Department of Diabetes, Endocrinology and Metabolism, Hull York Medical School, UK.
Ann Clin Biochem. 2012 Jan;49(Pt 1):80-5. doi: 10.1258/acb.2011.011071. Epub 2011 Oct 4.
Hyperandrogenaemia in polycystic ovary syndrome (PCOS) represents a composite of raised serum concentrations of testosterone, androstenedione, dehydroepiandrosterone (DHEA) and DHEA sulphate (DHEAS). In patients with PCOS, testosterone and androstenedione are primarily derived from the ovaries and DHEAS is a metabolite predominantly from the adrenals. It has been shown that atorvastatin reduces testosterone concentrations in patients with PCOS. The objective was to study the effect of atorvastatin on serum androstenedione and DHEAS concentrations in patients with PCOS.
A randomized, double-blind, placebo-controlled study was performed. Forty medication-naive patients with PCOs were randomized to either atorvastatin 20mg daily or placebo for three months. Subsequently, a three-month extension study for all patients was undertaken with metformin 1500 mg daily. The main outcome measures were change in androstenedione and DHEAS concentrations.
The mean (SD) baseline androstenedione (5.7 [0.8] versus 5.6 [1.3] nmol/L; P = 0.69) and DHEAS (7.1 [1.0] versus 7.2 [1.2] μmol/L; P = 0.72) concentrations were comparable between two groups. There was a significant reduction of androstenedione (5.7 [0.8] versus 4.7 [0.7] nmol/L; P = 0.03) and DHEAS (7.1 [1.0] versus 6.0 [0.9] μmol/L; P = 0.02) with three months of atorvastatin while there were no significant changes with placebo. Three months' treatment with metformin maintained the reduction of androstenedione and DHEAS concentrations with atorvastatin compared with baseline. There were no changes in either DHEAS or androstenedione concentrations in the initial placebo group after 12 weeks of metformin.
Twelve weeks of atorvastatin significantly reduced both DHEAS and androstenedione contributing to the total reduction of androgen concentrations and indicating that the reduction of the hyperandrogenaemia could be partly due to the action of atorvastatin at both the ovary and the adrenal gland in PCOS.
多囊卵巢综合征（PCOS）中的高雄激素血症表现为血清中睾酮、雄烯二酮、脱氢表雄酮（DHEA）和硫酸脱氢表雄酮（DHEAS）浓度升高。在 PCOS 患者中，睾酮和雄烯二酮主要来源于卵巢，而 DHEAS 主要来源于肾上腺。已有研究表明阿托伐他汀可降低 PCOS 患者的睾酮浓度。本研究旨在探讨阿托伐他汀对 PCOS 患者血清雄烯二酮和 DHEAS 浓度的影响。
本研究为一项随机、双盲、安慰剂对照研究。40 例未经药物治疗的 PCOS 患者随机分为阿托伐他汀 20mg/d 组或安慰剂组，治疗 3 个月。随后，所有患者均进行为期 3 个月的延长研究，给予二甲双胍 1500mg/d。主要观察指标为雄烯二酮和 DHEAS 浓度的变化。
两组患者的基线雄烯二酮（5.7[0.8]与 5.6[1.3]nmol/L；P=0.69）和 DHEAS（7.1[1.0]与 7.2[1.2]μmol/L；P=0.72）浓度相似。阿托伐他汀治疗 3 个月后，雄烯二酮（5.7[0.8]与 4.7[0.7]nmol/L；P=0.03）和 DHEAS（7.1[1.0]与 6.0[0.9]μmol/L；P=0.02）水平显著降低，而安慰剂组无显著变化。阿托伐他汀联合二甲双胍治疗 3 个月后，与基线相比，雄烯二酮和 DHEAS 浓度的降低得以维持。二甲双胍治疗 12 周后，初始安慰剂组的 DHEAS 和雄烯二酮浓度均无变化。
阿托伐他汀治疗 12 周可显著降低 DHEAS 和雄烯二酮水平，从而降低总雄激素浓度，表明 PCOS 患者的高雄激素血症降低可能部分归因于阿托伐他汀对卵巢和肾上腺的作用。
