多囊卵巢综合征胰岛素抵抗与瘦素关系的探讨

目的　探讨多囊卵巢综合征 (PCOS)妇女血清瘦素 (leptin)水平与胰岛素抵抗 (IR)的关系 ,为研究PCOS的发病机制和治疗新途径提供理论依据。方法　 5 1例PCOS患者及 2 3例正常妇女均测定体重指数(BMI)、腰臀比 (WHR)、血清生殖激素及leptin水平 ,同期行口服糖耐量 (OGTT)及胰岛素 (Ins)释放试验 ,OGTT示IR者给予二甲双胍 (1 5 g/d)治疗 3个月后复测上述指标。 结果　PCOS患者血清leptin水平高于相应对照组 ,且IR组显著高于NIR组 ;PCOS患者经二甲双胍治疗后血清Ins水平显著下降 ,胰岛素敏感指数 (ISI)显著上升 ,同时leptin水平下降。相关分析表明 ,PCOS患者血清leptin与BMI、WHR及T显著正相关 ,与ISI负相关 (r=0 6 7,P <0 0 1) ,多元回归显示leptin中有BMI、ISI引入。结论　PCOS患者血清leptin水平升高与胰岛素敏感性相关 ;二甲双胍治疗PCOS患者可提高其胰岛素敏感性 ,降低血清leptin水平。     

关于青春期多囊卵巢综合征胰岛素抵抗的探讨

目的　探讨青春期多囊卵巢综合征 (PCOS)胰岛素抵抗 (IR)和葡萄糖耐量减低 (IGT)的发生率。方法　选择 2 0 0 3年 2～ 9月复旦大学附属妇产科医院 2 9例 14～ 19岁的青春期PCOS患者 ,测定体重指数 (BMI)、腰臀比 (WHR)、卵巢体积、血清卵泡刺激素 (FSH)、黄体生成激素 (LH)和睾酮 (T) ,并行口服糖耐量试验 (OGTT)和胰岛素释放试验 ,根据空腹血糖 /胰岛素之比 (GIR)将其分为IR组 15例和非IR组 14例。结果　所有研究对象的空腹血糖均正常 ,两组间卵巢体积、LH/FSH比值、T水平无明显差异 (P >0 0 5 ) ,IR组BMI、WHR、曲线下葡萄糖面积 (AUC葡萄糖)和曲线下胰岛素面积 (AUC胰岛素)均高于非IR组 (P <0 0 5 ) ,而非IR组LH水平高于IR组 (P <0 0 5 ) ;IR组IGT患者占 4 0 0 % ,高于非IR组的 7 1% ,相关分析则显示GIR与BMI、WHR、空腹胰岛素水平、AUC葡萄糖 和AUC胰岛素 呈负相关。结论　肥胖和BMI正常者青春期PCOS均存在IR ,表现IR的青春期PCOS患者更易发生IGT ,要重视青春期PCOS患者IR的评估以及IGT的筛选。     

小檗碱治疗多囊卵巢综合征合并胰岛素抵抗疗效研究

目的探讨小檗碱(BBR)作为胰岛素增敏剂对多囊卵巢综合征(PCOS)的治疗效果。方法 2009年10月至2010年10月在哈尔滨医科大学附属第一医院将因不孕症就诊的PCOS合并胰岛素抵抗(IR)的患者随机分为4组,A组:复方环丙孕酮(CPA)+BBR;B组:CPA+二甲双胍(MET);C组:CPA+BBR+MET;D组:单用CPA。治疗前及治疗3个月后检测临床表现、性激素、糖脂代谢指标并加以比较。结果 A、B、C、D4组治疗后患者体重、BMI、WHR均降低,体重与BMI的改善4组间无统计学意义;WHR的改善A、C组更为显著(P<0.01)。A、B、C3组治疗后FIN、FPG以及HomaIR、AUCINS均明显下降,治疗前后比较差异有统计学意义(P<0.01);FIN、HomaIR、AUCINS降低程度表现为:C组优于A及B组(P<0.01);D组仅表现为AUCINS在治疗后有所下降。A、B、C3组治疗后TG、TC、LDL-C均有下降,HDL-C有所升高(P<0.05),A、C组优于B组(P<0.01),但C组与A组比较TG降低及HDL-C升高更显著(P<0.01),D组患者血脂变化在治疗前后无显著差异。与治疗...     

