Endocrinology Department, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
Front Endocrinol (Lausanne). 2023 Feb 9;14:1125569. doi: 10.3389/fendo.2023.1125569. eCollection 2023.
Follistatin is a glycoprotein that represses members of the transforming growth factor-β superfamily including activin. Higher follistatin levels have been associated with an increased risk for type 2 diabetes and with polycystic ovary syndrome (PCOS). In non-obese adolescent girls with PCOS, insulin sensitization results in a healthier endocrine-metabolic outcome than oral contraception (OC); we assessed whether those differences are underscored by changes in serum follistatin concentrations.
Circulating follistatin, endocrine-metabolic markers and hepato-visceral fat were measured longitudinally in 72 girls with PCOS [age, 16 years; body mass index (BMI), 23 Kg/m] randomized to receive PioFluMet [pioglitazone (7.5 mg/d), metformin (850 mg/d) and flutamide (62.5 mg/d), n=17]; EE-CA [an OC containing 35 µg ethinylestradiol (EE) and 2 mg cyproterone acetate (CA), n=17]; SPIOMET [Spironolactone (50 mg/d), pioglitazone (7.5 mg/d) and metformin (850 mg/d), n=18], or EE-LNG [an OC containing 20 µg EE and 100 mg levonorgestrel (LNG), n=20]. Twenty-eight age- and BMI-matched healthy girls served as controls.
Pre-treatment follistatin levels were similar in PCOS and controls. OCs raised serum follistatin after 6 months (6.8-fold vs 2.5-fold for EE-CA and EE-LNG, respectively). Neither SPIOMET nor PioFluMet changed follistatin levels. Follistatin correlated negatively with high-molecular weight adiponectin and positively with mean serum insulin concentrations during an oral glucose tolerance test at baseline, and with liver fat after 6 months.
In girls with PCOS, follistatin levels rise significantly after 6 months on OCs and this increase associates to a worsening of markers of insulin resistance and to changes in liver fat.
卵泡抑素是一种糖蛋白，可抑制转化生长因子-β超家族成员，包括激活素。较高的卵泡抑素水平与 2 型糖尿病和多囊卵巢综合征（PCOS）的风险增加有关。在非肥胖青少年 PCOS 患者中，胰岛素敏化的结果比口服避孕药（OC）更健康的内分泌代谢结局；我们评估这些差异是否由血清卵泡抑素浓度的变化所强调。
72 名患有 PCOS 的女孩[年龄 16 岁；体重指数（BMI）23 Kg/m]被随机分为接受 PioFluMet [吡格列酮（7.5 mg/d），二甲双胍（850 mg/d）和氟他胺（62.5 mg/d），n=17]；EE-CA[含有 35 µg 乙炔雌二醇（EE）和 2 mg 醋酸环丙孕酮（CA）的 OC，n=17]；SPIOMET[螺内酯（50 mg/d），吡格列酮（7.5 mg/d）和二甲双胍（850 mg/d），n=18]或 EE-LNG[含有 20 µg EE 和 100 mg 左炔诺孕酮（LNG）的 OC，n=20]。28 名年龄和 BMI 匹配的健康女孩作为对照。
治疗前，PCOS 和对照组的卵泡抑素水平相似。OC 在 6 个月后升高血清卵泡抑素（EE-CA 和 EE-LNG 分别为 6.8 倍和 2.5 倍）。SPIOMET 和 PioFluMet 均未改变卵泡抑素水平。卵泡抑素与基础口服葡萄糖耐量试验时的高分子量脂联素呈负相关，与平均血清胰岛素浓度呈正相关，与 6 个月后的肝脂肪呈正相关。
在患有 PCOS 的女孩中，OC 治疗 6 个月后卵泡抑素水平显著升高，这种升高与胰岛素抵抗标志物的恶化以及肝脂肪的变化有关。
