Pro12Ala polymorphism of the peroxisome proliferator-activated receptor-gamma gene in women with polycystic ovary syndrome.

AIM: The present study was designed to examine the relationship between Pro12Ala polymorphism of the peroxisome proliferator-activated receptor-gamma gene (PPAR-gamma) and clinical and hormonal characteristics in women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: One hundred patients with PCOS and 100 healthy subjects were included in the study. Serum levels of sex steroids were measured. Insulin resistance was evaluated by homeostasis model assessment (HOMA). The responses of glucose and insulin to an oral glucose tolerance test were analyzed by calculating the respective area under the curve (AUC) by the trapezoidal method. We used the restriction fragment length polymorphism technique and polymerase chain reaction to examine Pro12Ala polymorphism in exon 2 of PPAR-gamma. RESULTS: Pro12Ala polymorphism of PPAR-gamma was significantly elevated in control subjects (22%) compared with PCOS subjects (15%). All of the Pro12Ala polymorphisms of PPAR-gamma were heterozygous. When PCOS subjects with the Pro allele and the Ala allele of PPAR-gamma were compared, the latter had lower free testosterone, androstenedione, dehydroepiandrosterone sulfate, insulin and C-peptide levels, as well as lower luteinizing hormone/follicle-stimulating hormone ratio, HOMA insulin resistance index, AUCinsulin, Ferriman-Gallwey score, acne, body mass index and waist-to-hip ratio. CONCLUSION: We suggest that Pro12Ala polymorphism of the PPAR-gamma gene may be a modifier of insulin resistance in women with PCOS.     

Insulin resistance in polycystic ovary syndrome: hyperandrogenemia versus normoandrogenemia.

OBJECTIVE: The goal of this study was to evaluate the insulin resistance and glucose tolerance in hyperandrogenemic and normoandrogenemic groups of patients with polycystic ovary syndrome (PCOS). STUDY DESIGN: In this cross-sectional study, 17 hyperandrogenemic and 14 normoandrogenemic, age and weight-matched non-obese women with PCOS were studied. All patients had clinical hyperandrogenism and chronic anovulation with polycystic ovaries on ultrasound. Insulin resistance and glucose tolerance were determined by measuring insulin and glucose concentrations following a 75 g oral glucose tolerance test (OGTT). Fasting glucose to insulin ratio (FG:I ratio), insulin area under the curve (AUC(insulin)) during OGTT, and homeostasis model assessment for insulin resistance (HOMA-IR) were calculated. RESULTS: Hyperandrogenemic group of patients had fasting hyperinsulinemia, lower FG:I ratio, higher AUC(insulin), and HOMA-IR compared with normoandrogenemic group. The differences between two groups were statistically significant. CONCLUSION: PCOS has variable biochemical features. Hyperandrogenemia associated with insulin resistance differs from normoandrogenemia in this syndrome. Fasting insulin concentrations, FG:I ratio, AUC(insulin), and HOMA-IR are convenient markers for determining insulin resistance in PCOS.     

PPAR-gamma2 Pro12Ala polymorphism is associated with weight gain in women with gestational diabetes mellitus

OBJECTIVE: The polymorphisms of peroxisome proliferator-activator receptor-gamma2 (PPAR-gamma2) have been suggested to affect glucose metabolism and weight gain. Both conditions show great variations during pregnancy that makes pregnancy a suitable condition to detect any metabolic abnormalities related to PPAR-gamma2 polymorphisms. The objective of this study is to investigate the prevalence and metabolic impacts of PPAR-gamma2 polymorphism in control pregnant women and in patients with gestational diabetes mellitus (GDM). METHODS: In this case-control study, anthropometric and metabolic variables of 100 non-diabetic pregnant women and of 62 women who were diagnosed as having GDM according to 100 g oral glucose tolerance test (OGTT) were compared on the basis of PPAR-gamma2 polymorphism by univariate analysis of covariance. RESULTS: There were no statistically significant differences in baseline characteristics and the mean 50 g glucose challenge test values of pregnant women in both groups on the basis of PPAR-gamma2 genotype, although patients with Pro12Ala polymorphism were significantly taller in GDM group. The Pro12Ala polymorphism had no effect on 100 g OGTT results of patients with GDM. However, patients with GDM who had Pro12Ala polymorphism gained significantly more weight during their pregnancy. CONCLUSION: The PPAR-gamma2 Pro12Ala polymorphism was observed to have no effect on glucose metabolism in normal pregnant women and women with GDM. However, only the patients with GDM who had this polymorphism gained significantly more weight during their pregnancy. It seems that Pro12Ala polymorphism plays a dynamic and interactive role in the regulation of BMI and glucose homeostasis.     

