Díaz Marta, Gallego-Escuredo José Miguel, López-Bermejo Abel, de Zegher Francis, Villarroya Francesc, Ibáñez Lourdes
Endocrinology, Institut Pediàtric Hospital Sant Joan de Déu, University of Barcelona, Esplugues, 08950 Barcelona, Spain.
Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain.
Int J Endocrinol. 2018 Jul 19;2018:4192940. doi: 10.1155/2018/4192940. eCollection 2018.
Fetuin-A is a glycoprotein produced in the liver and related to metabolic syndrome; fetuin-A secretion is divergently regulated in different pathological conditions. In girls with polycystic ovary syndrome (PCOS), insulin sensitization results in a more favorable endocrine-metabolic outcome than oral contraception; we assessed whether those differences are underscored by changes in circulating fetuin-A.
Fetuin-A concentration endocrine-metabolic markers and hepatovisceral fat were measured longitudinally in 35 PCOS girls [age, 16 yr; body mass index (BMI), 23 kg/m] randomized to receive either oral contraception [ethinylestradiol-levonorgestrel ( = 18)] or a low-dose combination of spironolactone, pioglitazone, and metformin (SPIOMET, = 17) over 12 months. Healthy adolescent girls (age- and BMI-matched) were used as controls ( = 25).
Pretreatment fetuin-A serum levels in PCOS girls were lower than those in controls. After 12 months on treatment, fetuin-A raised to control levels only in the SPIOMET subgroup ( = 0.009, versus oral contraception); this increase was paralleled by a healthier metabolic profile with less hepatic fat (by MRI); baseline serum fetuin-A as well as the changes over 12 months was inversely related to hepatic adiposity.
A low-dose combination of insulin sensitizers and an antiandrogen-but not oral contraception-normalizes fetuin-A levels in adolescent girls with PCOS. This trial is registered with ISRCTN29234515.
胎球蛋白-A是一种在肝脏中产生的糖蛋白，与代谢综合征相关；在不同病理条件下，胎球蛋白-A的分泌受到不同调节。在患有多囊卵巢综合征（PCOS）的女孩中，胰岛素增敏治疗比口服避孕药能带来更有利的内分泌代谢结果；我们评估了循环胎球蛋白-A的变化是否突出了这些差异。
对35名PCOS女孩[年龄16岁；体重指数（BMI）23kg/m²]进行纵向测量，检测其胎球蛋白-A浓度、内分泌代谢标志物和肝内脏脂肪，这些女孩被随机分为接受口服避孕药[炔雌醇-左炔诺孕酮（n = 18）]或螺内酯、吡格列酮和二甲双胍的低剂量组合（SPIOMET，n = 17）治疗12个月。健康的青春期女孩（年龄和BMI匹配）作为对照（n = 25）。
PCOS女孩治疗前的胎球蛋白-A血清水平低于对照组。治疗12个月后，仅SPIOMET亚组的胎球蛋白-A升高至对照水平（P = 0.009，与口服避孕药组相比）；这种升高伴随着更健康的代谢状况和更少的肝脏脂肪（通过MRI检测）；基线血清胎球蛋白-A以及12个月内的变化与肝脏脂肪含量呈负相关。
胰岛素增敏剂和抗雄激素的低剂量组合——而非口服避孕药——可使患有PCOS的青春期女孩的胎球蛋白-A水平正常化。本试验已在ISRCTN29234515注册。
