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대한생식의학회지 제26권 제3호 2010년
다낭성 난포 증후군 환자에서 복강경적 laser vaporization 후 내분비적 변화 및 클로미펜에 대한 난소 반응성의 변화
성균관대학교 의과대학, 강북삼성병원 산부인과, 연세대학교 의과대학 산부인과학교실1
이상준, 김진영, 박기현1,
The endocrine changes and alteration of the ovarian response to clomiphen citrate after laparoscopic laser vaporization in patients with polycystic ovary syndrome
Lee sj, Kim jy, Park kh1
Objectives: Polycystic ovary syndrome(PCOS) has the feature of excessive LH, hyperandrogenism and disturbance of folliculogenesis. Also, insulin, IGF-I and IGFBP-1 are involved in the pathogenesis of PCOS. Various surgical and medical therapies have been used and the action mechanisms are related to the endocrine effect. Laparoscopic ovarian electrocautery or laser vaporization is effective in the restoration of ovulation and normal menstrual cycle with minimal invasive procedure especially in the patients resistant to medical therapy. Clomiphen citrate(CC) is used for the ovulation induction in PCOS and the resistance is known to be related to insulin, IGF-I, IGFBP-1 levels. This study was performed to evaluate the effect of the laparoscopic laser vaporization on the levels of LH, FSH, testosterone, IGF-I and IGFBP-1 and on the ovarian response to clomiphen citrate in patients with CC-resistant PCOS. Materials and Methods: The fasting basal serum LH, FSH, testosterone, IGF-I and IGFBP-1 level were measured in 10 PCOS patients with CC-resistance and 7 normal controls with regular menstrual cycle. In PCOS, after laparoscopic CO2 laser vaporization, endocrine levels were measured in 1 week interval for 4 weeks and then compared with preoperative levels. Results: In PCOS group, mean serum LH/FSH ratio, testosterone, IGF-I levels were higher and IGFBP-1 level was lower than control. LH/FSH ratio decreased from 2.51±0.67 to 1.7±0.6(P<0.05) in 2 weeks, to 0.56±0.2(P<0.01) in 3 week and to 1.41±0.3(P<0.01) in 4 week after operation. Testosterone level decreased from 1.51±0.82ng/ml to 0.65±0.34ng/ml(P<0.05) in 2 weeks, to 0.56±0.67ng/ml(P<0.01) in 3 weeks after operation. IGF-I level also decreased from 436±47.5μg/l to 187±38μg/l(P<0.01) in 1 week, to 167±42μg/l(P<0.01) in 2 weeks, 179±55μg/l(P<0.01) in 3 weeks and to 120±43μg/l(P<0.01) in 4 weeks after operation. IGFBP-1 level showed no significant change. In 8 of 10 PCOS patients, ovulation was induced with low dose clomiphen citrate. Conclusion: Laparoscopic CO2 laser vaporization restores normal menstrual cycle and ovulation through endocrine effect of decreasing LH/FSH ratio, testosterone and IGF-I level and increases the response to CC. Therefore it is useful for restoration of normal menstruation and induction of ovulation in CC resistant PCOS patients.
키워드 : Laparoscopic laser vaporization, Endocrine effect, CC response, Polycystic ovary syndrome
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