A meta-analysis on the association between PPAR-γ Pro12Ala polymorphism and polycystic ovary syndrome

Purpose

To investigate the influence of the peroxisome proliferator activated receptor gamma (PPAR-γ) Pro12Ala polymorphism on the susceptibility of polycystic ovary syndrome (PCOS) and body mass index (BMI), fast insulin levels, homeostasis model assessment of insulin resistance (HOMA-IR) in PCOS patients.

Methods

PubMed, EMBASE, MEDLINE and CENTRAL databases were searched to identify eligible studies. We then conducted a meta-analysis to examine the association between Pro12Ala polymorphism and PCOS.

Results

Seventeen eligible studies, including 2,149 patients and 2,124 controls were enrolled in this meta-analysis. Pro12Ala polymorphism was significantly associated with the susceptibility of PCOS (odds ratio [OR] 0.74, 95 % confidence interval [CI] [0.61, 0.90] for allele; OR 0.70, 95 % CI [0.57, 0.86] for genotype). In the European subgroup of PCOS, the X/Ala genotype was associated with lower BMI (mean difference [MD] −1.08, 95 % CI [−2.08, −0.09]) and fast insulin levels (MD −19.82, 95 % CI [−34.07, −5.58]). However, this polymorphism did not display an impact on HOMA-IR in PCOS patients.

Conclusions

Ala variant would decrease the risk of PCOS and result in lower BMI and fast insulin levels in a European population, but had no impact on HOMA-IR in PCOS patients. Further studies are required to elucidate these associations more clear.     

糖尿病家族青春期多囊卵巢综合征胰岛素抵抗的临床特征和治疗

目的:探讨糖尿病(DM)家族青春期多囊卵巢综合征(PCOS)胰岛素抵抗(IR)的程度及应用二甲双胍治疗的效果。方法:选择父亲或母亲被确诊患DM的7例青春期PCOS患者为实验组,以无DM家族史的28例青春期PCOS患者为对照组。测体重指数(BM I)、基础体温(BBT),抽血测FSH、LH、PRL、T、E2、P,行75g葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT)。计算空腹血糖胰岛素比率(FGIR)、糖负荷120m in血糖胰岛素比率(G120/I120)及稳态模型的胰岛素抵抗指数(HOMA-IR)。确诊IR患者进行包括二甲双胍在内的综合治疗,每3月重复检测1次上述指标。结果:实验组7例均超重(BM I≥25),其比率明显高于对照组(7/7vs12/28,P<0.01);实验组IR患病率亦明显高于对照组(7/7vs 9/21,P<0.01),且IR程度明显高于对照组IR患者(HOMA-IR为14.35vs 6.02,P<0.01)。两组接受二甲双胍综合治疗的IR患者治疗6月后空腹胰岛素(I0)比治疗前明显降低(32.47vs 40.36,P<0.05),胰岛素敏感性(IS)明显提高(FGIR为3.42 vs2.99,P<0.05),T降低,并有3例卵巢恢复排卵。结论:DM家族青春期PCOS患者可能存在较重IR,坚持二甲双胍综合治疗可减轻IR程度并恢复卵巢排卵功能。     

Can adiponectin predict abnormal glucose tolerance in Thai women with polycystic ovary syndrome?

