Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome
Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome
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DOI：
10.1056/nejm199904293401703
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发表时间：
1999-04-29
影响因子：
158.5
通讯作者：
Allan, G
中科院分区：
文献类型：
--
作者：
Nestler, JE;Jakubowicz, DJ;Allan, G
背景：多囊卵巢综合征患者存在胰岛素抵抗和高胰岛素血症，这可能是由于缺乏一种介导胰岛素作用的含有D-甲酰肌醇的磷酸多糖。我们假设给予D-环肌醇可以补充介质的储存并提高胰岛素敏感性。方法对44例患有多囊卵巢综合征的肥胖妇女在口服1200 mg D-环肌醇或安慰剂前后进行血清类固醇测定和口服葡萄糖耐量试验，连续6-8周。结果22例服用D-环肌醇的妇女口服葡萄糖后，胰岛素曲线下平均面积(+/-SD)由13,417+/-11,572降至5,158+/-6714亩U/分钟(81+/-69至31+/-40毫升/分钟)(P=0.007；与安慰剂组比较P=0.07)，糖耐量无明显变化。这22名妇女的血清游离睾酮浓度从每分升1.11±-0.80 ng降至0.50+/-0.5ng(每升38+/-28至17+/-17pmol)(与安慰剂组的变化相比，P=0.006)。女性的舒张压和收缩压分别下降了4毫米汞柱(P<；0.001和P=0.05，与安慰剂组的变化相比较)，她们的血浆甘油三酯浓度从每分升184+/-88降至110+/-61毫克(每升2.1+/-0.2至1.2/-0.1mmo1)(与安慰剂组的变化相比，P=0.002)。在安慰剂组中，这些变量都没有明显变化。接受D-氯化肌醇治疗的22名妇女中有19人排卵，而服用安慰剂的22名妇女中有6人排卵(P<；0.001)。结论D-氯化肌醇可增加多囊卵巢综合征患者胰岛素的作用，从而改善排卵功能，降低血清雄激素浓度、血压和血浆甘油三酯浓度(N Engl J Med 1999；340：1314-20)。(C)1999年，马萨诸塞州医学会。
Background Women with the polycystic ovary syndrome have insulin resistance and hyperinsulinemia, possibly because of a deficiency of a D-chiro-inositol-containing phosphoglycan that mediates the action of insulin. We hypothesized that the administration of D-chiro-inositol would replenish stores of the mediator and improve insulin sensitivity.Methods We measured steroids in serum and performed oral glucose-tolerance tests before and after the oral administration of 1200 mg of D-chiro-inositol or placebo once daily for six to eight weeks in 44 obese women with the polycystic ovary syndrome. The serum progesterone concentration was measured weekly to monitor for ovulation.Results In the 22 women given D-chiro-inositol, the mean (+/-SD) area under the plasma insulin curve after the oral administration of glucose decreased from 13,417+/-11,572 to 5158+/-6714 mu U per milliliter per minute (81+/-69 to 31+/-40 nmol per liter per minute) (P = 0.007; P=0.07 for the comparison of this change with the change in the placebo group); glucose tolerance did not change significantly. The serum free testosterone concentration in these 22 women decreased from 1.1+/-0.8 to 0.5+/-0.5 ng per deciliter (38+/-28 to 17+/-17 pmol per liter) (P = 0.006 for the comparison with the change in the placebo group). The women's diastolic and systolic blood pressure decreased by 4 mm Hg (P < 0.001 and P = 0.05, respectively, for the comparisons with the changes in the placebo group), and their plasma triglyceride concentrations decreased from 184+/-88 to 110+/-61 mg per deciliter (2.1+/-0.2 to 1.2+/-0.1 mmol per lit er) (P = 0.002 for the comparison with the change in the placebo group). None of these variables changed appreciably in the placebo group. Nineteen of the 22 women who received D-chiro-inositol ovulated, as compared with 6 of the 22 women in the placebo group (P < 0.001).Conclusions D-Chiro-inositol increases the action of insulin in patients with the polycystic ovary syndrome, thereby improving ovulatory function and decreasing serum androgen concentrations, blood pressure, and plasma triglyceride concentrations, (N Engl J Med 1999;340:1314-20.) (C)1999, Massachusetts Medical Society.