Proinsulina, adiponektyna i hsCRP u kobiet w wieku rozrodczym z zespołem policystycznych jajników (PCOS) — wpływ leczenia metforminą

Abstract

Introduction: Women with polycystic ovary syndrome (PCOS) often suffer from obesity and insulin resistance. The role of proinsulin, which is known to be an indicator of fertility outcomes in PCOS women, and that of adiponectin, in the pathogenesis of PCOS is not well elucidated. Our objective was to determine proinsulin, adiponectin, hsCRP and other hormonal and metabolic parameters in PCOS women before and after metformin treatment. Material and methods: Two PCOS groups of patients of reproductive age (90 lean and 88 obese or overweight) with two control groups, adjusted for body mass index (BMI), were compared at baseline. 32 PCOS women were studied at baseline, after three and six months of metformin (1,000 mg/day) treatment. Clinical, anthropometric, biochemical and hormonal parameters were assessed. Results: Proinsulin and hsCRP levels were the highest in obese PCOS women and were statistically different than in lean PCOS women (proinsulin: 11.4 v. 6.9 pmol/L; hsCRP 2.46 v. 0.47 mg/L, p < 0.01) and than in obese controls. Levels of adiponectin were dependant on BMI. Plasma proinsulin and androstenedione levels decreased after metformin treatment only in obese PCOS women. Conclusions: PCOS, when accompanied by obesity, is associated with elevated proinsulin concentrations, which correlates with higher hsCRP and increased FAI. Proinsulin level decreases due to metformin treatment. Our results suggest that obese or overweight PCOS and lean PCOS are characterised by different hormonal and metabolic parameters and have a different response to metformin treatment.

Impact of Treatment with Metformin on Adipocytokines in Patients with Polycystic Ovary Syndrome: A Meta-Analysis

“…Increased adiponectin levels observed in patients with PCOS after metformin administration may be the result of reduced insulin resistance and insulin levels. However, inconsistent with our results, the results of another study [ 31 ] indicated no change in adiponectin concentration after treatment with 1000 mg of metformin daily for 6 months. These conflicting results could be explained by the relatively small sample size and difference in study populations, including differences in race, BMI, and severity of insulin resistance.…”

“…Seven studies, including 280 women, were eligible for the meta-analysis [ 27 – 29 , 31 , 32 , 42 , 43 ]. The I 2 value was 69%, indicating moderate heterogeneity among the included studies.…”

“…However, the effect of metformin on adipocytokine levels remains controversial. Some studies reported positive results [ 27 – 30 , 34 – 40 ], whereas others found no significant changes in adipocytokine levels after metformin administration [ 26 , 31 ].…”

Związek między stężeniami lipokaliny-2 i testosteronu wolnego w zespole policystycznych jajników

“…It has been proposed that insulin resistance may have a pivotal role in the development of PCOS; nonetheless, the pathophysiology of this disease has not been wholly elucidated [4]. This syndrome is associated with a higher incidence of sub-clinical chronic inflammation, obesity, and related disorders including insulin resistance, metabolic syndrome, diabetes mellitus, hyperlipidaemia, and cardiovascular risk [2,[5][6]. Hyperinsulinaemia and decreasing insulin sensitivity usually contribute to metabolic disturbances in PCOS [2].…”

The Role of Metformin in Metabolic Disturbances during Pregnancy: Polycystic Ovary Syndrome and Gestational Diabetes Mellitus

“…Indeed, women who are able to maintain normal weight with aging appear to boast a healthier metabolic profile than those who do not [ 62 ]. These differences may influence the impact of metformin in each group [ 63 ]: whereas reproductive benefits are observed in both obese and lean PCOS women [ 64 ], metabolic advantages, such as lowering of proinsulin and insulin levels, are seen predominantly in the obese and overweight subset [ 65 ].…”