多囊卵巢综合征患者胰岛素抵抗的临床分析

目的探讨多囊卵巢综合征(PCOS)患者胰岛素抵抗(IR)和非胰岛素抵抗(NIR)的临床特征,为PCOS的合理治疗提供依据。方法 92例PCOS患者按稳态模式胰岛素抵抗指数(HOMA-IR)分为胰岛素抵抗组(n=60)和非胰岛素抵抗组(n=32)。测定记录两组患者年龄、体重指数(BMI)、腰围、臀围、腰臀比(WHR)、Ferriman-Gallwey(F-G)评分、痤疮分级;检测两组患者血清内分泌激素、口服糖耐量试验(OGTT)及胰岛素释放实验(IRT);用磁颗粒酶免法检测血清黄体生成素(LH)、促卵泡生成素(FSH)、雌激素(E2)、孕激素(P)、泌乳素(PRL)、睾酮(T);用葡萄糖氧化酶法测空腹血糖和餐后60,120,180 min血糖的含量;用放射免疫方法测定空腹胰岛素和餐后60,120,180 min胰岛素的含量。用SPSS 17.0软件对结果进行统计分析。结果 IR组患者肥胖、腰围、臀围、WHR及BMI均高于NIR组(P<0.05),IR组OGTT各时点血糖值及曲线面积(GAUC)、IRT各时点胰岛素值、胰岛素曲线下面积(IAUC)、HOMA-IR均明显高于NIR组(均P<0.01),而胰岛素敏感性指数(ISI)则明显低于NIR组(P<0.01),IR组的LH/FSH值低于NIR组,而E2高于NIR组。结论 IR可促进PCOS患者肥胖,尤其腹型肥胖的发生,并与PCOS糖代谢紊乱密切相关,早期干预对预防PCOS患者远期并发症具有重要意义。

Clinical analysis of insulin resistance in patients with polycystic ovary syndrome

Objective To investigate the clinical characteristics of polycystic ovary syndrome(PCOS)patients with insulin resistance and non-insulin resistance for providing a basis for the reasonable treatment of PCOS. Methods According to the homeostasis model insulin resistance index(HOMA-IR),92 patients with PCOS were divided into two groups:IR group(n=60) and NIR group(n=32).The age,body mass index(BMI),waist circumference,hip circumference,waist to hip ratio(WHR),Ferriman-Gallwey(FG) score and acne grade were determined and recorded,and the levels of endocrine hormones were detected in serum.The oral glucose tolerance test(OGTT) and insulin release test(IRT)in both groups were observed.The magnetic particle-based enzyme immunoassay was used to detect the levels of luteal hormone(LH) in the serum,follicle stimulating hormone(FSH),estrogen(E2),progesterone(P),prolactin(PRL) and testosterone(T).The glucose oxidase was used to measure the contents of fasting blood glucose and postprandial glucose at 60 min,120 min and 180 min.Radioimmunoassay was employed to measure the levels of fasting insulin and postprandial glucose at 60 min,120 min and 180 min.The data were statistically analyzed using SPSS 17.0 software. Results The values of obesity,waist circumference,hip circumference,waist to hip ratio and BMI in IR group were higher than that in NIR group(P<0.05),the levels of blood glucose in OGTT at each time point,area under the curve(GAUC) and levels of insulin at each time point,insulin area under the curve(IAUC),HOMA-IR were significantly higher in IR group than those in NIR group(P<0.01),while the insulin sensitivity index(ISI) in IR group was significantly lower than that in NIR group(P<0.01).The value of LH / FSH was lower in IR group than that in NIR group,while the E2 was higher in IR group than that in NIR group. Conclusion IR can promote the obesity in PCOS patients,especially the abdominal obesity,and is closely associated with disorder of glycometabolism.Early intervention has great importance to prevent the long term complications in patients with PCOS.