二甲双胍治疗多囊卵巢综合征新进展

多囊卵巢综合征（PCOS）是生育年龄妇女常见的生殖内分泌疾病。由于胰岛索抵抗在其发病中起重要作用．胰岛素增敏剂二甲双胍被用于PCOS的治疗。随着临床的广泛应用，对其作用机理和临床效果有了更深入的认识。兰甲双胍可以恢复规律月经，改善多毛，降低体质量，促进排卵，改善妊娠结局，改善子宫内膜的胰岛素抵抗，避免远期并发症．特别是对青春期PCOS患者有较好的疗效。不同剂量的二甲双胍具有不同的治疗作用。对二甲双胍在治疗PCOS中的新进展做综述。     

罗格列酮和二甲双胍治疗胰岛素抵抗多囊卵巢综合征的临床研究

目的　探讨罗格列酮 (rosiglitazone)和二甲双胍 (metformin)分别对有胰岛素抵抗的多囊卵巢综合征(polycysticovarysyndrome,PCOS)患者促排卵治疗的疗效对比。 方法　选择 2 0 0 2年 2月至 2 0 0 3年 6月存在胰岛素抵抗的PCOS患者 94例 ,将其随机分为A、B、C 3组。A组 36例口服罗格列酮联合克罗米芬治疗 ;B组 30例口服二甲双胍联合克罗米芬 (clomiphenecitrate ,CC)治疗 ;C组 2 8例口服克罗米芬治疗。 3组用药时间均为 3个月经周期。比较 3组用药后的胰岛素抵抗指数 (homainsulin resistance ,HomaIR)变化和排卵的发生情况。结果　A组用药 2个月后HomaIR开始由 1 12± 0 4 9下降为 0 86± 0 4 2 ,用药 3个月HomaIR由 1 12± 0 4 9降为0 6 1± 0 36 ,两者比较差异有显著性意义 (P <0 0 5 ) ;B组用药 2个月后HomaIR无明显下降 ,用药 3个月HomaIR由 1 15± 0 5 2降为 0 83± 0 32 ,两者比较差异有显著性意义 (P <0 0 5 )。C组用药前后HomaIR无变化。治疗后 3个月排卵率A组为 76 9% ,明显优于B组的 6 6 8%和C组的 5 8 8% ,差异有显著性意义 (P <0 0 5 )。结论　罗格列酮比二甲双胍能更快更好地改善PCOS的胰岛素抵抗 ,提高促排卵成功率。     

二甲双胍治疗多囊卵巢综合征

二甲双胍通过降血胰岛素的作用,纠正了PCOS患者的高雄激素血症,改善了卵巢排卵功能,提高了促排卵治疗疗效,是PCOS治疗的新选择。     

多囊卵巢综合征胰岛素抵抗新进展

多囊卵巢综合征(PCOS)是一种常见的影响育龄期女性生殖和内分泌功能的特殊疾病,其临床表现异质性,以慢性无排卵、卵巢多囊样改变、高雄激素血症为主要临床表现.胰岛素抵抗是其发生、发展的重要病理生理机制之一,也是导致高雄激素血症和卵巢功能改变的重要原因.近年来,PCOS患者胰岛素抵抗的分子机制得到深入研究,为临床治疗提供了...     

多囊卵巢综合征胰岛素抵抗新进展

多囊卵巢综合征（PCOS）是一种常见的影响育龄期女性生殖和内分泌功能的特殊疾病,其临床表现异质性,以慢性无排卵、卵巢多囊样改变、高雄激素血症为主要临床表现。胰岛素抵抗是其发生、发展的重要病理生理机制之一,也是导致高雄激素血症和卵巢功能改变的重要原因。近年来,PCOS患者胰岛素抵抗的分子机制得到深入研究,为临床治疗提供了理论依据。综述PCOS胰岛素抵抗的分子机制研究和药物治疗进展。     

二甲双胍治疗多囊卵巢综合征新进展

多囊卵巢综合征(PCOS)是生育年龄妇女常见的生殖内分泌疾病.由于胰岛素抵抗在其发病中起重要作用,胰岛素增敏剂二甲双胍被用于PCOS的治疗.随着临床的广泛应用,对其作用机理和临床效果有了更深入的认识.二甲双胍可以恢复规律月经,改善多毛,降低体质量,促进排卵,改善妊娠结局,改善子宫内膜的胰岛素抵抗,避免远期并发症,特别是对青春期PCOS患者有较好的疗效.不同剂量的二甲双胍具有不同的治疗作用.对二甲双胍在治疗PCOS中的新进展做.     