AIM: To evaluate whether adiponectin levels could predict abnormal glucose tolerance (AGT) in Thai women with polycystic ovary syndrome (PCOS). METHODS: A 75-g oral glucose tolerance test (OGTT) with fasting adiponectin and insulin (FI) blood sampling in 170 women with PCOS were performed consecutively. RESULTS: The prevalence of AGT was 45.9%. The body mass index (BMI), waist-to-hip ratio (WHR), fasting glucose and 2-h postload glucose were greater in the PCOS women with AGT than those without AGT (P<0.001). In addition, the PCOS women with AGT had more severe insulin resistance (IR) and lower adiponectin levels than those without AGT. However, the area under the ROC curve of adiponectin and insulin in predicting AGT was smaller than that of homeostatic model of IR (HOMA-IR) (P<0.01). The arbitrary cut-off values at 12 ug/mL of adiponectin, 10 microiu/mL of FI and 2 of HOMA-IR showed the sensitivity and specificity of 80.8% and 33.7%; 87.2% and 34.8%; and 89.7% and 31.5%, respectively. With these cut-off points, 46 (27.1%), 42 (24.7%) and 37 (21.8%) women, respectively, could be eliminated from performing OGTT. However, 15 (19.2%), 10 (12.8%) and 8 (10.3%), respectively, missed the diagnosis. In addition, with WHR and acanthosis nigricans adjustment, HOMA-IR, but not adiponectin, was a significant predictor of AGT. CONCLUSION: Our study demonstrated that almost half of the women with PCOS had AGT. Adiponectin levels were significantly lower in the PCOS women with AGT than those without AGT. However, adiponectin was not shown to be as strong a predictive factor and might not be such an excellent screening test as FI and HOMA-IR.     

Assessment of insulin resistance in Chinese PCOS patients with normal glucose tolerance

The study aimed to investigate insulin resistance (IR) status in polycystic ovary syndrome (PCOS) women with normal glucose tolerance (NGT), and further to evaluate feasible diagnostic method for those patients. Three hundred and twenty-five PCOS women with NGT and ninety-five healthy age-matched controls were recruited with Rotterdam criterion and 75 g oral glucose tolerance test (OGTT). IR status was estimated following a glycemic and insulinemic OGTT (0, 30, 60, 120, and 180 min). A modified HOMA-IR formula was applied to each time-course value of glycemia and insulinemia. The predictive performance of each IR index was analyzed with the use of ROC curves. Compared with healthy controls, both non-obese and obese PCOS patients with NGT had a higher BMI, serum glucose, insulin value (p?相似文献   

Pro12Ala PPAR γ2 gene polymorphism in PCOS women: the role of compounds regulating satiety

Five to ten percent of women of reproductive age suffer from polycystic ovary syndrome (PCOS). Leptin, NPY, galanin, cholecystokinin (CCK) are involved in the regulation of eating behavior. PPARγ are receptors that are probably involved in hyperandrogenism. This study was designed to assess associations between the Pro12Ala PPARγ2 gene polymorphism and satiety factors in PCOS. Fifty-four PCOS women and 51 healthy women were studied. Leptin, NPY, galanin, CCK levels, and genetic studies to detect Pro12Ala PPARγ2 gene polymorphism were assessed. The leptin levels in the PCOS women carrying Pro12Ala genotype were higher than in those with Pro12Pro and Ala12Ala. The PCOS women had higher leptin and NPY levels and lower galanin levels. Obese PCOS patients had lower CCK levels. Conclusions: In the PCOS women, a single Ala allele may have a protective role as far as hyperleptinemia is concerned. The PCOS women may reveal a disrupted central leptin/NPY feedback loop with some shifts in food intake.     

Association of betatrophin with metabolic characteristics in overweight/obese and lean women with PCOS

As a new hormone, betatrophin has gained attention as a potential new target to combat insulin resistance (IR) and diabetes. Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder among women of the reproductive age with long term sequelae which include IR and metabolic syndrome. The aim of this study is to evaluate the circulating plasma betatrophin levels in overweight/obese or lean women with or without PCOS and also to elucidate possible correlations with anthropometric and metabolic parameters. Thirty-two patients with PCOS as well as fifty-three control subjects were enrolled after obtaining informed written consent. Clinical and biochemical parameters of all subjects were determined. Plasma adiponectin, GLP-1 and betatrophin levels were measured by ELISA. Plasma betatrophin levels were significantly increased in lean patients with PCOS compared with lean and obese controls. Moreover, in PCOS group, betatrophin levels were significantly negatively correlated with waist hip ratio (WHR), fasting insulin level (FINS) and HOMA-IR, whereas, significantly positively correlated with adiponectin level. Multiple regression analysis showed that HOMA-IR was an independent factor influencing serum betatrophin levels. Further follow-up studies are needed to highlight whether and how increased betatrophin secretion play an important role in IR and carbohydrates metabolism in patients with PCOS.     

