体质量指数正常的多囊卵巢综合征伴胰岛素抵抗患者的临床特征及胰岛素抵抗影响因素分析

目的:观察体质量指数(BMI)正常的多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)患者的临床及生化表现,探讨其临床特征及IR的影响因素。方法:收集2015年8月至2016年6月就诊于黑龙江中医药大学附属第一医院妇科门诊的BMI正常(18.5 kg/m~2≤BMI≤23.9 kg/m~2)的PCOS患者116例,其中PCOS伴IR患者50例,PCOS不伴IR患者66例,分析、比较两组的临床特征、性激素水平、糖脂代谢水平,采用Spearman或Pearson相关分析稳态模型胰岛素抵抗指数(HOMA-IR)的影响因素。结果:1PCOS伴IR组患者腰臀比、多毛评分明显高于PCOS不伴IR组患者,差异有统计学意义(P0.05);2PCOS伴IR组患者空腹葡萄糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)显著高于PCOS不伴IR组患者,差异有统计学意义(P0.05),PCOS伴IR组患者高密度脂蛋白(HDL)显著低于PCOS不伴IR组患者,差异有统计学意义(P0.05);3对BMI正常的PCOS患者进行相关分析,HOMA-IR与年龄、BMI、卵泡刺激素(FSH)、黄体生成激素(LH)、LH/FSH、睾酮(T)、硫酸脱氢表雄酮(DHEAS)、雄烯二酮(AND)无关(P0.05);与腰臀比(r=0.386)、FPG(r=0.459)、FINS(r=0.981)、TC(r=0.360)、TG(r=0.343)和LDL(r=0.467)呈正相关(P0.01),与性激素结合球蛋白(SHBG)(r=-0.220,P0.05)、HDL(r=-0.288,P0.01)呈负相关。结论:BMI正常的PCOS伴IR患者腰臀比、多毛评分及糖、脂代谢指标较无IR的PCOS患者均有改变。BMI正常的PCOS患者的IR与腰臀比、FPG、FINS、TC、TG、LDL及SHBG、HDL相关。     

多囊卵巢综合征患者血脂异常类型及病理生理改变的研究进展

多囊卵巢综合征(PCOS)是一种常见的内分泌紊乱性疾病,与代谢综合征有某些共同特点,广泛影响着育龄期女性的健康。PCOS患者中,高水平的低密度脂蛋白(LDL)、甘油三酯(TG)以及低水平的高密度脂蛋白(HDL)等血脂异常比较常见。PCOS患者血脂异常与肥胖、高胰岛素血症、高雄激素血症等病理状态密切相关。虽然界定各种因素的因果关系存在困难,但它们既独立又相互关联影响着PCOS患者异常的脂代谢。     

多囊卵巢综合征患者血清中血管生成素相关生长因子水平的评价

目的探讨多囊卵巢综合征(PCOS)患者血清中血管生成素相关生长因子(angiopoientin-related growth factor,AGF)水平变化,及AGF与PCOS患者胰岛素抵抗的关系。方法 2010年3月至2011年3月在沧州市中心医院选择67例未合并糖尿病的PCOS患者作为研究组,同期选择112例健康女性作为对照组,测定所有研究对象血清AGF质量浓度及与胰岛素抵抗相关的内分泌代谢指标。结果研究组血清AGF水平显著高于对照组(345.3±38.6)vs.(288.7±33.4)μg/L,P<0.05;PCOS胰岛素抵抗组血清AGF水平显著高于PCOS非胰岛素抵抗组(350.9±29.6)vs.(338.4±31.6)μg/L,P<0.05。AGF与BMI(r=0.23,P<0.05)、胰岛素抵抗(IR)指数(HOMA-IR)(r=0.19,P<0.05)呈正相关,与年龄、低密度脂蛋白(LDL-C)、腰臀比(WHR)、空腹血糖(FBG)、2h糖耐量试验(OGTT)、空腹胰岛素(FINS)无关。结论升高的AGF可能在PCOS患者糖脂代谢紊乱的发生发展过程中发挥作用。     

