青春期多囊卵巢综合征胰岛素抵抗及其与生殖内分泌代谢异常的相关性分析

目的：分别比较青春期多囊卵巢综合征（PCOS）与青春期健康人群、青春期PCOS胰岛素抵抗（IR）与非IR患者的生殖内分泌指标，认识青春期PCOS的IR及其与生殖内分泌代谢异常的相关性，为该疾病的早期诊断和治疗提供循证医学依据。方法青春期PCOS患者（青春期PCOS组）88例，青春期健康对照人群（对照组）87例，并根据胰岛素抵抗稳态模型指数（HOMA- IR）将青春期PCOS患者分为IR组（40例）和非IR组（48例）。测定LH、FSH、硫酸脱氢表雄酮（DHEAS）、性激素结合蛋白（SHBG）、总睾酮（TT）、FBG、空腹胰岛素（FINS）、瘦素（LEP）和脂联素（ADPN）水平，并加以对照研究。结果（1）青春期PCOS组与对照组的比较：青春期PCOS组LH、LH/FSH、DHEAS、TT、FAI、FINS、HOMA- IR、LEP均明显高于对照组，SHBG明显低于对照组，两组间FBG、ADPN未见有统计学差异。（2）青春期PCOS IR组与非IR组的比较：IR组LH明显低于非IR组，而DHEAS、FAI均明显高于非IR组，两组间LH/FSH、TT无统计学差异。IR组SHBG明显低于非IR组，且SHBG与BMI （r=-0.31，P＜0.05）、血DHEAS （r=-0.225，P＜0.05）均呈明显负相关。IR组FINS、FBG、HOMA- IR均明显高于非IR组，且FBG与BMI呈明显正相关（r=0.348，P＜0.05）。IR组LEP水平明显高于非IR组，而ADPN明显低于非IR组，且LEP水平与BMI呈明显正相关（r=0.605，P＜0.05），ADPN水平与BMI呈明显负相关（r=-0.418，P＜0.05）。结论 PCOS在青春期即出现不同程度的胰岛素敏感性下降，IR发病率增高，并与高雄激素血症、肥胖相互作用，形成内分泌代谢的恶性循环，促进PCOS疾病进展，使得代谢综合征等远期并发症风险增高。脂肪因子ADPN和LEP或可成为机体胰岛素敏感性的预测指标，但还需进一步大样本研究。

Endocrinal abnormalities in adolescents with polycystic ovary syndrome

Objective To investigate the endocrinal abnormalities of adolescent polycystic ovary syndrome（PCOS） with or without insulin resistance （IR）. Methods Eighty eight adolescent patients with polycystic ovary syndrome（PCOS group）, includ-ing 40 cases with IR and 48 cases without IR, and 87 healthy women （control group） were enrol ed in the study. The serum en-docrine levels were measured and their relationships with homeostasis model of assessment for insulin resistance （HOMA- IR ） were analyzed. Results Compared to control group, PCOS group had a higher levels of 1uteinizing hormone （LH）, luteinizing hormone/follicle stimulating hormone ratio（LH/FSH ratio）, dehydroepiandrosterone sulfate（DHEAS）, total testosterone（TT） and free androgen index （FAI）, but a lower level of the sex hormone binding globulin （SHBG）. There was a significant difference in serum fasting insulin （FINS） and HOMA- IR levels, but no difference in serum fasting bloodglucose （FBG） between adolescent PCOS and control groups. The adolescent PCOS group had a higher level of leptin, but there was no difference in adiponectin level be-tween two groups. The DHEAS and FAI levels in IR group of PCOS patients were higher, while SHBG and LH levels were lower than those in non- IR group. The serum SHBG level was negatively correlated with BMI（r=- 0.31, P〈0.05） and serum DHEAS level （r=- 0.225, P〈0.05） in adolescent patients with PCOS. There were no significant differences in TT and LH/FSH ratio between two groups. The IR group had a higher levels of FINS, FBG and HOMA- IR. The FBG level was positively correlated with BMI （r=- 0.348, P〈0.05）. The leptin level was significantly higher and adiponectin level was lower in IR group than those in non- IR group. The adiponectin level was negatively correlated with BMI（r=- 0.418, P〈0.05）;while the leptin level was positively correlated with BMI （r=0.605, P〉0.05）. Conclusion The PCOS patients have decreased insulin sensitivity with various degrees and in-creased incidence of IR. IR is reciprocal y correlated with hyperandrogenism and obesity, forming a vicious cycle of endocrinal metabolism and a higher risk of longterm complications. The adiponectin and leptin might be a predictive index for insulin resis-tance, which need to be confirmed by further study.