多囊卵巢综合征的胰岛素抵抗

胰岛素抵抗 (ｉｎｓｕｌｉｎｒｅｓｉｓｔｅｎｃｅ ,ＩＲ)是多囊卵巢综合征(ｐｏｌｙｃｙｓｔｉｃｏｖａｒｙｓｙｎｄｒｏｍｅ ,ＰＣＯＳ)患者主要和常见的代谢紊乱。多囊卵巢综合征和胰岛素抵抗是两种复杂的、牵涉广泛病理生理变化的病症。自 1980年 ,Ｂｕｒｇｈｅｎ[1] 等发现ＰＣＯＳ与高胰岛素血症相关后 ,对ＰＣＯＳ的胰岛素抵抗进行了广泛和深入的研究[2～ 4] ,本文对此进行简要的综述。1　胰岛素抵抗的概念1 1　胰岛素抵抗的定义胰岛素抵抗的定义目前仍不完全统一。根据美国糖尿病协会 (ＡｍｅｒｉｃａｎＤｉａｂｅｔｅｓＡｓｓｏｃ…     

二甲双胍联合枸橼酸氯米芬治疗多囊卵巢综合征伴胰岛素抵抗患者的疗效观察

目的　探讨二甲双胍联合枸橼酸氯米芬治疗多囊卵巢综合征 (PCOS)胰岛素抵抗性不孕症的疗效及二甲双胍对PCOS胰岛素抵抗伴假性黑棘皮病的治疗效果。方法　将 70例PCOS胰岛素抵抗性不孕症患者 (A组 ) ,按治疗方法不同分为Aa组、Ab组各 2 0例 ,Ac组 30例。Ac组口服二甲双胍 ,每日 3次 ,每次 5 0 0mg ,连用 3个月 ,从月经周期或撤退性出血第 5天开始口服枸橼酸氯米芬片 ,每日 1次 ,每次 5 0mg,连服 5d ,共用 3个周期 ;Aa组单用二甲双胍 ,Ab组单用枸橼酸氯米芬 ,Aa及Ab两组的用药方法分别同Ac组中二甲双胍和枸橼酸氯米芬的用法。 30例PCOS伴假性黑棘皮病和胰岛素抵抗的患者为B组 ,口服二甲双胍片治疗 3个月 ,用法同Aa组 ,观察各组患者治疗前后体重指数、腰臀比例、空腹胰岛素、空腹血糖、血浆胆固醇、甘油三酯、性激素 (卵泡刺激素、黄体生成素、催乳素、雌二醇、孕酮、睾酮 )水平的变化及B组的皮损变化。结果　 (1)Ac组治疗后胰岛素抵抗状态明显改善 ,妊娠率达 5 7% ,明显高于Aa组 (2 0 % )和Ab组 (15 % ) ,差异有极显著性 (P <0 0 1) ;Ac组治疗前 ,空腹胰岛素、体重指数、睾酮、血浆胆固醇、甘油三酯分别为 (4 9 7± 6 4 )mU/L、2 9 4± 2 2、(6 4± 2 2 )nmol/L、(6 3± 0 5 )mmol/L、(4 1± 1 0     

多囊卵巢综合征患者血清脂联素水平及与胰岛素抵抗相关性的研究

目的:检测多囊卵巢综合征(PCOS)患者血清脂联素(APN)水平,探讨APN与胰岛素抵抗(IR)的相关性。方法:研究对象于月经周期第3~5天行75g糖耐量实验(OGTT实验),分别测定0h、1h、2h的血糖(FPG、PG1h、PG2h)、胰岛素(FINS、INS1h、INS2h)和脂联素(FAPN、APN1h、APN2h)。PCOS患者给予达英-353个周期联合二甲双胍治疗3个月后复查上述指标,比较治疗前后的变化。结果:(1)PCOS组与对照组均表现为肥胖组APN水平低于非肥胖组,且PCOS组中肥胖组与非肥胖组的APN水平均低于对照组(P<0.05);(2)PCOS组中肥胖组与非肥胖组的FINS、INS1h、INS2h、AUCins及HOMA-IR均高于对照组,且肥胖PCOS组高于非肥胖PCOS组(P<0.05);(3)PCOS组经二甲双胍联合达英-35治疗后FINS、INS1h、INS2h、AUCins、HOMA-IR均降低(P<0.05),而APN水平明显升高;(4)相关性分析表明,PCOS患者APN水平与FINS、INS1h、INS2h、FPG、AUCins、HOMA-IR和BMI均呈负相关。多元逐步回归分析显示,APN与FINS、HOMA-IR的相关性最显著。结论:PCOS患者APN水平显著降低与IR密切相关。     

Agreement among insulin sensitivity indexes on the diagnosis of insulin resistance in polycystic ovary syndrome and ovulatory women