不同程度妊娠期糖尿病患者糖代谢异常与脂代谢紊乱关系的研究

目的 探讨新诊断标准下不同程度妊娠期糖尿病(GDM)患者糖脂代谢变化及两者的关系.方法 选取于2010年至2011年首都医科大学附属复兴医院产检的孕妇,孕24～28周、行75 g葡萄糖耐量试验(OGTT)及血脂六项.根据OGTT结果,分为GDM组共266例,其中任意一项异常GDM1组148例,两项异常GDM2组86例,三项异常GDM3组32例.正常组NGT 100例.结果 ①与NGT组比较,GDM组胰岛素抵抗指数HOAM-IR增高(4.18±1.67、3.13±1.22)、胰岛细胞分泌功能指数HBCI降低[(5.41±0.44)、(5.93±0.48)],甘油三酯TG增高(3.18±0.85、2.77±0.67) mmol/L、载脂蛋白ApoB/ ApoA1 (0.47±0.14、0.42±0.14)差异有统计学意义(P＜0.05);②组内GDM3组HOAM-IR (5.06±1.79),LnHBCI(5.09±0.48)、TG (3.78±1.12) mmol/L、Ln (TG/HDL-C) (0.25±0.14)、ApoB/ApoA1 (0.56±0.17)ApoB (1.13±0.26) g/L较GDM1、GDM2变化显著,差异有统计学意义(P＜0.05);③TG与空腹血糖FPG、胰岛素FIN、糖化血红蛋白HbA1c水平及HOMA-IR呈正相关;高密度脂蛋白HDL-C与FPG、FNS及HO-MA-IR水平呈负相关;ApoA1与HBCI呈正相关.结论 不同程度妊娠期糖尿病患者存在糖脂代谢紊乱,血脂异常与胰岛功能和胰岛素抵抗存在着密切关系.     

青春期和育龄期多囊卵巢综合征的临床生化特征分析比较

目的:探讨青春期多囊卵巢综合征(PCOS)患者的临床生化特征.方法:收集2010年8月至2012年10月四川大学华西二院妇产科门诊收治的126例青春期PCOS患者(青春期组)和368例育龄期PCOS患者(育龄期组),分析和比较两组患者的临床及生化指标.结果:(1)青春期组患者的初潮年龄(12.59±1.39)显著低于育龄期组(13.28±5.36)(P＜0.05),但均在正常范围内;高雄症状的程度和发生率均显著高于育龄期组(P＜0.05),体重指数(BMI)、腰围、腰臀比(WHR)和平均舒张压均显著低于育龄期组(P＜0.05);(2)两组的平均血睾酮(T)、LH、FSH、LH/FSH及FINS、HOMA-IR、HDL无显著差异(P＞0.05).青春期组的平均空腹血糖(FPG)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、TC/HDL及LDL/HDL均显著低于育龄期组(P＜0.05);(3)青春期组的腰围≥80cm、收缩压≥130mmHg和FPG ≥5.6mmol/L的发生率显著低于育龄期组(P＜0.05).结论:青春期PCOS患者具有PCOS特征性的高雄、代谢障碍问题,需加以关注,并及早治疗.     

多囊卵巢综合征患者抗苗勒氏管激素水平与代谢综合征的相关性探讨

目的:探讨PCOS患者AMH水平与代谢综合征(MS)的相关性。方法:选取安徽医科大学第一附属医院生殖中心收治的PCOS患者184例,于月经第2~5天检测基础性激素、空腹血糖、胰岛素、血脂、血AMH值。按MS标准将PCOS患者分为合并MS组和未合并MS组,比较两组的年龄、身高、体重、BMI、腰围、臀围、WHR、血压、性激素、糖代谢、脂代谢等指标差异。按AMH水平分为高AMH组(AMH≥10ng/ml)和低AMH组(AMH10ng/ml),比较两组的性激素、糖脂代谢指标的差异。将总AMH、高AMH、低AMH分别与代谢指标之间进行相关性分析。结果:合并MS组与未合并MS组的AMH值比较,差异无统计学意义。高AMH组和低AMH组的LH、LH/FSH、T值比较,差异有统计学意义;两组的FPG、INS、HOMA-IR、TG、TC、HDL、LDL-C等比较,无显著差异。低水平AMH与INS、HOMA-IR呈负相关性,总AMH以及高水平AMH与INS、HOMA-IR、TC、TG、HDL、LDL、VLDL等均无关。结论:PCOS患者的AMH高低水平与LH、LH/FSH、T有关,与FPG、INS、HOMA-IR、TG、TC、HDL、LDL-C等代谢紊乱无关;低水平的AMH值与糖代谢异常呈负相关,未来更易发展成MS。     

