Department of Obstetrics and GynecologyPenn State College of Medicine, Hershey, PA.
Department of Public Health SciencesPenn State College of Medicine, Hershey, PA.
J Clin Endocrinol Metab. 2021 Jan 1;106(1):108-119. doi: 10.1210/clinem/dgaa682.
To examine the effects of common treatments for polycystic ovary syndrome (PCOS) on a panel of hormones (reproductive/metabolic).
Secondary analysis of blood from a randomized controlled trial of three 16-week preconception interventions designed to improve PCOS-related abnormalities: continuous oral contraceptive pills (OCPs, N = 34 subjects), intensive lifestyle modification (Lifestyle, N = 31), or a combination of both (Combined, N = 29).
Post-treatment levels of activin A and B, inhibin B, and follistatin (FST), as well as Insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 2 (IGFBP-2), glucagon, glucagon-like peptide 1 (GLP-1) and 2, and oxyntomodulin were compared to baseline, and the change from baseline in these parameters were correlated with outcomes.
Oral contraceptive pill use was associated with a significant suppression in activin A, inhibin A, and anti-mullerian hormone (AMH), but a significant increase in FST. IGF-1, IGFBP-2, glucagon, and GLP-2 levels were significantly decreased. Oxyntomodulin was profoundly suppressed by OCPs (ratio of geometric means: 0.09, 95% confidence interval [CI]: 0.05, 0.18, P < 0.001). None of the analytes were significantly affected by Lifestyle, whereas the effects of Combined were similar to OCPs alone, although attenuated. Oxyntomodulin was significantly positively associated with the change in total ovarian volume (rs = 0.27; 95% CI: 0.03, 0.48; P = 0.03) and insulin sensitivity index (rs = 0.48; 95% CI: 0.27, 0.64; P < 0.001), and it was inversely correlated with change in area under the curve (AUC) glucose [rs = -0.38; 95% CI: -0.57, -0.16; P = 0.001]. None of the hormonal changes were associated with live birth, only Activin A was associated with ovulation (risk ratio per 1 ng/mL increase in change in Activin A: 6.0 [2.2, 16.2]; P < 0.001).
In women with PCOS, OCPs (and not Lifestyle) affect a wide variety of reproductive/metabolic hormones, but their treatment response does not correlate with live birth.
研究多囊卵巢综合征（PCOS）的常见治疗方法对一系列激素（生殖/代谢）的影响。
对三个为期 16 周的孕前干预措施的随机对照试验的血液进行二次分析，这些措施旨在改善与 PCOS 相关的异常：连续口服避孕药（OCP，N=34 例）、强化生活方式改变（生活方式，N=31）或两者的组合（联合，N=29）。
将治疗后激活素 A 和 B、抑制素 B 和 follistatin（FST）以及胰岛素样生长因子 1（IGF-1）、胰岛素样生长因子结合蛋白 2（IGFBP-2）、胰高血糖素、胰高血糖素样肽 1（GLP-1）和 2以及 oxyntomodulin 的水平与基线进行比较，并将这些参数的基线变化与结果进行相关性分析。
口服避孕药的使用与激活素 A、抑制素 A 和抗苗勒管激素（AMH）的显著抑制有关，但 FST 显著增加。IGF-1、IGFBP-2、胰高血糖素和 GLP-2 水平显著降低。OCP 显著抑制 oxyntomodulin（几何均数比：0.09，95%置信区间[CI]：0.05，0.18，P<0.001）。生活方式对任何分析物均无显著影响，而联合治疗的作用与单独使用 OCP 相似，尽管作用减弱。Oxyntomodulin 与总卵巢体积变化呈显著正相关（rs=0.27；95%CI：0.03，0.48；P=0.03）和胰岛素敏感性指数（rs=0.48；95%CI：0.27，0.64；P<0.001），与曲线下面积（AUC）葡萄糖变化呈负相关（rs=-0.38；95%CI：-0.57，-0.16；P=0.001）。激素变化均与活产无关，只有激活素 A 与排卵有关（每增加 1ng/mL 变化，活产的风险比：6.0[2.2，16.2]；P<0.001）。
在患有 PCOS 的女性中，OCP（而非生活方式）会影响多种生殖/代谢激素，但它们的治疗反应与活产无关。
