多囊卵巢综合征患者腰臀比与糖脂代谢、胰岛素样生长因子-1及胰岛素抵抗的相关性

目的: 研究多囊卵巢综合征(polycystic ovary syndrome, PCOS)患者腰臀比与糖脂代谢、胰岛素样生长因子-1(insulin like growth factor-1, IGF-1)、胰岛素抵抗(insulin resistance, IR)的相关性。方法: 选择2018年1月至2021年9月南京医科大学附属江苏盛泽医院收治的PCOS患者110例作为PCOS组，另选择同期健康体检者60例作为对照组。测定两组腰臀比、糖脂代谢指标、IGF-1以及稳态模式IR指数(HOMA-IR)，其中糖脂代谢指标包括空腹血糖（FPG）、餐后2 h血糖(2 h PBG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)和空腹胰岛素(FINS)。将PCOS组中腰臀比≥0.80的患者纳入腹型肥胖组，＜0.80的患者纳入非腹型肥胖组，比较两组糖脂代谢指标、IGF 1及HOMA IR。采用Pearson相关分析PCOS患者腰臀比与糖脂代谢、IGF 1及IR的相关性。采用ROC曲线分析腰臀比对PCOS患者糖脂代谢异常、IGF 1及IR的预测价值。结果: 与对照组相比，PCOS组腰臀比、2 h PBG、LDL-C、TG、FINS、IGF-1、HOMA-IR水平均明显增高，HDL-C水平明显降低(P均＜0.05)，FPG、TC水平差异无统计学意义(P均＞0.05)。与非腹型肥胖组相比，腹型肥胖组2 h PBG、LDL-C、TG、FINS、IGF-1、HOMA-IR水平明显增高，HDL-C水平明显降低(P均＜0.05)，FPG、TC水平差异无统计学意义(P均＞0.05)。PCOS患者腰臀比与2 h PBG、TG、IGF-1、HOMA IR呈明显正相关，与HDL-C呈明显负相关(P均＜0.05)。腰臀比对PCOS患者血糖、血脂代谢异常及IR均具有较好的预测价值(AUC分别为0.821、0.793、0.782)。结论:PCOS患者尤其是腰臀比较高的患者表现为明显的糖脂代谢紊乱、IGF-1异常增高以及IR，且腰臀比对PCOS患者糖脂代谢异常、IR具有较好的预测价值。

Correlation of waist hip ratio with glucose and lipid metabolism,insulin-like growth factor 1 and insulin resistance in patients with polycystic ovary syndrome

Objective To study the correlation of waist hip ratio with glucose and lipid metabolism, insulin like growth factor 1(IGF 1) and insulin resistance(IR) in polycystic ovary syndrome（PCOS) patients. Methods A total of 110 PCOS patients who were admitted to Jiangsu Shengze Hospital Affiliated to Nanjing Medical University from January 2018 to September 2021 were selected as the PCOS group, and 60 healthy subjects during the same period as the control group. Waist hip ratio, glucose and lipid metabolism indexes, IGF 1 and homeostasis model for IR （HOMA IR) were measured in the two groups. The glucose and lipid metabolism indexes included fasting blood glucose(FPG), 2 h postprandial blood glucose （2 h PBG), total cholesterol(TC), high density lipoprotein cholesterol(HDL C), low density lipoprotein cholesterol(LDL C), triglyceride(TG) and fasting insulin （FINS). The patients with waist hip ratio≥0.80 in the PCOS group were subgrouped into the abdominal obesity group, and the patients with waist hip ratio <0.80 into the non abdominal obesity group, and the glucose and lipid metabolism indexes, IGF 1, and HOMA IR were compared between the two groups.Pearson correlation analysis was used to evaluate the correlation between waist hip ratio and glucose and lipid metabolism, IGF 1 and IR in PCOS patients. The ROC curve was used to analyze the predictive value of waist hip ratio for abnormal glucose and lipid metabolism, IGF-1 and IR in PCOS patients. Results Compared with the control group, the PCOS group showed higher levels of the waist hip ratio, 2 h PBG, LDL-C, TG, FINS, IGF-1, HOMA-IR, and lower level of HDL-C (all P<0.05), while there was no significant difference between the levels of FPG and TC (both P>0.05). Compared with the non abdominal obesity group, the levels of 2 h PBG, LDL C, TG, FINS, IGF-1 and HOMA-IR in the abdominal obesity group were significantly increased, and the levels of HDL-C were significantly decreased (all P<0.05), while there was no statistically significant difference between the levels of FPG and TC (both P>0.05). In PCOS patients, waist hip ratio was positively correlated with 2 h PBG, TG, IGF-1, HOMA-IR (all P<0.05), while negatively correlated with HDL-C(P<0.05). Waist hip ratio had good predictive value for abnormal blood glucose metabolism, abnormal blood lipid metabolism and IR in PCOS patients（AUC were 0.821, 0.793, 0.782, respectively). Conclusion PCOS patients, especially those with higher waist hip ratio, showed obvious glycolipid metabolism disorders, abnormal increase of IGF 1 and IR, and waist hip ratio has a good predictive value for glycolipid metabolism disorders and IR in PCOS patients.