抑制素B与多囊卵巢综合征不同临床表型相关性研究

目的分层对照分析多囊卵巢综合征(PCOS)患者的临床基本特征,探讨抑制素B(INH B)对PCOS的临床意义及与不同临床表型的相关性。方法选取2013年6月至2015年12月广东省计划生育专科医院按照Rotterdam标准诊断的148例PCOS患者为病例组,选取月经规律且有正常生育史的女性40例为对照组。收集调查对象基本信息,根据血清睾酮(T)≥1.97 nmol/L分为高雄激素血症(HA)组和非高雄激素血症(NHA)组;根据稳态模式胰岛素抵抗指数(HOMA-IR)≥2.69分为胰岛素抵抗(IR)组和非胰岛素抵抗(NIR)组;根据BMI≥24分为超重组和非超重组;将3组进行对照分析,探讨INH B与PCOS不同临床表型的相关性。结果对照组和PCOS组在BMI、黄体生成素(LH)、LH/卵泡刺激素(FSH)、T、抗苗勒管激素(AMH)和HOMA-IR差异有统计学意义[23.13±3.72 vs.30.15±4.42,(7.83±4.53)U/L vs.(4.65±2.00)U/L,1.73±1.82 vs.0.94±0.41,(2.40±1.42)nmol/L vs.(1.45±0.85)nmol/L,(9.21±4.77)μg/L vs.(5.44±3.01)μg/L,3.96±2.45 vs.1.70±0.50,P0.01];INH B差异无统计学意义(P0.05)。在HA组和NHA组的比较中,INH B差异有统计学意义[(53±28)ng/L vs.(112±37)ng/L,P=0.000],AMH、BMI和HOMA-IR比较差异无统计学意义(P0.05);在IR组和NIR组的比较中,BMI和INH B在两组中的差异有统计学意义[21.85±3.41 vs.23.89±3.71,(89±32)ng/L vs.(32±27)ng/L,P0.05],T和AMH差异无统计学意义(P0.05);在超重组和非超重组的比较中,HOMAIR和INH B在两组中的差异有统计学意义[(3.35±1.99 vs.5.02±2.76,(86±24)ng/L vs.(38±22)ng/L,P=0.001),T和AMH差异无统计学意义(P0.05)。结论 PCOS具有高度的临床异质性,高雄激素、胰岛素抵抗和超重等不同临床表型可能具有不同的病理生理机制,导致INH B在不同表型反映不同。     

高雄激素血症与多囊卵巢综合征中非酒精性脂肪性肝病的关系

目的:探讨高雄激素血症(HT)与多囊卵巢综合征(PCOS)患者非酒精性脂肪性肝病(NAFLD)发病的关系。方法:对306例PCOS患者进行基础内分泌、口服糖耐量试验及胰岛素释放试验、肝功能、血脂等检查,B超诊断脂肪肝。结果:306例PCOS患者中诊断出NAFLD94例,发病率为30.7%;其中NAFLD轻度56例(59.6%),中度34例(36.2%),重度4例(4.2%)。PCOS患者NAFLD的发病率与HA无明显相关性,与稳态模型评估胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)呈正相关。PCOS合并NAFLD组胰岛素抵抗(IR)发生率明显高于PCOS不合并NAFLD组,P<0.05;PCOS高雄激素血症(PCOS-HA)组IR发生率与PCOS非高雄激素血症(PCOS-NHA)组无明显差异,P>0.05。结论:PCOS患者NAFLD发病率较高,PCOS患者NAFLD的发生与IR、代谢异常密切相关,与HA无明显相关。     