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.     

Insulin response to oral glucose in healthy,lean young women and patients with polycystic ovary syndrome

Background and aim. Insulin resistance and consequent hyperinsulinemia are common among patients with polycystic ovary syndrome (PCOS). Ethnicity and dietary habits affect insulin levels. There is little published information from India on insulin levels in PCOS patients. Thus the present study aimed to determine the insulin response to oral glucose in women with PCOS and healthy women.

Methods. In a case–control study design, women with PCOS and lean healthy women without a family history of diabetes mellitus underwent oral glucose tolerance testing. Samples were collected at 0, 1 and 2 h after glucose ingestion.

Results. Two hundred and eighty-five women with PCOS and 27 lean healthy young women were enrolled into the study. The mean age of controls was 22.8 ± 4.5 years (range 15–32 years) and their mean body mass index (BMI) was 19.7 ± 2.6 kg/m². Mean blood glucose at 0, 1 and 2 h was 88.2 ± 7.2, 115.5 ± 25.5 and 91.8 ± 20.5 mg/dl, respectively. Corresponding plasma insulin levels were 5.8 ± 1.1, 32.7 ± 26.5 and 14.6 ± 9.6 mIU/l. Peak insulin levels were seen at 1 h and these came down to less than 40% of the peak value by 2 h. Glucose/insulin ratio at 0, 1 and 2 h was 15.6 ± 3.1, 7.0 ± 3.1 and 11.4 ± 7.0. Homeostasis model assessment of insulin resistance (HOMA-IR) was 1.2 ± 0.2.

The age of the PCOS women ranged from 15 to 40 years (mean 23.4 ± 6.2 years) and their BMI ranged from 16.4 to 50.4 kg/m² (mean 27.7 ± 6.3 kg/m²). One hundred and seventy-six (62%) PCOS patients had normal glucose tolerance (NGT), 39 (14%) had impaired fasting glucose (IFG), 49 (17%) had impaired glucose tolerance (IGT) and 21 (7%) had type 2 diabetes mellitus (T2DM). Insulin response was higher in women with PCOS. Peak insulin was observed at 1 h. The difference between 1-h and 2-h post-glucose insulin decreased with worsening glucose tolerance. Both plasma insulin and BMI showed a rising trend from NGT to IFG to IGT. There was no further increase in either insulin or BMI from IGT to T2DM. Glucose/insulin ratio at 0, 1 and 2 h was lower (8.3 ± 4.2, 2.0 ± 1.6 and 3.2 ± 3.5) than that of healthy controls. HOMA-IR was 3.1 ± 3.0.

Conclusion. Women with PCOS had an exaggerated insulin response to glucose. Thirty-eight percent of PCOS women had some form of abnormal glucose tolerance. Greater insulin response was seen with impairment of glucose tolerance. Obesity had no effect on fasting insulin or insulin response to oral glucose in PCOS women with NGT.     

Polycystic ovary syndrome and abnormalities in glucose tolerance

Objectives

To compare the prevalence of abnormal glucose tolerance (AGT) among women with polycystic ovary syndrome (PCOS) and controls, and assess risk factors associated with PCOS.

Method

A fasting oral glucose tolerance test after ingestion of 75 g of glucose was administered to 264 women with and 116 without PCOS. Moreover, fasting glucose, insulin, and testosterone levels were measured in the women with PCOS. Body mass index (BMI), waist-to-hip ratio (WHR), and homeostasis model assessment-insulin resistance (HOMA-IR) were calculated for each woman with PCOS.

Results

The AGT prevalence was 14.4% in the PCOS group and 11.2% in the control group (P = 0.17). The women with both PCOS and AGT had significantly higher BMIs, WHRs, testosterone levels, and HOMA-IR values than those with normal glucose tolerance.

