Department of Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy.
J Endocrinol Invest. 2011 Oct;34(9):685-91. doi: 10.3275/7726. Epub 2011 May 17.
The aims of the study were to understand the association between insulin-like factor 3 (INSL3) and functional ovarian hyperandrogenism (FOH) in PCOS and the regulatory role played by LH.
Fifteen PCOS women were classified as FOH (FOH-PCOS, no.=8) and non-FOH (NFOH-PCOS, no.=7) according to the response of 17OH-progesterone to buserelin (a GnRH analogue) with respect to 15 controls. FOH-PCOS and NFOH-PCOS were compared for basal INSL3 levels. In addition, the effect of buserelin on INSL3 concentrations and the relationship between basal and buserelin-stimulated LH and 17OH-progesterone and INSL3 were evaluated.
Basal INSL3 levels were higher in FOH-PCOS than NFOH-PCOS (p=0.001) and controls (p=0.001), whereas they did not differ between NFOHPCOS and controls. In addition, FOH-PCOS had a higher response of LH to buserelin with respect to NFOH-PCOS. Within all PCOS women the levels of INSL3 positively correlated with free testosterone (p=0.022) and negatively with SHBG (r= p=0.031). Moreover, positive correlations with the absolute increase of 17OH-progesterone (p<0.001) and with the LH area under the curve (p=0.001) after buserelin administration were found. In the multiple regression analysis INSL3 persisted significantly correlated only with 17OH-progesterone response to buserelin. Finally, INSL3 was not significantly modified after buserelin administration either in FOHPCOS or in NFOH-PCOS.
These data suggest that INSL3 is related to FOH in PCOS women, but this association seems not to be mediated by LH, further reinforcing the concept that a pathophysiological heterogeneity for ovarian hyperandrogenism in PCOS exists.
本研究旨在探讨胰岛素样因子 3（INSL3）与多囊卵巢综合征（PCOS）患者功能性卵巢高雄激素血症（FOH）之间的关系，以及 LH 的调节作用。
根据促性腺激素释放激素类似物（buserelin）对 17-羟孕酮的反应，将 15 名 PCOS 患者分为 FOH（FOH-PCOS，n=8）和非 FOH（NFOH-PCOS，n=7）。比较 FOH-PCOS 和 NFOH-PCOS 的基础 INSL3 水平。此外，还评估了 buserelin 对 INSL3 浓度的影响，以及基础和 buserelin 刺激的 LH 与 17-羟孕酮和 INSL3 之间的关系。
FOH-PCOS 的基础 INSL3 水平高于 NFOH-PCOS（p=0.001）和对照组（p=0.001），而 NFOH-PCOS 与对照组之间无差异。此外，与 NFOH-PCOS 相比，FOH-PCOS 对 buserelin 的 LH 反应更高。在所有 PCOS 患者中，INSL3 水平与游离睾酮呈正相关（p=0.022），与 SHBG 呈负相关（r= p=0.031）。此外，与 buserelin 给药后 17-羟孕酮的绝对增加（p<0.001）和 LH 曲线下面积（p=0.001）呈正相关。多元回归分析显示，只有 INSL3 与 buserelin 对 17-羟孕酮的反应显著相关。最后，无论是在 FOH-PCOS 还是 NFOH-PCOS 患者中，INSL3 在 buserelin 给药后均无明显变化。
这些数据表明，INSL3 与 PCOS 患者的 FOH 有关，但这种关联似乎不是由 LH 介导的，进一步强化了 PCOS 中卵巢高雄激素血症存在病理生理异质性的概念。