多囊卵巢综合征患者外周血Ang-(1-7)、AngⅡ/Ang-(1-7)比值与胰岛素抵抗及脂代谢的相关性研究

目的探讨多囊卵巢综合征(PCOS)患者中肾素血管紧张素系统(renin angiotensin system,RAS)与胰岛素抵抗(IR)及脂代谢的关系。方法 PCOS患者根据胰岛素抵抗指数(HOMA-IR)分为IR组(HOMA-IR≥2.69,n=80)与非IR组(NIR组,HOMA-IR2.69,n=67),另以25例正常月经周期女性作为对照组。采用酶联免疫法(ELISA)测定外周血血管紧张素Ⅱ(AngⅡ)、血管紧张素1-7[Ang-(1-7)]的水平,化学发光法测定血清性激素、空腹胰岛素(FINS)、血脂水平。结果 (1)IR组与NIR组外周血中AngⅡ和Ang-(1-7)水平均高于对照组(P0.05),IR组与NIR组间AngⅡ水平无统计学差异(P0.05),但Ang-(1-7)水平IR组低于NIR组(P0.05);(2)IR组外周血中AngⅡ/Ang-(1-7)比值高于NIR组及对照组(P0.05),NIR组AngⅡ/Ang-(1-7)比值较对照组无统计学差异(P0.05);(3)Pearson相关分析显示,IR组外周血中Ang-(1-7)与FINS、HOMA-IR、体质量指数(BMI)呈负相关,与卵泡刺激素(FSH)呈正相关(P0.05);NIR组外周血中Ang-(1-7)与甘油三酯(TG)呈负相关,与高密度脂蛋白(HDL)呈正相关(P0.05)。结论 PCOS患者外周血存在AngⅡ、Ang-(1-7)亢进现象;AngⅡ/Ang-(1-7)比值失衡与PCOS患者的IR及代谢紊乱有关,Ang-(1-7)水平的提高可能改善IR及代谢紊乱。     

中心型肥胖对多囊卵巢综合征不孕患者体外受精结局的影响

目的：探讨中心型肥胖对多囊卵巢综合征(PCOS)不孕患者体外受精(IVF)结局的影响。方法：回顾性分析2009-2010年中山大学孙逸仙纪念医院 PCOS不孕患者行IVF治疗的188个新鲜周期,按照是否为中心型肥胖分为腰围≥80 cm组(70个周期)和腰围<80 cm组(118个周期),比较两组基础内分泌代谢和IVF的临床及实验室参数。结果：腰围≥80 cm与腰围<80 cm组相比,体重指数(BMI)、腰臀比增加,血游离雄激素指数(FAI)高,性激素结合球蛋白(SHBG)低,空腹葡萄糖、空腹胰岛素、稳态胰岛素评价指数(HOMA-IR)、2 h口服葡萄糖耐量试验(OGTT2h)葡萄糖及胰岛素高,胰岛素抵抗、空腹血糖受损(IFG)、糖耐量异常(IGT)的发生率高,三酰甘油(TG)高、高密度脂蛋白(HDL)低,差异均有统计学意义(P<0.05)。校正BMI后,腰围与空腹胰岛素、HOMA-IR及FAI呈正相关(P<0.01);促性腺激素(Gn)用量[(2014.8±825.8)U vs.(1491.2±558.9)U ]及天数[(12.5±4.0)d vs.(10.7±3.0)d]增加(P<0.01),峰值雌二醇水平低[(8492.7±4771.2)pmol/L vs.(11918.1±5329.0)pmol/L,P<0.001],诱发卵子成熟的人绒毛膜促性腺激素(HCG)用量多(P=0.011)而成熟卵泡及获卵数少[(11.6±5.7)个vs.(13.8±7.3)个,P<0.05];胚胎种植率降低(24.3% vs.36.3%,P=0.019),早期流产率增加(38.5% vs.7.5%,P=0.002),临床妊娠率差异无统计学意义(40.6% vs.55.2%, P=0.07)。校正年龄及病因,Logistic回归分析显示HOMA-IR是PCOS患者IVF妊娠后早期流产的风险因素(OR=0.143,95%CI=0.026~0.768,P=0.023)。结论：中心型肥胖PCOS患者胰岛素抵抗和高雄激素血症更显著,糖脂代谢紊乱发生率高,负面影响PCOS患者IVF促排卵的反应,且胚胎种植率下降、早期流产率增加。     

Evaluation of insulin resistance and metabolic syndrome in patients with polycystic ovary syndrome

Aim.?Polycystic ovary syndrome (PCOS) is associated with the clustering of states including insulin resistance (IR), obesity, elevated blood pressure, and dyslipidemia that are termed as metabolic syndrome (MBS). This study was designed to assess the differences between homeostatic model assessment (HOMA) values in PCOS and healthy women.

