生殖医学杂志

目的 探讨血清胰岛素样生长因子结合蛋白7(IGFBP7)水平与多囊卵巢综合征(PCOS)及其胰岛素抵抗(IR)的关系。方法 选择2021年10月至2022年12月于徐州市中心医院生殖中心就诊的PCOS患者为PCOS组(91例),收集同时期同年龄段因输卵管因素或男方因素行辅助生殖的女性为对照组(85例)。收集所有研究对象的一般资料，包括年龄、体质量指数(BMI)、腰围等；检测研究对象血清中部分生化指标如血糖、脂代谢相关指标、生殖激素水平等。采用二元Logistic回归分析评价血清IGFBP7水平与PCOS及其IR发生的关系；采用多因素线性回归分析筛查与PCOS患者IGFBP7水平升高有关的因素。结果 PCOS组患者的BMI、腰围、抗苗勒管激素(AMH)、黄体生成素(LH)、总睾酮(TT)、游离睾酮(FT)、游离雄激素指数(FAI)、空腹血糖(FPG)、空腹胰岛素(FIN)、胰岛素抵抗的稳态模型指数(HOMA-IR)、总胆固醇(CHOL)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-c)、IGFBP7水平均显著高于对照组(P<0.05),而年龄、高密度脂蛋白胆固醇(HDL-c)、性激素结合球蛋白(SHBG)水平均显著低于对照组(P<0.05);两组间卵泡刺激素(FSH)、雌二醇(E₂)水平差异均无统计学意义(P>0.05)。二元Logistic回归分析结果显示，血清AMH、TT、SHBG及IGFBP7水平与PCOS的患病独立相关(P<0.05);TG、HDL-c、IGFBP7水平与PCOS患者合并IR独立相关(P<0.05)。在PCOS组中，血清IGFBP7水平与FAI、FPG、FIN、HOMA-IR、TG呈正相关，与SHBG、HDL-c呈负相关(P<0.05)。线性回归分析结果显示，FAI、FIN水平升高是IGFBP7水平升高的独立相关因素(P<0.05)。结论 血清IGFBP7水平的升高与PCOS及其IR的发生独立相关；FAI与FIN水平的升高与PCOS患者血清IGFBP7水平的升高独立相关。

Objective:To investigate the relationship between serum insulin-like growth factor binding protein 7(IGFBP7) levels and polycystic ovary syndrome(PCOS) and insulin resistance(IR).Methods:The PCOS patients treated in the Reproductive Medicine Center of Xuzhou Central Hospital from October 2021 to December 2022 were selected as PCOS group(n=91),and the women due to tubal or male factors for ART of the same age at the same period were collected as the control group(n=85). General data, including age, body mass index(BMI) and waist circumference were collected for all enrolled patients. Some biochemical indexes such as blood glucose, lipid and lipoprotein, reproductive hormone were detected. Binary logistic regression analysis was used to evaluate the relationship between serum IGFBP7 levels and PCOS and IR. Multifactor linear regression analysis was used to screen the factors related to the increase of IGFBP7 level in PCOS patients.Results:The levels of BMI,waist circumference, anti-Müllerian hormone(AMH),LH,total testosterone(TT),free testosterone(FT),free androgen index(FAI),fasting blood glucose(FPG),fasting insulin(FIN),homeostasis model index of insulin resistance(HOMA-IR),total cholesterol(CHOL),triglyceride(TG),low density lipoprotein cholesterol(LDL-c) and IGFBP7 levels in PCOS group were significantly higher than those of control group(P<0.05),while the age, high density lipoprotein cholesterol(HDL-c) and sex hormone-binding globulin(SHBG) levels were significantly lower than those of control group(P<0.05). There were no significant differences in the levels of FSH and estradiol(E₂) between two groups(P>0.05). The results of binary logistic regression analysis show that serum AMH,TT,SHBG,and IGFBP7 levels were independently correlated with PCOS(P<0.05). Serum TG,HDL-c, and IGFBP7 levels were independently correlated with the IR in PCOS patients(P<0.05). In the PCOS group, serum IGFBP7 levels were positively correlated with FAI,FPG,FIN,HOMA-IR,TG,and negatively correlated with SHBG and HDL-c(P<0.05). The results of linear regression analysis show that increased levels of FAI and FIN were independent factors related to the increase in IGFBP7 levels(P<0.05).Conclusions:The increase of serum IGFBP7 level was independently related to PCOS and IR. The increase of FAI and FIN levels was independently correlated with the increase of serum IGFBP7 levels in PCOS patients.