OBJECTIVE: The objective was to compare agreement on the diagnosis of insulin resistance (IR) among insulin sensitivity indexes in both ovulatory women and those with polycystic ovary syndrome (PCOS). STUDY DESIGN: In an observational study, the 75-g oral glucose tolerance test was performed in 105 women with PCOS and 51 ovulatory women. The insulin sensitivity indexes used were insulin quantitative sensitivity check index (QUICKI), 1/homeostasis model assessment-insulin resistance (1/HOMA-IR), area under curve for insulin (AUC-I), and the Matsuda insulin sensitivity index (COMP). For the IR diagnosis we used cut-off values described in recent publications (insulin >12 microIU/ml, 1/HOMA-IR <0.47, QUICKI < or =0.333, AUC-I > or =7000 microIU/ml 120 min, and COMP <4.75. RESULTS: Excellent agreement was assessed among insulin, QUICKI, and 1/HOMA-IR. However, the rate of IR detected by these indexes in the PCOS group (44.8-51.4%) was lower than expected. New cut-offs were then determined based on COMP results. Using these values, 1/HOMA-IR and QUICKI showed excellent agreement (kappa=0.83) with COMP. CONCLUSION: The observed agreements among insulin, QUICKI and 1/HOMA-IR were higher than 93%. Therefore, clinicians may choose any of those obtaining similar results. For clinicians who prefer COMP, but are looking for a simpler test to detect IR in PCOS women, the use of QUICKI and 1/HOMA-IR with the new cut-offs seems reasonable.     

Assessment of insulin resistance in young women with polycystic ovary syndrome

OBJECTIVES: To determine whether serum levels of potential markers could detect insulin resistance (IR) in young women with polycystic ovary syndrome (PCOS). METHODS: Serum levels of fasting glucose, insulin, intact proinsulin, resistin, and adiponectin were measured in 50 women with PCOS and known homeostatic model assessment (HOMA)-IR values (>or=2 indicating IR). The women were all younger than 25 years. RESULTS: Of the 50 women, 49 had undetectable levels of resistin, 50 had intact proinsulin levels within the normal range, and 50 had adiponectin levels of 8.4+/-3.3 mg/L, just below the normal range. When groups were compared, however, the 26 women (52%) with IR (HOMA-IR values >or=2) had significantly higher intact proinsulin levels (3.2+/-2.0 pmol/L vs 1.8+/-1.0 pmol/L; P<0.005) and significantly lower adiponectin levels (7.2+/-2.9 mg/L vs 9.7+/-3.3 mg/L; P<0.01), than the 24 women (48%) without IR. CONCLUSION: Serum levels of intact proinsulin, resistin, or adiponectin were not detectors of IR in individual young women with PCOS.     

Serum leptin levels correlate with clinical and biochemical indices of insulin resistance in women with polycystic ovary syndrome

Objectives To compare serum leptin levels in women with polycystic ovary syndrome (PCOS) and healthy subjects, and to evaluate the relationship between leptin concentration and insulin resistance.

Methods Forty-five women with PCOS and 20 controls were included in the study. Serum levels of leptin, testosterone, immune-reactive insulin (IRI), sex hormone-binding globulin, dehydroepiandrosterone sulfate, cortisol, LH and FSH were measured. Free androgen index (FAI) and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. Body mass index (BMI) and waist-to-hip ratio (WHR) were assessed.

Results Serum leptin levels in PCOS patients were higher than in the control group independently of BMI, WHR and waist circumference. In PCOS patients there was a strong positive correlation between leptin and IRI (r = 0.592, p < 0.01) on the one hand, and leptin and HOMA-IR, on the other (r = 0.637, p < 0.01). In PCOS patients with more pronounced insulin resistance (IR) the correlation between leptin levels and HOMA-IR is independent of BMI, WHR and waist circumference. We did not find any correlation between leptin and other hormonal indices in PCOS patients.

Conclusions Our study confirms the existence of a significant positive correlation between serum leptin levels and clinical and hormonal indices of IR. The hyperleptinaemia is probably due to leptin resistance and may be characteristic of the syndrome. The lack of correlation with other hormonal parameters is probably due to the heterogeneity of the PCOS group.     

Insulin resistance, dyslipidemia, and metabolic syndrome in women with polycystic ovary syndrome

Objective

To investigate the association of insulin resistance with dyslipidemia and metabolic syndrome (MBS) in women with polycystic ovary syndrome (PCOS).