Methods.?In a case–control study, 55 women with PCOS and 59 women with normal cycles (control group) aged 15–40 years old were evaluated. In all the subjects (after obtaining written informed consent), blood pressure, body weight, height, body mass index (BMI), waist /hip ratio(WHR) and fasting blood glucose (FBG), triglycerides (TG), HDL, C-peptide, insulin, HOMA Index, and FGIR (fasting glucose to insulin ratio) were measured.

Results.?In this study, the prevalence of MBS was significantly higher in PCOS group compared with the control group (p = 0.028). There were no significant differences in age, waist/hip ratio, fasting glucose, insulin, and C-peptide levels between patients with PCOS and control group. Furthermore, the prevalence of impaired fasting glucose (IFG) and the mean of HOMA and FGIR did not differ significantly between PCOS and control group.

Conclusion.?Criteria of MBS are frequently present in young women with PCOS and may be more useful as a prognostic factor than IR indexes in this age group. We suggest evaluation of IR in older age women with PCOS.     

Metabolic syndrome in Mediterranean women with polycystic ovary syndrome: when and how to predict its onset

Polycystic ovary syndrome (PCOS) is associated with the metabolic syndrome (MetS). The metabolic disorders are not universal and may vary with race, age and phenotype. Our purpose was to determine the clinical and biochemical characteristics of Mediterranean PCOS women with MetS, compare them with non-MetS PCOS patients, and assess the ability of clinical data and biochemical tests to predict these abnormalities within our population. A total of 218 subjects, 196 PCOS women and 22 controls, undergo a physical examination and laboratory evaluation for a diagnosis of MetS. MetS was categorized according to NCEP ATP III guidelines. PCOS patients were analyzed separately and compared in three subgroups: three or more MetS criteria, two criteria, one or no criteria. The overall prevalence of MetS was 21.4%. Women with MetS had higher glucose (G) levels than PCOS women with two criteria (5.7?±?1.5 vs 5?±?0.4, p?相似文献   

糖代谢异常孕妇脐血血脂与新生儿体质指数的关系

目的 探讨在血糖控制良好的糖代谢异常的孕妇中,脐血血脂与新生儿体质指数的关系. 方法 收集2006年11月至2007年2月住院分娩的孕妇150例,其中糖代谢异常(包括妊娠期糖尿病和妊娠期糖代谢异常)且血糖控制良好的孕妇73例,糖耐量正常的孕妇77例,其新生儿分为大于胎龄儿(large for gestational age,LGA)25例和适于胎龄儿(appropriate forgestational age,AGA)125例两组.分析两组新生儿的体质指数、脐血血脂[包括高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)、甘油三酯(triglyceride,TG)、总胆固醇(total cholestrol,TC)]等指标,并对上述指标进行比较和相关、回归分析. 结果 脐血HDL、LDL、TC水平在两组间无差异,脐血TG水平LGA组高于AGA组[(0.23±0.16)mmol/L和(0.14±0.08)mmol/L,P＜0.05].在糖代谢异常孕妇的新生儿中,LGA儿的出生体重与脐血TG水平正相关(r=0.625,P＜0.05),与脐血HDL、LDL、TC不相关.在糖耐量正常孕妇的新生儿中,LGA儿的体质指数与脐血血脂指标均不相关.分娩LGA儿的危险因素为:孕期增重≥18 kg,脐血TG＞0.11 mmol/L. 结论 血脂代谢与新生儿体质指数密切相关;脐血TG可能参与了精代谢异常孕妇分娩LGA的发病机制;脐血TG＞0.11 mmol/L时更容易发生LGA.     

