Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Esplugues, Barcelona, Spain.
Gynecol Endocrinol. 2011 Mar;27(3):197-8. doi: 10.3109/09513590.2010.490612. Epub 2010 Jun 8.
Randomized studies have disclosed that ethinylestradiol-drospirenone and flutamide-metformin have divergent effects on the body adiposity and adipokines of adolescents and young women with hyperinsulinemic androgen excess. We have now tested in 41 patients from those original studies whether the divergent effects on body adiposity could be mediated by divergent levels of follistatin, an adipokine that promotes subcutaneous adipogenesis. Circulating follistatin was measured, at study start and after 9 months, with an enzyme-linked immunosorbent assay. Treatment with ethinylestradiol-drospirenone was accompanied by a more adipose body composition and by a nearly 4-fold rise of follistatinemia (P<0.0001). In contrast, treatment with low-dose flutamide-metformin did not increase body adiposity and did not alter follistatinemia detectably. Finally, combined treatment with ethinylestradiol-drospirenone and flutamide-metformin was accompanied by an intermediate (2- to 3-fold) rise of follistatinemia (P<0.005). In conclusion, the principle that ethinylestradiol-drospirenone and flutamide-metformin exert diverging effects on adipokines is herewith broadened to include circulating follistatin. Hyperfollistatinemia may be among the mechanisms whereby oral contraceptives aggravate the body adiposity of adolescents and young women with hyperinsulinemic androgen excess.
随机研究表明，炔雌醇-屈螺酮和氟他胺-二甲双胍对存在高胰岛素血症伴高雄激素血症的青少年和年轻女性的体脂和脂肪因子有不同的影响。我们现在在来自这些原始研究的 41 名患者中进行了测试，以确定对体脂的不同影响是否可以通过不同水平的卵泡抑素来介导，卵泡抑素是一种促进皮下脂肪生成的脂肪因子。采用酶联免疫吸附试验在研究开始时和 9 个月后测量循环卵泡抑素水平。炔雌醇-屈螺酮治疗伴随着更具脂肪的身体成分和卵泡抑素血症近 4 倍的升高（P<0.0001）。相比之下，小剂量氟他胺-二甲双胍治疗不会增加体脂，也不会明显改变卵泡抑素血症。最后，炔雌醇-屈螺酮和氟他胺-二甲双胍联合治疗伴随着卵泡抑素血症的中度（2-3 倍）升高（P<0.005）。总之，炔雌醇-屈螺酮和氟他胺-二甲双胍对脂肪因子产生不同影响的原则在此基础上扩大到包括循环卵泡抑素。高卵泡抑素血症可能是口服避孕药加重存在高胰岛素血症伴高雄激素血症的青少年和年轻女性体脂的机制之一。
