多囊卵巢综合征患者糖代谢异常发生率及其特点

目的 探讨多囊卵巢综合征患者糖代谢异常特点及其发生率.方法 回顾性分析2006年6月1日至2009年2月1日广州中山大学孙逸仙纪念医院妇产科收治的初诊多囊卵巢综合征患者654例(青春期101例,成人553例),以120名年龄匹配的健康志愿者为对照组(青春期40名,成人80名).病例和对照组均行口服葡萄糖耐量试验和胰岛素释放试验,比较病例组和对照组、成人多囊卵巢综合征与青春期多囊卵巢综合征、不同体重指数亚组中糖代谢异常的特点及其发生率.结果 多囊卵巢综合征患者糖代谢异常的发生率为24.5%(160/654),显著高于对照组的3.3%(4/120)(χ2=27.11,P<0.0001);成人病例组糖代谢异常的发生率高于青春期病例组(分别为26.6%、12.9%,χ2=8.688,P=0.003),青春期病例组代谢异常的发生率高于青春期对照组(分别为12.9%、0%,χ2=5.671,P=0.02).多囊卵巢综合征患者糖代谢异常主要表现为糖耐量受损(62.5%),其次为空腹血糖受损(43.8%),糖尿病仅占少数(8.1%);糖尿病13例,仅4例(30.8%)空腹血糖>7.0 mmol/L,9例(69.2%)通过口服葡萄糖耐量试验筛查发现.多囊卵巢综合征组糖代谢异常的发生率随体重指数升高而升高(χ2=53.71,P<0.0001).结论 多囊卵巢综合征患者为糖代谢异常的高危人群,其糖代谢异常以糖耐量受损为主,空腹血糖受损次之.多囊卵巢综合征患者(尤其是肥胖者)应行口服葡萄糖耐最试验,以早期发现其糖代谢异常.

Characteristics and prevalence of abnormal glucose metabolism in patients with polycystic ovary syndrome

Objective To evaluate the characteristics and prevalence of abnormal glucose metabolism in polycystic ovary syndrome (PCOS) patients. Methods A retrospective case-control study was performed in 654 PCOS patients (101 were in adolescence, 553 were adults) and 120 healthy controls (40 were in adolescence, 80 were adults). Oral glucose tolerance test (OGTT), insulin releasing test (IRT), and other biochemical testing were underwent in all patients and controls. The characteristics and prevalence of abnormal glucose metabolism were analyzed and compared. Results The prevalence of abnormal glucose metabolism, including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus (DM), was 24.5% in PCOS patients, which was significantly higher than that in the controls (χ2 = 27.11, P < 0.0001). The prevalence of abnormal glucose metabolism in adolescent PCOS patients was lower than that in adult PCOS patients (12.9% and 26.6%, respectively; χ2 = 8.688, P =0.003), but higher than that in age-matched adolescent controls (12.9% and 0%, respectively; χ2=5.671, P = 0.02). IGT was the most common manifestation of abnormal glucose metabolism in PCOS patients (62.5%), followed by IFG (43.8%) and DM (8.1%). In PCOS patients, 13 patients were diagnosed with DM, however, 9 of them (69.2%) were exposed by OGTT screening. In PCOS patients, the prevalence of abnormal glucose metabolism increased with body mass index(BM1) (χ2 = 53.71, P <0.0001). Conclusions PCOS patients are at a higher risk of abnormal glucose metabolism, and IGT may be the most common phenotype. It' s recommended that all PCOS patients should be screened for abnormal glucose metabolism by using 2-h OGTT.