Atherogenic metabolic profile in PCOS patients: role of obesity and hyperandrogenism

Objective. To investigate glyco-lipidic metabolism and androgenic profile in a cohort of women with polycystic ovary syndrome (PCOS) divided according to Rotterdam phenotypes and body mass index (BMI).

Design. A prospective case–control study.

Setting. Gynecology department in a teaching hospital.

Patients. A total of 223 PCOS women and 25 healthy control women were studied.

Methods. Patients and controls were subdivided into three groups according to their BMI: normal weight (18.5?≤?[BMI]?≤24.9?kg/m²), overweight (25.0?≤?BMI?≤29.9?kg/m²), or obese (BMI?≥30.0?kg/m²) and according to Rotterdam criteria of PCOS.

Main outcome measures. Pituitary-gonadal axis assessment including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, PRL, testosterone, androstenedione, DHEA-S, 17-hydroxyprogesterone and inhibin B. Metabolic parameters included cholesterol (Chol), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and apolipoproteins (APO) AII and B as well as serum fasting insulin, glucose and HOMA-IR.

Results. Serum fasting insulin, glucose, HOMA-IR, TG and HDL were significantly higher in women with PCOS compared to controls. Additionally, serum levels of Chol, LDL and TG were significantly higher and HDL levels were significantly lower in obese PCOS women compared with overweight/normal PCOS irrespective of Rotterdam phenotypes. Free testosterone index but not androstenedione or total testosterone significantly correlated with TG, HDL and APO B. No significant correlations were detected between gonadotropins, inhibin B or estradiol with metabolic parameters studied.

Conclusions. Obesity but not overweight in PCOS is associated with dyslipidemia. Hyperandrogenic women showed the most atherogenic lipid profiles.     

内脏脂肪素mRNA表达变化与妊娠期糖尿病的相关性

目的 探讨晚期妊娠孕妇大网膜组织内脏脂肪素(VF)Mrna表达的变化与妊娠期糖尿病(GDM)的相关性.方法 采用半定量RT-PCR技术检测100例晚期妊娠妇女大网膜组织VFmRNA的表达水平,其中包括GDM孕妇45例(GDM组)、糖耐量正常(NGT)孕妇55例(NGT组).检测各组孕妇空腹血糖、空腹血清胰岛素、总胆固醇(TC)及甘油三酯(TG)水平,采用稳态模型(HOMA)计算胰岛素抵抗(IR)指数(HOMA-IR)并计算孕前体重指数(BMI).结果 GDM组与NGT组大网膜组织中VF Mrna表达水平分别为0.8±0.4、0.5±0.3,空腹血糖水平分别为(4.12±0.14)、(3.65±0.13)mmol/L,空腹血清胰岛素水平分别为(72±5)、(61±5)pmol/L,TG水平分别为(5.6±0.3)、(3.8±0.3)mmol/L,TC水平分别为(5.6±0.9)、(3.9±0.3)mmol/L,孕前BMl分别为(22.6±0.8)、(20.9±0.4)ks/m2,HOMA-IR分别为12.5±5.9、9.5±0.8,两组以上各值分别比较,GDM组各值均高于NGT组,差异均有统计学意义(P<0.05).VF Mrna表达水平与孕前BMI呈正相关关系(r=0.32,P<0.01),但与HOMA-IR、TC、TG无相关性.结论 VF Mrna表达上调可能与GDM、肥胖的发生密切相关.     

