非肥胖型多囊卵巢综合征胰岛素抵抗与糖、脂代谢及脂肪分布的关系

目的 探讨非肥胖型多囊卵巢综合征(Nob-PCOS)胰岛素抵抗(IR)与糖、脂代谢及脂肪分布的关系.方法 选取60例非肥胖(体质指数<28 kg/m2)PCOS患者,根据是否存在IR分为IR(+)组(n=40)和IR(-)组(n=20).比较IR(+)组和IR(-)组患者的生化指标、各项性激素水平结果 及脂肪分布情况.结果(1)两组年龄、体重、体质指数、腰围、臀围、腰臀比、三酰甘油、总胆固醇、低密度脂蛋白、高密度脂蛋白差异无统计学意义.IR(+)组收缩压、舒张压、空腹血糖、空腹胰岛素、游离睾酮指数均高于IR(-)组,IR(+)组性激素结合球蛋白低于IR(-)组,差异有统计学意义(P<0.05);(2)两组总脂肪量、全身脂肪含量百分比、肌肉量差异无统计学意义.IR(+)组的躯干脂肪百分比、腹区脂肪百分比、躯干脂肪/大腿脂肪、腹区脂肪/臀区脂肪均高于IR(-)组,差异有统计学意义(P<0.05);(3)HMOA-IR与躯干脂肪/大腿脂肪(r=0.430,P<0.01)、腹区脂肪/臀区脂肪(r=0.399,P<0.05)、肌肉量(r=0.366,P<0.05)呈正相关;(4)多元回归分析显示:躯干脂肪/大腿脂肪、肌肉量是Nob-PCOS患者IR的独立影响因素.结论 中心型脂肪分布在Nob-PCOS患者IR发生中起重要作用,对Nob-PCOS患者不仅要重视对IR的治疗,也要重视减少内脏脂肪的治疗.

The impact of insulin resistance on clinical,hormonal and metabolic parameters and fat distribution in non -obese women with polycystic ovary syndrome

Objective To assess the effects of insulin resistance (IR)on glucose and lipid metabolism and fat distribution in non - obese women with polycystic ovary syndrome (PCOS). Methods Sixty non - obese (body mass in-dex < 28 kg/ m2 )PCOS subjects were included,among whom 40 were in IR group and 20 in non - insulin resistant group. Clinical hormonal,metabolic characteristics and fat distribution of the two groups were compared. Results The insulin resistant group and non - insulin resistant group had similar age,weight,BMI,waistline,hipline,waist - to - hip ratio,triglyceride,total cholesterol,low - density lipoprotein cholesterol,and high - density lipoprotein cholesterol (P >0. 05). Compared to non - insulin resistant group,the insulin resistant group had significantly higher systolic blood pres-sure (SBP),diastolic blood pressure (DBP),fasting plasma glucose (FPG),fasting insulin (FINS),and free androgen index (FAI);and significantly lower sex hormone binding globulin (SHBG)(P < 0. 05). The insulin resistant group and non - insulin resistant group had similar total fat mass,total fat percentage,and lean mass (P > 0. 05). The insulin re-sistant group had significantly higher trunk fat percentage,android fat percentage,trunk fat/ lower limb fat,android fat/gynoid fat than non - insulin resistant group (P < 0. 05). HOMA - IR values were found to be positively correlated with trunk fat/ lower limb fat (r = 0. 430,P < 0. 01),android fat/ gynoid fat (r = 0. 399,P < 0. 05),and lean mass (r =0. 366,P < 0. 05). In a multiple regression analysis,both trunk fat/ lower limb fat and lean mass were independent pre-dictors of IR. Conclusion Central fat distribution plays an important role in the occurrence of IR in Nob - PCOS sub-jects. It is important not only to pay attention to the treatment of IR,but also to reduce their visceral fat.