不同肥胖标准在评估多囊卵巢综合征胰岛素抵抗中的价值

目的 分析不同肥胖标准:体质量指数（BMI）、腰围(WC)、内脏脂肪面积(VAA，CT测量)在评估多囊卵巢综合征（PCOS）患者胰岛素抵抗中的价值。方法 选择300例已确诊为PCOS的患者作为研究对象，以WC为标准分为:腹型肥胖（WC≥80 cm）210例，非腹型肥胖（WC＜80 cm）90例；以BMI为标准分为:整体肥胖（BMI≥25 kg/m2）97例，非整体肥胖(BMI＜25 kg/m2)203例；以VAA为标准分为:内脏型肥胖（VAA≥80 cm2)198例，非内脏型肥胖（VAA＜80 cm2)102例。分别检测其空腹血糖（FPG）、空腹胰岛素（FINS），并计算稳态模型指数(HOMA-IR)；分析3种（BMI、WC、VAA）标准下对PCOS患者肥胖的检出率、胰岛素抵抗的检出率、胰岛素抵抗的漏诊率。同时检测血性激素全套、甲状腺功能、血浆总皮质醇（PTC）。结果 ① 3种标准下，各组血性激素水平〔含促黄体生成素(LH)/卵泡刺激素(FSH)〕、甲状腺相关激素、皮质醇、空腹血糖组间差异均无统计学意义（P>0.05），但体质量及FINS组间差异有统计学意义（P<0.05）。②3种标准下对PCOS患者的肥胖检出率分别为:整体肥胖率为32.33%（97/300）、腹型肥胖率为70.00%（210/300）、内脏型肥胖率为66.00%（198/300），3者两两比较，BMI作为肥胖判断标准与WC、VAA作为肥胖判断标准相比，其肥胖检出率最低，差异均有统计学意义（P均＜0.05），而VAA与WC相比，肥胖检出率差异无统计学意义（P>0.05）。③3种标准下胰岛素抵抗的检出率分别为:BMI 38.60%（83/215）、WC 85.11%（183/215）、VAA 69.77%（150/215），WC的检出率最高，BMI的检出率最低，3种标准对胰岛素抵抗的检出率两两比较，差异均有统计学意义（P均＜0.05）。④3种标准下胰岛素抵抗的漏诊率分别为:BMI 61.40%（132/215）、WC 14.88%（32/215）、VAA 30.23%（65/215），BMI漏诊率最高，WC漏诊率最低，两者差异有统计学意义（P<0.05），VAA较WC漏诊率稍高，差异亦有统计学意义（P<0.05）。结论 在肥胖的检出率、降低胰岛素抵抗漏诊率方面，BMI存在明显不足，WC较BMI、VAA均具有明显优势，WC在评估肥胖型PCOS患者胰岛素抵抗方面可能更有临床价值。

The Value of Different Obese Criteria for the Assessment of Insulin Resistance in Women with Polycystic

Objective To investigate the value of three different obese criteria: body mass index (BMI), waist circumference (WC) and visceral fat area (VAA, CT measurement) in the evaluation of polycystic overy syndrome (PCOS) with insulin resistance. Methods There were 300 cases of PCOS included in this study. According to the three criteria, there were 210 cases of abdominal obesity (WC≥80 cm), and 90 cases of non-abdominal obesity (WC<80 cm); 97 cases of overall obesity (BMI≥25 kg/m2), and 203 cases of non-overall obese (BMI<25 kg/m2); 198 cases of visceral obesity (VAA≥80 cm2), and 102 cases non-visceral obesity (VAA<80 cm2). Fasting plasma glucose (FPG) and fasting insulin (FINS) were detected, and HOMA-IR index was calculated; analyze the detection rate of the three criteria in the diagnosis of obese PCOS patients and insulin resistance. The serum levels of sex hormones, thyroid hormones, and plasma total cortisol (PTC) were measured as well. Results ①The levels of blood hormone (including LH/FSH), thyroid hormone, PTC, fasting blood glucose were no significant differences between groups (P>0.05), while the weight and fasting insulin were significantly difference between groups (P<0.05) in three different obese. ②The detection rates of obese PCOS patients in three criteria: overall obesity was 32.33% (97/300), abdominal obesity was 70.00% (210/300), visceral obesity was 66.00% (198/300). Compared to WC and VAA, BMI had the lowest detection rate of obesity, the differences were statistically significant (P<0.05), while the detection rates of obesity in VAA and WC were no significant difference (P>0.05). ③The detection rates of insulin resistance in BMI,WC,VAA were respectively 38.60% (83/215), 85.11% (183/215), 69.77% (150/215), the differences were significant (P<0.05).④The misdiagnosis rates of insulin resistance in BMI, WC,VAA were 6140% (132/215), 14.88% (32/215), 30.23% (65/215) respectively, and the differences were statistically significant (P<0.05). Conclusion There was obviously insufficient of BMI in screening obesity, WC may has more advantages than BMI and VAA in the assessment of insulin resistance in obese PCOS patients.