Objective To discuss the serum levels of vascular endothelial growth factor (VEGF) and endostatin (ES) of patients with polycystic ovary syndrome (PCOS),and their effects on ovarian stromal blood flow.Methods A total of 96 patients with PCOS,who sought medical treatment in the reproductive center of the Second Affiliated Hospital of Harbin Medical University from July 2014 to September 2015,were selected as PCOS group;72 healthy women who came to our hospital due to male infertility at the same time were selected as the control group.According to the insulin resistance index of homeostasis model assessment (HOMA-IR),PCOS group was divided into PCOS insulin resistance group (PCOS-IR group,n =47) and PCOS non-insulin restance group (PCOS-NIR group,n =49).The serum level of VEGF and ES of all the participants were measured by enzyme linked immunosorbent assay (ELISA) method.The bilateral ovarian stromal blood flow at early follicular phase of all the patients was detected by transvaginal color doppler ultrasound,the hemodynamic parameters including pulsatility index (PI) and resistance index (RI) were calculated.Results The levels of VEGF and ES in PCOS-NIR and PCOS-IR groups were significantly higher than those in the control group (P ＜ 0.05);while their PI and RI were significantly lower than those in the control group (P ＜ 0.05);the levels of VEGF and ES in PCOS-IR groups were significantly higher than those in the PCOS-NIR group (P ＜ 0.05);while PI and RI were significantly lower than those in the PCOS-NIR group (P ＜0.05).The level of VEGF of PCOS patients was linearly positively correlated with the level of luteinizing hormone (LH),testosterone (T) and LH/ follicle-stimulating hormone (FSH) and HOMA-IR (P ＜ 0.05),and was linearly negatively correlated with PI and RI (P ＜0.05).There was no significant linear correlation between ES levels and LH,T levels as weet as LH/FSH (P ＞ 0.05),but ES levels were linearly negatively correlated with PI and RI (P ＜ 0.05) and linearly positively correlated with HOMA-IR and VEGF level (P ＜ 0.05).PI and RI of PCOS patients were linearly negatively correlated with levels of LH,T,as well as LH/FSH and HOMA-IR (P ＜ 0.05).Multiple linear regression analysis revealed that the levels of T,VEGF and HOMA-IR were the influencing factors of PI of PCOS patients (P ＜ 0.05).The levels of LH,T,VEGF and HOMA-IR were the influencing factors of RI of PCOS patients (P ＜ 0.05).Conclusion VEGF and ES are highly expressed in the serum of PCOS patients,and there was a positive linear correlation between them.VEGF and ES are closely related with HOMA-IR.The expression level of VEGF is also correlated with serum levels of LH and T.The imbalance of expression of VEGF and ES and HOMA-IR play an important role in the abnormal increasing of PCOS ovarian stromal blood flow.%目的 探讨多囊卵巢综合征(PCOS)患者血清血管内皮生长因子(VEGF)、内皮抑素(ES)水平及对卵巢间质血流的影响.方法 选取2014年7月-2015年9月在哈尔滨医科大学附属第二医院生殖中心就诊的PCOS患者96例作为PCOS组;选取同期因男方因素不孕而就诊于本院生殖中心的健康女性72例作为对照组.PCOS组根据稳态模型评价的胰岛素抵抗指数(HOMA-IR),分为PCOS胰岛素抵抗组(PCOS-IR组,n=47)和PCOS非胰岛素抵抗组(PCOS-NIR组,n=49).采用酶联免疫吸附法测定所有受试者血清中的VEGF、ES水平.同时所有患者于卵泡早期应用经阴道彩色多普勒超声监测双侧卵巢间质血流,并计算出血流动力学参数:搏动指数(PI)和阻力指数(RI).结果 PCOS-NIR、PCOS-IR组VEGF、ES水平高于对照组,PI、RI低于对照组,差异有统计学意义(P＜0.05);PCOS-IR组VEGF、ES水平高于PCOS-NIR组,PI、RI低于PCOS-NIR组,差异有统计学意义(P＜0.05).PCOS患者VEGF水平与黄体生成素(LH)、睾酮(T)水平及LH/促卵泡刺激素(FSH)、HOMA-IR呈直线正相关(P＜0.05),与PI、RI呈直线负相关(P ＜0.05);ES水平与LH、T水平及LH/FSH无直线相关性(P＞0.05),而与PI、RI呈直线负相关(P＜0.05),与HOMA-IR及VEGF水平呈直线正相关(P＜0.05).PCOS患者PI、RI与LH、T水平及LH/FSH、HOMA-IR均呈直线负相关(P＜0.05).多元线性回归分析结果显示,T、VEGF水平及HOMA-IR是PCOS患者PI的影响因素(P＜0.05);LH、T、VEGF水平及HOMA-IR是PCOS患者RI的影响因素(P＜0.05).结论 VEGF、ES在PCOS患者血清中呈高表达,二者之间呈直线正相关且均与PCOS患者的HOMA-IR密切相关,同时VEGF的表达水平还与血清LH、T水平密切相关;VEGF与ES的表达失衡及HOMA-IR在PCOS卵巢间质血流异常增多中起主要作用.
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