多囊卵巢综合征患者性激素结合球蛋白和总睾酮与胰岛素抵抗的相关性

目的 了解性激素结合球蛋白(SHBG)和总睾酮在预测多囊卵巢综合征(PCOS)患者胰岛素抵抗和生殖内分泌以及糖脂代谢紊乱中的作用.方法 选择2004年6月至2006年5月在复旦大学附属妇产科医院就诊的344例PCOS患者为病例组,年龄12～35岁,平均年龄(23±5)岁.选择同期月经规律、基础体温双相的100名妇女作为对照组,比较PCOS患者SHBG和总睾酮与对照组的差异,并用Spearman相关分析法分别分析SHBG和总睾酮与其他指标的相关性,Logistic回归分析胰岛素抵抗的风险因子并做SHBG对胰岛素抵抗的受试者操作特征(ROC)曲线,获得预测胰岛素抵抗的风险值,比较不同水平SHBG患者的糖脂代谢紊乱的程度.结果 PCOS患者SHBG为(114±88)mmol/L,与对照组(201±106)mmol/L]比较差异有统计学意义(t=-5.60,P<0.01),总睾酮为(2.8±1.0)nmol/L,与对照组(1.7±0.6)nmol/L]比较差异有统计学意义(t=7.73,P<0.01);SHBG与空腹胰岛素、胰岛素释放试验曲线下面积、口服葡萄糖耐量试验(OGTT)的葡萄糖曲线下面积、胰岛素抵抗指数、甘油三酯和腰围/臀围比呈负相关(r值分别为:-0.30、-0.26、-0.29、-0.19、-0.20、-0.29、-0.22,均P<0.01);总睾酮与空腹胰岛素(r=0.14,P<0.01)、胰岛素释放试验(1、2、3 h的r值分别为0.15、0.12、0.11,均P<0.05)以及相应的曲线下面积(r=0.15,P<0.05)、胰岛素抵抗指数(r=0.11,P<0.05)呈正相关.Logistic回归分析发现SHBG是PCOS患者胰岛素抵抗的独立危险因素(OR=3.741).由ROC曲线得到SHBG预测胰岛素抵抗的大致风险值为88 mmol/L(95%CI为0.668～0.774).在低SHBG(<88 mmol/L)患者中,空腹胰岛素、胰岛素释放试验相应的曲线下面积、胰岛素抵抗指数、空腹血糖、OGTT的葡萄糖曲线下面积与高SHBG(≥88 mmoL/L)患者比较差异有统计学意义(t值分别为-6.45、-5.08、-6.19、-3.16、-3.66,均P<0.01),甘油三酯也高于高SHBG患者(t=-2.06,P<0.05).结论 PCOS患者总睾酮水平高于对照组,SHBG低?

Correlation between sex hormone binding globulin and total testosterone and insulin resistance in polycystic ovary syndrome

Objective To investigate the effect of sex hormone binding globulin (SHBG) and total testosterone (TT) on predicting insulin resistance (IB), reproductive endocrine hormones,carbohydrate and lipid changes in polycystic ovary syndrome (PCOS) patients. Methods Three hundred forty-four cases of PCOS and 100 cases of normal women cellected from June 2004 to May 2006 in the Obstetrics and Gynecology Hospital of Fudan University were included in the study, the mean age was (23±5) years, the levels of SHBG and TT in serum were compared between PCOS and normal control, the correlation between SHBG/TT and basal body index, waist to hip ratio, endocrine hormone, lipids and glucose profile were analyzed by Spearman correlation. The impact of age, ovarian volume, leuteinizing hormone(LH), follicle stimulating hormone (FSH), LH/FSH ratio, TT, SHBG, dehydroepiandrosterone-sulphate, prolactin and cortisol on IR were analyzed by Logistic regression. A receiver operating characteristic(ROC) curve between SHBG and IR were taken and acquired a cut-off point, difference between groups with higher/lower SHBG were compared. Results SHBG was lower in PCOS group than in normal control ((114±88) vs (201±106) mmoL/L, t = -5.60,P <0.01) and TT was higher in PCOS than in normal control ((2.8±1.0) vs (1.7±0.6) nmol/L, t = 7.73, P < 0.01), the difference had significantly statistic mean. SHBG had an inverse correlation with fasting plasma insulin, insulin area under curve, glucose area under curve, homeostasis model assessment insulin resistance, triglycerides and waist-hipo ratio (r = - 0.30, - 0.26, -0.29, -0.19, - 0.20, - 0.29, - 0.22, respectively, all P < 0.01). Total testosterone had a positive correlation with fasting plasma insulin (r =0.14, P <0.01),all the point of insulin releasing test (1,2,3 h r =0.15,0.12,0.11, respectively, all P <0.05),the corresponding insulin area under curve(r =0.15,P <0.05) and homeostasis model assessment insulin resistance (r = 0.11, P < 0.05). Logistic regression demonstrated that SHBG was an independent predictor of IR (OR = 3.741). A SHBG level of 88 mmol/L (95% CI: 0.668 to 0.774) was used as the cut-off point for predicting IR according to the ROC curve. Fasting plasma insulin, insulin area under curve, homeostasis model assessment insulin resistance, fasting plasma glucose,glucose area under curve were higher in patients with SHBG < 88 mmol/L than those SHBG≥88 mmol/L(t = -6.45, -5.08, -6.19, -3.16, -3.66, respectively, all P <0.01),the same trend as triglycerides (t = - 2.06, P < 0.05). Conclusions TT in serum is higher in PCOS women while SHBG on the control. TT has a positive correlation and SHBG has a negative correlation with IR in PCOS. SHBG is perhaps the only independent risk factor to predict IR in PCOS women.