Shokeir T, El-Kannishy G
Department of Obstetrics and Gynecology Mansoura University Hospital Mansoura Faculty of Medicine, Mansoura, Egypt -
Minerva Ginecol. 2014 Apr;66(2):209-18.
The aim of this paper was to investigate whether laparoscopic ovarian drilling (LOD) has an effect on endothelial function in women with polycystic ovary syndrome (PCOS) using well validated marker of brachial artery flow-mediated dilation (FMD) and to determine which hormonal and/or metabolic parameters are responsible for postoperative endothelial response.
In a prospective pilot trial, 34 infertile women with PCOS were studied for measurement of brachial artery FMD and insulin-like growth factor (IGF)-I. Blood samples for total testosterone (T), sex hormone binding globulin (SHBG), lipid profile as well as insulin resistance index (HOMA-IR) were measured before and 3 months after LOD. Twenty-six normal fertile subjects matched for age and body mass index (BMI) served as control group.
Baseline %FMD in patients with PCOS was significantly lower than that in control subjects. After LOD 24 women had increased %FMD (responders), whereas 10 women had decreased or unchanged %FMD (non-responders). However, neither fasting plasma glucose, insulin levels nor HOMA-IR changed after LOD. Serum levels of T, IGF-1, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and sex-hormone binding globulin (SHBG) significantly decreased whereas high-density lipoprotein cholesterol (HDL-C) significantly increased (P<.05). Responders had significantly lower baseline %FMD than did non-responders and both IGF-I and T significantly decreased in responders, but not in non-responders after LOD (P<0.05). Simple regression analysis revealed that the change of %FMD showed a significant negative correlation (r=-0.731, P=0.007) with that of LDL-C, but not with IGF-1 nor T in responders.
Women with PCOS have evidence for endothelial dysfunction which might be improved shortly after LOD. This results from decrease in LDL-C rather than decrease in androgens and/or IGF-1 per se.
本文旨在利用经过充分验证的肱动脉血流介导的血管舒张（FMD）标志物，研究腹腔镜卵巢打孔术（LOD）对多囊卵巢综合征（PCOS）女性内皮功能的影响，并确定哪些激素和/或代谢参数负责术后内皮反应。
在一项前瞻性试点试验中，对34名患有PCOS的不孕女性进行了肱动脉FMD和胰岛素样生长因子（IGF）-I的测量。在LOD术前和术后3个月测量总睾酮（T）、性激素结合球蛋白（SHBG）、血脂谱以及胰岛素抵抗指数（HOMA-IR）的血样。26名年龄和体重指数（BMI）相匹配的正常可育受试者作为对照组。
PCOS患者的基线FMD百分比显著低于对照组。LOD术后，24名女性的FMD百分比增加（反应者），而10名女性的FMD百分比降低或不变（无反应者）。然而，LOD术后空腹血糖、胰岛素水平和HOMA-IR均未改变。血清T、IGF-1、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和性激素结合球蛋白（SHBG）水平显著降低，而高密度脂蛋白胆固醇（HDL-C）显著升高（P<0.05）。反应者的基线FMD百分比显著低于无反应者，LOD术后反应者的IGF-I和T均显著降低，而无反应者则未降低（P<0.05）。简单回归分析显示，反应者中FMD百分比的变化与LDL-C的变化呈显著负相关（r=-0.731，P=0.007），而与IGF-1和T无关。
PCOS女性存在内皮功能障碍证据，LOD术后短期内可能改善。这是由于LDL-C降低而非雄激素和/或IGF-1本身降低所致
