07-0642. Epub 2007 May 29.
Increased serum ferritin levels, indicating increased body iron stores, have been found in overweight and obese women with polycystic ovary syndrome (PCOS). This finding might result from reduced menstrual losses secondary to oligo- or amenorrhea or from hyperinsulinism secondary to insulin resistance, because insulin favors the intestinal absorption and the tissue deposition of iron. To explore which of these mechanisms is responsible for the increase in body iron stores in women with PCOS, we have monitored the changes in serum ferritin levels during treatment with an antiandrogenic oral contraceptive or an insulin sensitizer.
Thirty-four consecutive PCOS patients were randomized to an oral contraceptive containing 35 microg ethinyl-estradiol plus 2 mg cyproterone acetate (Diane(35) Diario) or metformin (850 mg twice daily), and their serum ferritin levels were evaluated at baseline and after 12 and 24 weeks of treatment.
Despite the fact that treatment with Diane(35) Diario restored regular menstrual cycles in all the patients, whereas metformin only did so in 50% of them, serum ferritin levels decreased at 12 and 24 weeks of treatment only with metformin, in association with a marked increase in insulin sensitivity. On the contrary, no changes in ferritin and insulin sensitivity were observed with Diane(35) Diario.
Our present results suggest that insulin resistance and hyperinsulinism, and not the reduced menstrual losses secondary to from oligo- or amenorrhea, are responsible of the increased ferritin levels and body iron stores found in overweight and obese women with PCOS.
在患有多囊卵巢综合征(PCOS)的超重和肥胖女性中,发现血清铁蛋白水平升高,这表明体内铁储存增加。这一发现可能是由于继发于月经稀发或闭经的月经失血减少,或继发于胰岛素抵抗的高胰岛素血症,因为胰岛素有利于铁的肠道吸收和组织沉积。为了探究这些机制中哪一种导致了PCOS女性体内铁储存增加,我们监测了使用抗雄激素口服避孕药或胰岛素增敏剂治疗期间血清铁蛋白水平的变化。
34例连续的PCOS患者被随机分为两组,一组服用含35μg炔雌醇加2mg醋酸环丙孕酮的口服避孕药(达英 - 35),另一组服用二甲双胍(850mg,每日两次),并在基线以及治疗12周和24周后评估她们血清铁蛋白水平。
尽管服用达英 - 35使所有患者恢复了规律月经周期,而二甲双胍仅使50%的患者恢复规律月经周期,但仅二甲双胍治疗12周和24周时血清铁蛋白水平下降,同时胰岛素敏感性显著增加。相反,服用达英 - 35时铁蛋白和胰岛素敏感性未观察到变化。
我们目前的结果表明,超重和肥胖的PCOS女性中血清铁蛋白水平升高和体内铁储存增加是由胰岛素抵抗和高胰岛素血症导致的,而非继发于月经稀发或闭经的月经失血减少。