Conclusion

While AGT was not associated with PCOS, the women with both PCOS and AGT were significantly more obese, hyperandrogenic, and insulin resistant than those with PCOS and normal glucose tolerance.     

Insulin resistance in nonobese Japanese women with polycystic ovary syndrome is associated with poorer glucose tolerance,delayed insulin secretion,and enhanced insulin response

PurposeTo determine the prevalence of insulin resistance (IR) and impaired glucose tolerance (IGT) in PCOS patients, the optimal screening method, and to compare our findings between nonobese and obese Japanese women with PCOS.MethodsNinety‐eight PCOS patients were included in this research from 2006 to 2013. Glucose tolerance test (OGTT) was performed. Serum glucose and insulin concentration were assayed before and 30, 60, and 120 min after taking 75 g of glucose.ResultsAll examined metabolic parameters were significantly favorable in the nonobese subjects, below 25 kg/m². HOMA‐IR, fasting insulin, glucose₁₂₀, and insulin₁₂₀ showed strong correlations with BMI. A total of 1.4 % of nonobese women had IR based on fasting insulin or HOMA‐IR. However, 15.5 % (11/71) of nonobese women had IR as determined by a continuous increase of serum insulin level in OGTT. In comparison, the prevalence of IR among the obese women ranged from 41 to 59 %. AUC_glucose, glucose₆₀, glucose₁₂₀, and insulin₁₂₀ in nonobese women with a continuous insulin increase were higher than those without such a continuous increase.ConclusionsAll examined metabolic parameters were significantly correlated with BMI. As the presence of a continuous increase of insulin level reflects to some degree poorer glucose tolerance, delayed insulin secretion, and enhanced insulin response compared with non‐continuous insulin increase, OGTT might not been excluded to determine IR and IGT for nonobese women with PCOS.     

多囊卵巢综合征合并胰岛素抵抗患者脂肪组织中磷脂酰肌醇3激酶的检测及其意义

目的检测多囊卵巢综合征(PCOS)合并胰岛素抵抗(IR)患者脂肪组织中磷脂酰肌醇3激酶(PI-3K)的表达,探讨PCOS患者发生IR的机制。方法检测PCOS发生IR 19例患者(PCOS IR组)、PCOS未发生IR 10例患者(PCOS非IR组)及因单纯子宫肌瘤施行手术的15例患者(对照组)的空腹血清胰岛素(FIN)及空腹血糖(FPG)的水平。采用稳态模型(HOMA)法评价及计算IR指数(HOMA-IR);采用蛋白印迹法检测脂肪组织中PI-3K蛋白的表达;采用RT-PCR技术检测PI-3K mRNA的表达;采用免疫沉淀技术、薄层层析及γ液体闪烁计数仪检测PI-3K的活性,设对照组平均PI-3K活性为100%。结果(1)PCOS IR组患者血清FIN为(25．2±3．8)mU/L,HOMA-IR为1．6±0．3;PCOS非IR组分别为(13．4±3．8)mU/L及0．9±0．3;对照组分别为(9．5±2．6)mU/L及0．5±0．3,3组分别比较,差异均有统计学意义(P＜0．05)。(2)PCOS IR组PI-3K蛋白及mRNA相对表达水平分别为0．65±0．10及0．92±0．12;PCOS非IR组分别为0．72±0．10及1．01±0．10;对照组分别为0．73±0．14及1．00±0．12,3组分别比较,差异均无统计学意义(P＞0．05)。(3)PCOS IR组PI- 3K活性下降为81%,PCOS非IR组下降为89%,PCOS IR组及PCOS非IR组分别与对照组比较,差异均有统计学意义(P＜0．01,P＜0．05)。PCOS IR组和PCOS非IR组PI-3K活性与HOMA-IR均呈显著负相关关系(r=-0．69,P＜0．01;r=-0．62,P＜0．05)。结论PCOS IR患者的PI-3K蛋白及mRNA的表达无明显改变,但PCOS患者PI-3K活性降低,可能是PCOS患者发生IR的机理之一。     

