Salman Dina Akeel, Nori Wassan, Akram Wisam
Department of Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, Iraq.
Prz Menopauzalny. 2025 Jun;24(2):120-125. doi: 10.5114/pm.2025.152414. Epub 2025 Jun 30.
Polycystic ovarian syndrome (PCOS) is a leading cause of infertility linked to insulin resistance and obesity. Zinc-α2-glycoprotein (ZAG) is an adipokine involved in lipid metabolism and insulin sensitivity. We hypothesized that reduced ZAG serum levels among PCOS cases could predict fertility odds. The aim is to examine ZAG's relationship with fertility parameters and to test its role as a predictor for fertility potential.
A comparative cross-sectional study recruited PCOS cases into two groups: the infertile and fertile group; = 60 for each. Women's anthropometric (age, body mass index - BMI, waist circumference) hormonal (follicle-stimulating hormone, luteinizing hormone, anti-Müllerian hormone (AMH), total testosterone, and prolactin) metabolic parameters and ZAG serum levels, estimated ELIZA/ELISA were recorded.
Body mass index was significantly high in infertile cases; ZAG levels were significantly lower among the infertile group (37.08 ±3.885 vs. 54.25 ±14.71 µg/ml; < 0.0001). Zinc-α2-glycoprotein was inversely and significantly correlated to BMI, waist circumference ( = -0.81, -0.78; < 0.0001), and all hormonal and metabolic parameters. Zinc-α2-glycoprotein cut-off value of > 42 µg/ml predicted fertility potential in PCOS, with 67% sensitivity, 97.50% specificity, and < 0.0001, but it did not surpass AMH.
Zinc-α2-glycoprotein is a potential biomarker for fertility that links metabolic and reproduction dysfunction in PCOS women. It mediates 13.5% of obesity's inverse effect on fertility. Restoring normal ZAG levels may improve fertility odds and can have prognostic value in following the therapy in those populations. Further longitudinal, larger-sized studies are recommended to explore newer diagnostic and prognostic avenues to improve reproduction potential among PCOS cases.
多囊卵巢综合征（PCOS）是导致不孕症的主要原因之一，与胰岛素抵抗和肥胖有关。锌-α2-糖蛋白（ZAG）是一种参与脂质代谢和胰岛素敏感性的脂肪因子。我们假设PCOS患者血清ZAG水平降低可预测生育几率。目的是研究ZAG与生育参数的关系，并测试其作为生育潜力预测指标的作用。
一项比较性横断面研究将PCOS患者分为两组：不孕组和生育组，每组60例。记录了女性的人体测量指标（年龄、体重指数 - BMI、腰围）、激素指标（促卵泡生成素、促黄体生成素、抗苗勒管激素（AMH）、总睾酮和催乳素）、代谢参数以及通过酶联免疫吸附测定（ELISA）估算的ZAG血清水平。
不孕患者的体重指数显著较高；不孕组的ZAG水平显著较低（37.08±3.885 vs. 54.25±14.71μg/ml；P<0.0001）。锌-α2-糖蛋白与BMI、腰围呈显著负相关（r = -0.81，-0.78；P<0.0001），与所有激素和代谢参数也呈显著负相关。ZAG截断值>42μg/ml可预测PCOS患者的生育潜力，敏感性为67%，特异性为97.50%，P<0.0001，但它并未超过AMH。
锌-α2-糖蛋白是一种潜在的生育生物标志物，它将PCOS女性的代谢和生殖功能障碍联系起来。它介导了肥胖对生育的13.5%的反向影响。恢复正常的ZAG水平可能会提高生育几率，并且对这些人群的治疗随访具有预后价值。建议进一步开展纵向、更大规模的研究，以探索新的诊断和预后途径，提高PCOS患者的生殖潜力。