磷脂酰肌醇-3激酶的表达及其活性变化与妊娠期糖尿病胰岛素抵抗的关系

目的 研究磷脂酰肌醇-3激酶(phosphatidyl inositol-3 kinase,PI-3K)在妊娠期糖尿病(gestational diabetes mellitus,GDM)患者脂肪组织中的表达及其活性变化,分析其与GDM胰岛素抵抗(insulin resistance,IR)的关系.方法 采用Western印迹法、RT-PCR法分别检测20例GDM孕妇(GDM组)和20例正常妊娠晚期孕妇(正常妊娠组)脂肪组织中PI-3K p85α蛋白质和mRNA的表达,采用ELISA法检测两组孕妇脂肪组织中PI-3K的活性,葡萄糖氧化酶法和放射免疫法检测两组孕妇空腹血糖(fasting plasma glucose,FPG)及空腹胰岛素(fasting insulin,FIN)水平,并采用稳态模型(homeostasis model assessment,HOMA)计算IR指数.结果 (1)PI-3K p85a蛋白的表达GDM组高于正常妊娠组(0.93±0.04和0.71±0.06,P＜0.01).(2)GDM组PI-3K p85emRNA表达高于正常妊娠组(0.83±0.03和0.53±0.07,P＜0.01).(3)GDM组PI-3K的活性为正常妊娠组的30%,明显降低(1.7±0.6和5.2±0.5,P＜0.01)(4)GDM组FPG、FINS、HOMA-IR分别为(5.8±0.2)mmol/L、(14.8±0.2)mmol/L和1.3±0.4,正常晚孕组分别为(4.7±0.3)mmol/L、(11.2±0.3)mmol/L和0.9±0.3,两组间各指标比较均有统计学意义(P＜0.01).PI-3K活性与HOMA-IR呈负相关(r=-0.68,P＜0.01).结论 GDM患者脂肪组织中PI-3K活性降低是其发生胰岛素抵抗的分子机制之一.     

胎儿生长迟缓与新生儿胰岛素敏感性变化的相关性

目的探讨胎儿生长迟缓(FGR)与新生儿胰岛素敏感性变化的关系。 方法昆明医学院第一附属医院于2004年4~12月，对72例小于胎龄儿(SGA)和48例适于胎龄儿(AGA)空腹血糖(FPG)、空腹胰岛素(FINS)、C 肽、HDL C、LDL C、TG、非酯化脂肪酸(NEFA)等指标，计算葡萄糖/胰岛素比值(G/I)、胰岛素敏感性指数(ISI)、胰岛素抵抗指数(HOMA IR)、胰岛β细胞功能(HBCI)等，探讨FGR与新生儿胰岛素敏感性变化的关系。 结果(1)SGA组FPG、HDL C低于AGA组，而FINS、LDL C、TG、NEFA高于AGA组(P<001)；(2)SGA组G/I比值、ISI低于AGA组，HOMA IR高于AGA组(P<001)，而HBCI两组相比差异无显著性(P>005)。 结论FGR儿在生命早期存在胰岛素敏感性降低和不同程度的胰岛素抵抗(IR)，而胰岛β细胞功能无明显变化。     

Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome

OBJECTIVE: To determine the prevalence of insulin resistance (IR) in women with polycystic ovary syndrome (PCOS) using baseline fasting blood measurements of glucose and insulin. DESIGN: Prospective clinical study. SETTING: Academic endocrinology unit in Palermo, Italy. PATIENT(S): Two hundred and sixty-seven women with PCOS, consecutively evaluated, and 50 consecutively selected ovulating controls. INTERVENTION(S): Fasting blood was obtained for glucose and insulin measurements from all women. For 60 women with PCOS and 20 controls an insulin tolerance test (ITT) was also performed. MAIN OUTCOME MEASURE(S): Assessment of normal and abnormal values for fasting insulin, glucose/insulin ratio, and the calculated indices of the homeostasis model assessment (HOMA), quantitative sensitivity check index (QUICKI), as well as Kitt (kinetic disappearance of glucose) values after ITT. Evaluation was performed of the ability to detect IR using these methods in obese and nonobese women with PCOS. RESULT(S): Normal insulin sensitivity was defined by insulin levels <12 mU/mL, glucose/insulin ratios of >6.4, HOMA values of <47, and QUICKI values of >0.333. In the entire PCOS groups, IR was diagnosed in 65.4% of women using glucose/insulin ratios and in 77% and 79.2% using HOMA and QUICKI. In obese women (body mass index >28 in 48% of group), IR was present in 76.7% as measured by glucose/insulin ratios but was significantly higher (95.3%) using values of either HOMA or QUICKI (P<.01). All indices correlated with Kitt values with QUICKI showing the best correlation. CONCLUSION(S): Insulin resistance was detected in approximately 80% of women with PCOS, and in 95% of obese women. The detection of IR is superior using the calculated indices HOMA and QUICKI.