PCOS患者外周血miR-21与PI3K/AKT通路的关系及其临床意义#br#

目的研究多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者外周血微小RNA-21(micro RNA-21,miR-21)与PI3K/AKT通路的关系及其临床意义。方法选择2018年6月至2020年12月在上海市浦东新区人民医院就诊的156例PCOS患者作为研究对象。按是否存在胰岛素抵抗(insulin resistance,IR)分为86例IR PCOS组及70例非IR PCOS组。另取同期在本院体检的70例健康女性作为对照组。检测所有受试者空腹血糖(fasting blood glucose,FBG)、空腹胰岛素(fasting insulin,FINS)及胰岛素抵抗指数(HOMA insulin resistance index,HOMA-IR)、荧光定量PCR检测外周血miR-21 mRNA、PI3K mRNA、AKT mRNA表达水平,Western blot检测内膜组织的p-PI3K、p-AKT表达及miR-21下游靶基因的预测。结果与对照组比,非IR PCOS组和IR PCOS组外周血的mi R-21m RNA、PI3Km RNA、AKTm RNA、HOMA-IR、FBG及FINS,内膜p-PI3K、p-AKT表达均明显增高(P<0.05),与非IR PCOS组比,IR PCOS组外周血的mi R-21m RNA、PI3Km RNA、AKTm RNA、HOMA-IR、FBG及FINS,内膜p-PI3K、p-AKT表达均明显增高(P<0.05)。外周血mi R-21m RNA与HOMA-IR呈正相关关系(r=0.646,P<0.05),外周血PI3K mRNA、AKT mRNA、子宫内膜p-PI3K、p-AKT与HOMA-IR呈负相关关系(r=-0.546、-0.567、-0.578、-0.643,均P<0.05)。根据Targetscan检索,miR-21的靶基因为PI3K/AKT通路基因。结论PCOS患者miR-21表达增加可过度激活PI3K/AKT通路,导致IR。     

Polymorphisms of the peroxisome proliferator-activated receptor-gamma and its coactivator-1alpha genes in Chinese women with polycystic ovary syndrome

The polymorphisms of the peroxisome proliferator-activated receptor-gamma (Pro12Ala) and its coactivator-1 (Gly482Ser) genes were investigated among 201 Chinese Han women with polycystic ovary syndrome (PCOS) and among 147 regularly cycling women as control subjects. We did not find statistically significant differences with peroxisome proliferator-activated receptor-gamma2 Pro12Ala and peroxisome proliferator-activated receptor-gamma-1alpha Gly482Ser polymorphism distributions between Chinese women with PCOS and controls, or with body mass index and reproductive hormones among various genotypic groups of PCOS, suggesting that these genetic mutants did not have an effect on the susceptibility to PCOS.     

The impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical,hormonal and metabolic parameters in lean women with polycystic ovary syndrome

This study was performed to assess the impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical, hormonal, and metabolic parameters in lean women with PCOS. Retrospective analysis of 120 consecutive lean PCOS subjects was performed. Subjects were divided into two groups according to HOMA-IR, as IR?+?and IR?. A HOMA-IR value above 2.5 was used to indicate IR. Clinical, hormonal and metabolic parameters were compared between the two groups. Correlations between LAP and VAI and clinical, hormonal, metabolic features in women PCOS were analyzed. One hundred twenty lean PCOS subjects were enrolled, of which 39 were insulin resistant. Comparison of group means showed significantly higher values for TG levels, FAI, FGS, TG/HDL-c, TyG, LAP, and VAI indexes and lower values for glucose/insulin ratio and QUICKI in the IR?+?group. LAP and VAI were both found to be positively correlated with each other and with WC, FAI, FGS, TG, TC levels, lipid ratios, TyG index, and HOMA-IR and negatively correlated with Glucose/Insulin ratio, QUICKI, and HDL-c in lean women with PCOS. LAP and VAI may be promising in early identification of IR and cardiometabolic risk and may be useful for the assessment of hyperandrogenism in lean women with PCOS.     

