Study Of The Relationship Between The Metabolic Disturbance Of Homocysteine And Polycystic Ovary Syndrome

Homocysteine(Hcy) is an intermediate formed during the breakdown of the amino acid methionine. Elevated levels of plasma homocysteine have recently been implicated as a independent risk factor for cardiovascular disease. In addition, hyperhomocysteinemia has also been suggested to be related to a range of adverse pregnancy outcomes. The patients with polycystic ovary syndrome(PCOS) have a low implantation rate and a high miscarriage rate and has also been found to be associated with premature cardiovascular disease and a series of obstetric complications. Thus, it seems logical to hypothesize that there is a relationship between plasma homocysteine and polycystic ovary syndrome. This study was designed to examine the relationship between plasma total homocysteine(tHcy) and PCOS and to investigate the clinical effects and safety of Diane-35 and metformin in treating patients with polycystic ovary syndrome. Objective: 1. To investigate the relationship between plasma total homocysteine(tHcy) and features of polycystic ovary syndrome by analyzing body weight index(BMI), plasma tHcy , vitamin B₁₂, folic acid, fasting plasma insulin(FIns), fasting plasma glucose(FPG), Homa insulin-resistance(Homa IR) and reproductive hormones in PCOS group and the control group. 2. To observe the clinical effects and safety of Diane-35 by comparing the levels of BMI, tHcy ,Vitamin B12, folic acid, FIns, FPG, Homa IR and sex hormones both before and after three cycles of treatment in patients with PCOS. 3. By screening and analyzing the above-mentioned clinical and biochemical indices before and after three months of treatment with metformin in patients with PCOS to examine the benefits and risks of metfomin. Methods: 1. The study group (The PCOS group):24 cases of infertility patients caused by PCOS were selected and were randomly divided into two groups (group A and group B).Patients in group A took Diane-35 for three menstrual cycles. Patients in group B received metformin 375mg only, three times daily for three months. The following indices were measured or calculated before and after three months or cycles of treatment in all the patients with PCOS:BMI, FIns, tHcy, vitamin-B12, folic acid and sex hormones 〔follicle stimulating hormone(FSH), luteotropic hormone(LH), testosterone(T)〕and Homa IR. We compared these indices between study group and control group and observed these parameters,changes after the treatment. 2. The control group: The control group consisted of 15 healthy women with regular menstrual cycle (28±2days) andnormal ovaries, aged 22³5 years old, being treated for other infertility diagnoses. Blood samples of them were collected on the day 3 of menstrual cycle. Main indices were measured in them as in the study group. Results: 1. Mean plasma total homocysteine(tHcy) in the PCOS group was significantly higher than in the normal ovary group [(11.69±3.53) versus (7.31±1.85)umol/L,P<0.0001].The levels of FIns, Homa IR,T and LH/FSH were also significantly higher in the PCOS group comparing to the controls, while there were no significant differences in the level of age, BMI, vitamin-B12 and folic acid between two groups. 2. Insulin-resistant PCOS patients(PCOS-IR) had significantly higher plasma total homocysteine(13.20±3.60)umol/L than non-insulin-resistant PCOS patients(PCOS-NIR) (9.57±2.12)umol/L(P=0.002), being all significantly higher than that in the control group (both P <0.05). 3. The pretreatment levels of FIns, Homa IR and T were (18.87±3.87)mU/L, 4.24±1.00, (2.65±0.59)nmol/L in PCOS-IR patients, and (11.94±2.56)mU/L, 2.58±0.52, (2.17±0.47)nmol/L in the PCOS-NIR patients, with significant difference between them (all P<0.05). In addition , the levels of Homa IR and T in the two groups were all significantly higher than those in the control group (all P<0.05). There were no obvious differences among three groups in terms of the levels of vitamin B12 and folic acid.4. Correlation analysis results suggested that the plasma tHcy concentration were correlated positively to FIns (r=0.77, P=0.001),...