Assessment Of Serum Irisin In PCOS Patients And The Preliminary Study Of Insulin Resistance In PCOS

Objective:To assess serum Irisin level in polycystic ovary syndrome(PCOS)patients and healthy women of childbearing age,to initially discuss the possible role of Irisin in the pathogenesis of PCOS.To evaluate the effect of insulin resistance(IR)on metabolism indexes and hormone levels in PCOS patients.To evaluate the effect of overweight and obesity on metabolic indexes and hormone levels in PCOS patients.To investigate the differences of biochemical and endocrine hormone levels in PCOS patients and patients with IR who had menstrual disorders but did not meet the criteria of PCOS diagnosis.To evaluate the efficacy of metformin and/or pioglitazone in the treatment of PCOS patients.Method:This study included 37 PCOS patients(PCOS group)and 15 patients with IR who had menstrual disorders but did not meet the criteria of PCOS diagnosis(IR group),all from the outpatient department or inpatient department of Tianjin Medical University General Hospital.8 healthy women in the control group were from the physical examination center of Tianjin Haibin People’s Hospital.All subjects were fasted at least for 8 hours.After collecting blood at 8 am the next day,all subjects took 75 g glucose and blood was collected again at 1 h and 2 h after orally taking 75 g glucose.1.To collect clinical manifestations,body parameters,hormones and metabolic indexes of PCOS patients.PCOS patients were grouped according to BMI,to compare differences of these indexes between standard body group and overweight/obesity group.PCOS patients were grouped according to HOMA-IR and to compare the differences of these indexes in between HOMA-IR ≤2.5 and HOMA-IR>2.5 groups.2.To collect the clinical manifestations,body parameters,hormones and metabolism indexes of IR group.To compare the differences of these indexes between IR group and PCOS group.3.To assess serum Irisin levels in PCOS patients,IR group patients,and women in control group.To collect the body parameters,hormones and metabolic indexes of women in the three groups and to analyze their correlation with Irisin levels.4.To collect the clinical manifestations,body parameters,hormones and metabolism indexes of PCOS and IR group patients after 3-6 months treatment of metformin(1g-1.5g/d)and/or pioglitazone(15-30mg/d).To compare the differences before and after treatment and evaluate how the clinical performance improved.Result:1.The results of grouping PCOS patients by BMI showed that the OGTT test 5 time points blood glucose,0h,2h,3h insulin levels,HOMA-IR,blood TP,ALT,BUA,CRP,fT4 levels in the overweight/obesity group were significantly higher than the standard body group.HDL-C level was significantly lower than the standard body group.Furthermore,the prevalence of IR,abnormal glucose metabolism,abnormal lipid metabolism,non-alcoholic fatty liver disease(NAFLD),and hyperuricemia were significantly higher in the overweight/obesity group than in the standard group.2.The results of grouping PCOS patients by HOMA-IR showed that weight,BMI,GLO,OGTT test 0h,0.5h,1h,2h blood glucose,five time points insulin,blood total testosterone and fT4 levels in HOMA-IR>2.5 group were significantly higher than those in the HOMA-IR≤2.5 group.And the overweight/obesity rate,the prevalence of abnormal lipid metabolism and the NAFLD were significantly higher than those in the HOMA-IR≤2.5 group.3.The levels of LH/FSH,progesterone and total testosterone in PCOS patients were significantly higher than IR group patients.The degree of IR and the prevalence of abnormal glucose and lipid metabolism were similar in both groups.4.There was no statistical difference in fasting Irisin level between PCOS group,simple IR group and control group.There was no statistical difference of serum Irisin level at 1h and 2h after taking 75 g glucose between three groups.Fasting Irisin of the whole subjects was negatively correlated with fasting glucose and HOMA-IR.Fasting Irisin of PCOS group was negatively correlated with fasting blood glucose,insulin,and HOMA-IR.5.After 3-6 months treatment of metformin and/or pioglitazone,1h insulin level after taking 75 g glucose was significantly reduced.There was also a decreasing trend in fasting blood glucose,insulin and total testosterone levels.Conclusion:1.Fasting Irisin of the whole subjects was negatively correlated with fasting glucose and HOMA-IR.Fasting Irisin of PCOS group was also negatively correlated with fasting blood glucose and HOMA-IR.It is suggested that Irisin may participate in the regulation of fasting blood glucose in women of childbearing age,and there may be insufficient secretion of Irisin in PCOS patients with high insulin resistance.2.In PCOS patients,there is a close relationship between obesity and IR.Overweight or obesity significantly increased the degree of IR in PCOS patients and significantly increased the prevalence of abnormal glucose metabolism,lipid metabolism,NAFLD,and hyperuricemia.This suggests that weight management in overweight or obese PCOS patients can help reduce IR levels and metabolic abnormalities.Part of the body weight standard PCOS patients still has IR,the mechanism needs further study.3.Most of the PCOS patients with IR were accompanied by obesity.IR significantly increased the prevalence of abnormal glucose metabolism,abnormal lipid metabolism,and NAFLD in PCOS patients.When treating the PCOS patients with IR,attention should also be paid to managing blood lipids,preventing cardiovascular diseases,and screening and treating the NAFLD.4.The levels of LH/FSH,progesterone and total testosterone in PCOS group were significantly higher than IR group,suggesting that PCOS patients have more complicated pathogenic mechanism besides IR.5.The 3–6 months treatment of insulin sensitizer metformin and/or pioglitazone significantly reduced the 1h insulin level after taking glucose in PCOS and IR group patients.Fasting blood glucose,insulin,and total testosterone levels also showed decreasing trend.It suggests it will be a long-term treatment and needs to explore more effective treatment.