婴幼儿胰岛素敏感性与母孕期糖代谢情况及糖尿病家族史的关系

目的 探讨影响婴幼儿期胰岛素敏感性的相关因素.方法 对北京大学第三医院儿童保健中心2006年1月到2008年5月建档并定期体检的符合人选标准的246名婴儿和120名幼儿进行回顾性分析,用胰岛素稳态模型法(homeostasis model assessment,HOMA)计算胰岛素抵抗指数(insalin resistance,IR)、胰岛素作用指数(insulin action index,IAI)、血糖胰岛素比值(fasting glu-cose-to-insulin ratio,FGIR)以及胰岛细胞功能(HOMA-β).数据用中位数(M)和P25～P75表示,不同孕母孕期糖代谢情况及糖尿病家族史时各指标差异的比较采用多个独立样本非参数秩和检验,有组间差异者(P＜0.05)再进行组间比较,调整P值结果以P＜0.017为差异有统计学意义.结果 母孕期有糖尿病的婴儿HOMA-IR[3.24(2.76～4.12)]和HOMA-β[164.00(114.44～192.85)]高于母孕期无糖代谢异常的婴儿[1.51(0.86～2.50)和67.07(41.83～106.22)](Z分别=3.76、3.35,P均＜0.017),而IAI[-7.18(-7.41～-7.02)]和FGIR[7.31(5.82～8.55)]低于母孕期无糖代谢异常的婴儿[-6.41(-6.92～-5.85)和14.84(9.49～24.79)],差异均有统计学意义(Z分别=3.76、3.71,P均＜0.017);与母孕期有糖耐量受损的婴儿相比,母孕期有糖尿病的婴儿HOMA-IR增高(Z=3.19,P＜0.017)、IAI降低(Z=3.19,P＜0.017).母孕期无糖代谢异常和仅有糖耐量受损的婴幼儿胰岛素敏感性差异无统计学意义(P＞0.017).一级亲属有糖尿病史与无糖尿病家族史的婴、幼儿比较HOMA-IR增高、IAI和FGIR降低[婴儿:HOMA-IR为3.24(2.73～4.13)和1.41(0.84～2.50)IAI为-7.18(-7.42～-7.00)和-6.34(-6.91～-5.82);FGIR为7.31(5.40～7.48)和14.87(9.53～25.17).幼儿:HOMA-IR为3.98(2.62～4.80)和1.70(0.92～3.04);IAI为-7.38(-7.57～-6.97)和-6.54(-7.11～-5.92);FGIR为6.17(6.04～8.00)和12.65(8.33～21.53).P均＜0.017],婴儿期HOMA-β增高[164.00(137.82～198.00)和67.06(40.40～106.83),P＜0.017].结论 母孕期有糖尿病和/或一级亲属有糖尿病史的婴幼儿胰岛素敏感性降低.     

多囊卵巢综合征患者血循环中瘦素水平及其相关因素的临床研究

目的 :探讨多囊卵巢综合征 (PCOS)患者血循环中瘦素水平与其它内分泌、代谢指标之间的关系 ,进一步研究瘦素的作用规律。方法 :PCOS患者 82例 ,行葡萄糖耐量试验 (OGTT)、胰岛素释放试验 ,测定 5个时点的血糖、胰岛素以及C 肽 (C P)浓度 ;测定空腹血瘦素、性激素及促性腺激素浓度 ;同时测定患者的体重指数 (BMI)、腰臀比例(WHR) ,观察胰岛素增敏剂治疗对瘦素的影响。瘦素和胰岛素用放免法测定 ,C 肽和性激素用发光免疫法测定。结果 :肥胖组瘦素水平显著高于消瘦组 (P =0 .0 0 0 1 ) ,瘦素水平与体重指数呈高度正相关 (P =0 .0 0 0 1 ) ;与腰臀比例、空腹、60min、1 2 0min胰岛素浓度呈显著正相关 (P分别为 0 .0 1 96、0 .0 3 0 8、0 .0 0 0 6、0 .0 0 1 4) ;与OGTT各时点的血糖、C 肽浓度以及血糖、胰岛素、C 肽曲线下面积之间无显著相关性 (P >0 .0 5 )。二甲双胍、文迪雅对瘦素水平无显著影响。结论 :PCOS患者的瘦素浓度与体内脂肪含量及分布密切相关。PCOS患者可能同时存在瘦素抵抗和胰岛素抵抗。用改善胰岛素敏感性药物治疗对瘦素水平无显著影响。