Methods

Fasting glucose (G), insulin (I), and lipid levels were measured in 50 infertile women with PCOS. A fasting G/I ratio of 4.5 or less (n = 29) defined insulin resistance (IR).

Results

The mean levels of total cholesterol (P < 0.001), low-density lipoprotein (P = 0.02), and triglycerides (P < 0.001) were significantly higher and the mean levels of high-density lipoprotein were significantly lower (P < 0.001) in the IR group. The prevalence of MBS (P = 0.02) and obesity (P = 0.04), hypertension (P = 0.02), fasting hyperglycemia (P = 0.03), low high-density lipoprotein levels (P = 0.02), and hypertriglyceridemia (P = 0.02) were also significantly higher in the IR group.

Conclusion

Insulin resistance is associated with dyslipidemia and MBS in women with PCOS. Lifestyle modification and insulin-sensitizing agents should be part of the management plan.     

多囊卵巢综合征患者血清脂联素水平与胰岛素抵抗关系的研究

目的探讨多囊卵巢综合征(PCOS)患者血清脂联素(APN)水平与胰岛素抵抗的关系。方法采用酶联免疫吸附法(ELISA)测定40例PCOS患者[PCOS组,根据体重指数(BMI)分为肥胖者(BMI≥25kg/m2)19例,非肥胖者(BMI<25kg/m2)21例]及15例健康志愿者和10例非PCOS不孕患者(对照组,其中肥胖者9例,非肥胖者16例)的APN水平,化学发光法、葡萄糖氧化酶法、放射免疫法分别测定空腹胰岛素、空腹血糖、肿瘤坏死因子α(TNF-α)水平。计算两组患者胰岛素敏感指数(ISI),评价胰岛素抵抗程度。结果(1)PCOS组肥胖者APN水平为(1·6±0·5)mg/L,PCOS组非肥胖者为(3·0±0·6)mg/L,对照组肥胖者为(3·2±0·3)mg/L,非肥胖者为(4·9±0·5)mg/L,两组分别比较,差异均有统计学意义(P<0·05)。(2)PCOS组肥胖者胰岛素水平为(17±6)mU/L,非肥胖者为(14±6)mU/L,对照组肥胖者为(10±3)mU/L,非肥胖者为(7±3)mU/L,两组分别比较,差异有统计学意义(P<0·05)。(3)PCOS组肥胖者空腹血糖为(5·2±0·7)mmol/L,非肥胖者为(5·1±0·6)mmol/L,对照组肥胖者为(5·4±0·5)mmol/L,非肥胖者为(4·8±0·6)mmol/L,两组分别比较,差异无统计学意义(P>0·05)。(4)PCOS组肥胖者TNF-α水平为(1·32±0·14)μg/L,非肥胖者为(1·02±0·12)μg/L,对照组肥胖者为(0·93±0·15)μg/L,非肥胖者为(0·63±0·18)μg/L,两组分别比较,差异有统计学意义(P<0·05)。(5)PCOS组肥胖者ISI为-4·5±0·3,非肥胖者为-4·1±0·4,对照组肥胖者为-3·6±0·3,非肥胖者为-3·1±0·4,两组分别比较,差异也有统计学意义(P<0·05)。PCOS组患者APN水平与BMI呈显著负相关关系(r=-0·56,P<0·05),与ISI呈显著正相关关系(r=0·49,P<0·05)。结论PCOS患者APN水平降低,并以PCOS肥胖者降低更明显;PCOS患者APN水平下降与胰岛素敏感性及胰岛素抵抗相关。     

Effect of folic acid in women with and without insulin resistance who have hyperhomocysteinemic polycystic ovary syndrome.

OBJECTIVE: To study the effect of folic acid on homocysteine (Hcy) levels in women with insulin resistance and polycystic ovary syndrome (PCOS) in a prospective clinical trial. METHOD: Of 210 women with PCOS, 70 were hyperhomocysteinemic; and of these, 32 were insulin resistant and 38 were not. The 70 women were treated with folic acid for 3 months. Baseline and serum levels of Hcy and insulin were measured in both groups. RESULTS: In both groups Hcy concentrations were significantly decreased following folic acid supplementation. The mean+/-SD levels before and after treatment were 14.03+/-1.5 micromol/L and 12.53+/-1.72 micromol/L in group 1 (P<0.001), and they were 12.07+/-0.87 micromol/L and 8.83+/-0.78 micromol/L in group 2 (P<0.001). CONCLUSION: The Hcy levels of hyperhomocysteinemic women with PCOS were reduced after 3 months of folic acid supplementation, and the rate of reduction was higher among women without insulin resistance. No change was found in fasting insulin levels.