Pasquali R, Antenucci D, Casimirri F, Venturoli S, Paradisi R, Fabbri R, Balestra V, Melchionda N, Barbara L
Institute of Clinical Medicine and Gastroenterology, S. Orsola Hospital, Bologna, Italy.
J Clin Endocrinol Metab. 1989 Jan;68(1):173-9. doi: 10.1210/jcem-68-1-173.
We studied a group of obese hyperandrogenic amenorrheic women to determine the effects of weight loss on anthropometry, hormonal status, menstrual cycles, ovulation, and fertility. Fourteen women had polycystic ovaries, two the hyperandrogenism-insulin resistance-acanthosis nigricans syndrome, one hirsutism of adrenal origin, and three idiopathic chronic anovulation. The duration of amenorrhea before the study ranged from 3-17 months [mean, 8.6 +/- 4.5 (+/- SD)]. All women ate a hypocaloric diet for a period of 8.0 +/- 2.4 months. Weight loss ranged from 4.8 to 15.2 kg (mean, 9.7 +/- 3.1 kg; 1.35 +/- 0.56 kg/month) and the waist to hip ratio, which was used as a measurement of body fat distribution, decreased from 0.86 +/- 0.1 to 0.81 +/- 0.06 (P less than 0.0001). The women's mean plasma testosterone and LH concentrations decreased significantly (P less than 0.001 and P less than 0.005, respectively). A significant positive correlation was found between the decreases in plasma testosterone levels and the decreases in glucose-stimulated insulin levels. Moreover, the decreases in the waist to hip ratio correlated positively with the decreases in glucose-stimulated insulin levels and inversely with the decreases in plasma 17 beta-estradiol. No relationships were found between weight loss and the changes in plasma insulin, steroid, and gonadotropin concentrations. The responsiveness to the weight reduction program was evaluated by comparing the number of menstrual cycles during the study period with the number reported before it. Eight women had significantly improved menstrual cyclicity (responders), while 12 did not (nonresponders). The clinical characteristics and hormone values were similar in responder and nonresponder women. In the group as a whole, 33% of the menstrual cycles during the study were ovulatory, and 4 pregnancies occurred. Hirsutism improved significantly in more than half of the women, as did acanthosis nigricans when present. We conclude that weight loss is beneficial in all obese hyperandrogenic women regardless of the presence of polycystic ovaries, the degree of hyperandrogenism, and the degree and distribution of obesity.
我们研究了一组肥胖的高雄激素性闭经女性，以确定体重减轻对人体测量学、激素状态、月经周期、排卵和生育能力的影响。14名女性患有多囊卵巢，2名患有高雄激素血症-胰岛素抵抗-黑棘皮综合征，1名患有肾上腺源性多毛症，3名患有特发性慢性无排卵。研究前闭经持续时间为3至17个月[平均，8.6±4.5（±标准差）]。所有女性均食用低热量饮食8.0±2.4个月。体重减轻范围为4.8至15.2千克（平均，9.7±3.1千克；1.35±0.56千克/月），用作身体脂肪分布测量指标的腰臀比从0.86±0.1降至0.81±0.06（P<0.0001）。女性的平均血浆睾酮和促黄体生成素（LH）浓度显著降低（分别为P<0.001和P<0.005）。血浆睾酮水平的降低与葡萄糖刺激的胰岛素水平的降低之间存在显著正相关。此外，腰臀比的降低与葡萄糖刺激的胰岛素水平的降低呈正相关，与血浆17β-雌二醇的降低呈负相关。未发现体重减轻与血浆胰岛素、类固醇和促性腺激素浓度的变化之间存在关联。通过比较研究期间的月经周期数与之前报告的月经周期数来评估对体重减轻计划的反应性。8名女性的月经周期显著改善（反应者），而12名女性则未改善（无反应者）。反应者和无反应者女性的临床特征和激素值相似。在整个组中，研究期间33%的月经周期有排卵，并且发生了4次妊娠。超过一半的女性多毛症显著改善，存在黑棘皮症的女性也是如此。我们得出结论，体重减轻对所有肥胖的高雄激素女性有益，无论是否存在多囊卵巢、高雄激素血症的程度以及肥胖的程度和分布情况如何。
