Jain Priyanka, Jain Madhu, Haldar Chandana, Singh Tej Ball, Jain Shuchi
Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Zoology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
J Hum Reprod Sci. 2013 Oct;6(4):253-8. doi: 10.4103/0974-1208.126295.
Polycystic ovarian syndrome (PCOS) is considered to be the most common endocrine disorder affecting women. Melatonin, a small lipophilic indoleamine, and reproductive hormones may be interrelated. Melatonin influences sex steroid production at different stages of ovarian follicular maturation as melatonin receptors have been demonstrated at multiple sites in ovary and in intrafollicular fluid. It plays role as an antioxidant and free radical scavanger which protects follicles from oxidative stress, rescuing them from atresia, leading to complete follicular maturation and ovulation.
To study the role of melatonin in PCOS and to investigate its correlation with testosterone in patients suffering from PCOS.
A total of 50 women with PCOS (Rotterdam criteria, 2003) and 50 age and weight matched healthy controls were selected and serum melatonin estimation was done in both the groups and correlated with serum total testosterone levels.
In a case-control study, detailed history, clinical examination and hormonal evaluation [basal levels of leutinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, prolactin, insulin, total testosterone, progesterone and melatonin] were carried out in all the participants including both cases and controls. For melatonin estimation, blood samples were collected between 12:00 am and 04:00 am on day 2(nd) of menstrual cycle and analyzed by using commercially available enzyme-linked immunosorbent assay kit.
Student's t-test was used to compare the significant difference in mean values between cases and control groups. Chi-square test was used to test the significant association between the qualitative variables. Linear correlation coefficient and regression analysis were done to see the amount and direction of relationship between quantitative variables.
The mean melatonin level was observed to be significantly increased in patients (63.27 ± 10.97 pg/mL) than in controls (32.51 ± 7.55 pg/mL). Melatonin was found to be raised in all the cases of PCOS (above cut-off value of ≥45 pg/mL, P < 0.001). Total testosterone level was also raised in 72% of patients. Melatonin levels were found to be positively associated with increased testosterone (P < 0.001). In regression analysis using melatonin as dependent variable and testosterone as an independent variable, the value of R2 Χ 100 (percent variation) was found to be 72.1%.
Women with PCOS have significantly raised serum melatonin levels and hyperandrogenemia along with increased number of atretic follicles. Further studies are required to establish a definite role of melatonin in PCOS cases with disturbed hormonal milieu. This could open up the way for therapeutic role of melatonin in treatment of patients suffering from PCOS.
多囊卵巢综合征（PCOS）被认为是影响女性的最常见内分泌疾病。褪黑素是一种亲脂性小分子吲哚胺，与生殖激素可能存在关联。褪黑素在卵巢卵泡成熟的不同阶段影响性类固醇的产生，因为已在卵巢和卵泡液中的多个部位证实了褪黑素受体。它作为一种抗氧化剂和自由基清除剂发挥作用，保护卵泡免受氧化应激，使其免于闭锁，从而导致卵泡完全成熟和排卵。
研究褪黑素在PCOS中的作用，并调查其与PCOS患者睾酮的相关性。
选取50例符合2003年鹿特丹标准的PCOS女性患者以及50例年龄和体重匹配的健康对照，对两组进行血清褪黑素测定，并将其与血清总睾酮水平进行相关性分析。
在一项病例对照研究中，对所有参与者（包括病例组和对照组）进行详细的病史、临床检查和激素评估[促黄体生成素、促卵泡生成素、促甲状腺激素、催乳素、胰岛素、总睾酮、孕酮和褪黑素的基础水平]。为了测定褪黑素，在月经周期第2天的上午12:00至凌晨04:00采集血样，并使用市售的酶联免疫吸附测定试剂盒进行分析。
采用学生t检验比较病例组和对照组均值的显著差异。采用卡方检验检验定性变量之间的显著关联。进行线性相关系数和回归分析以观察定量变量之间关系的数量和方向。
观察到患者的平均褪黑素水平（63.27±10.97 pg/mL）显著高于对照组（32.51±7.55 pg/mL）。在所有PCOS病例中均发现褪黑素升高（高于≥45 pg/mL的临界值，P<0.001）。72%的患者总睾酮水平也升高。发现褪黑素水平与睾酮升高呈正相关（P<0.001）。在以褪黑素为因变量、睾酮为自变量的回归分析中，R2×100（变异百分比）的值为72.1%。
PCOS女性患者血清褪黑素水平显著升高，伴有高雄激素血症和闭锁卵泡数量增加。需要进一步研究以确定褪黑素在激素环境紊乱的PCOS病例中的明确作用。这可能为褪黑素在PCOS患者治疗中的治疗作用开辟道路。
