多囊卵巢综合征患者糖代谢异常的发生与临床特征的相关性

目的 探讨多囊性卵巢综合征(PCOS)患者糖代谢异常的发生及临床特征.方法 对257例PCOS患者进行75 g葡萄糖耐量(OGTY)及胰岛素释放试验,分别检测空腹、餐后1、2 h血糖及胰岛素.应用世界卫生组织(WHO)对糖尿病及糖代谢异常的诊断标准进行诊断.结果 257例PCOS患者中178例(69.3%)糖耐量正常(NGT),73例(30.7%)糖代谢异常,其中67例(26.1%)为糖耐量损伤(IGT),12例(4.7%)为2型糖尿病(2DM)(P<0.05).NGT、IGT与2DM组间年龄、体重指数、卒腹血糖、餐后2 h血糖(2 hPG)、空腹胰岛素(FINS)、餐后2 h胰岛素(2 hINS)及胰岛素抵抗指数均逐渐升高(P<0.05),胰岛素敏感指数逐渐降低(P<0.05);30～34岁年龄段糖代谢异常的发生率是20～29岁之间的2倍;肥胖PCOS患者中糖耐量异常(IGT/2DM)的发生率是非肥胖患者的近4倍(P<0.001).结论 PCOS患者中糖代谢异常的发生与年龄及体重指数有关;胰岛素抵抗是PCOS患者发生糖代谢异常的基础.

Characteristics of abnormal glucose tolerance in patients with polycystic ovary syndrome

Objective To analyze the characteristics of abnormal glucose tolerance in patients with polycystic ovary syndrome (PCOS). Methods A 75 g oral glucose tolerance test (OGTT) with plasma glucose and serum insulin (INS) levels was performed in 257 PCOS patients. The states of glucose tolerance were classified by fasting plasma glucose (FPG) and plasma glucose at 120 minutes according to the Word Health Organization (WHO) criterion. Results According to the WHO criteria, 69. 3% were classified as normal glucose tolerance (NGT) and 30. 7% as with abnormal glucose metabolism, with 26. 1% of them presenting impaired glucose tolerance (IGT) and 4. 7% diabetes mellitus (DM). Age, BMI, fasting glucose or 2 h glucose concentration, fasting insulin or 2 h glucose concentration and homeostasis model assessment-insulin resistance (HOMA-IR) increased gradually among NGT, IGT and 2DM. QUICKI and the ratio of fasting glucose/fasting insulin decreased gradually. The prevalence of abnormal glucose tolerance was significantly higher after 30 years old. There was significant correlation between abnormal glucose tolerance and age or BMI. A positive correlation was found between BMI and fasting glucose or 2-h glucose concentration. Conclusion Abnormal glucose tolerance was correlated with age and BMI in PCOS patients.Insulin resistance is the mechanistic basis of abnormal glucose tolerance. Thus PCOS patients should be screened by glucose tolerance at an early time and a regular interval.