青春期多囊卵巢综合征患者胰岛素抵抗及糖代谢异常的分析

目的 分析青春期多囊卵巢综合征(PCOS)患者胰岛素抵抗(IR)及糖代谢异常的发生情况.方法 PCOS组为15～19岁诊断为PCOS的患者141例,对照组为年龄匹配、月经规则、无糖尿病家族史的女中学生266名.对照组测定空腹胰岛素(FINS)及空腹血糖(FIG),计算稳态模型评估的胰岛素抵抗指数(HOMA-IR),取对照组FINS及HOMA-IR 75%位点值为生理高限值.将PCOS患者分为肥胖(OB-PCOS)及非肥胖(NOB-PCOS)组,均行口服葡萄糖耐量试验(OGTT).结果 FINS生理高限值为13.13mIU/L,HOMA-IR为2.69.PCOS组FINS(17.68±16.13对10.40±5.33)mIU/L,P<0.01]及HOMA-IR(2.64±2.01对2.01±1.61,P<0.01)均高于对照组,其中OB-PCOS组FINS(22.04±18.01对13.06±12.60)mIU/L,P<0.01]及HOMA-IR(4.62±3.87对2.38±2.26,P<0.01)高于NOB-PCOS组.PCOS组中FINS和HOMA-IR超过生理高限值的患者分别有75例(53.19%)和67例(47.52%),其中79例OB-PCOS患者中FINS和HOMA-IR超过生理高限值的患者有56(70.89%)和52(65.82%)例;62例NOB-PCOS患者中有19(30.65%)和15(24.19%)例.PCOS组发生糖尿病2例(1.42%),2例FINS及HOMA-IR均升高;糖耐量受损(IGT)患者12例(8.51%),11例患者FINS和HOMA-IR均升高.结论 青春期PCOS患者普遍存在病理性IR,尤其在肥胖型PCOS患者中更严重、更常见,其中部分患者已发生糖代谢异常.

Insulin resistance and abnormal glucose metabolism in adolescent polycystic ovary syndrome

Objective To analyze the occurrence of insulin resistance ( IR ) and abnormal glucose metabolism in adolescent polycystic ovary syndrome (PCOS). Methods PCOS group included 141 patients aged 15-19 years old, who were diagnosed as PCOS according to criteria by reference to the European Society of Reproduction and Embryology/American Society for Reproductive Medicine proposed in 2003, at Rotterdam; and 266 age-matched female students,with regular menstrual cycles and no family history of diabetes, were enrolled in control group. Fasting insulin(FINS),fasting plasma glucose(FPC) ,and homeostasis model assessment for insulin resistance ( HOMA-IR) were measured in control group. 73% percentile value of control group was set as physical upper limits of FINS and HOMA-IR. PCOS patients were divided into obese ( OB-PCOS) and non-obese (NOB-PCOS) groups, and oral glucose tolerance test(OGTT) were performed. Results According to 75% percentile value of control group,the physical upper limits of FINS and HOMA-IR were 13.13 mIU/ L and 2.69, respectively. FINS and HOMA-IR values in PCOS group were higher than those in control group (17.68±16. 13 vs 10.40±5. 33)mIU/L,2. 64±2.01 vs 2. 01 ±1. 61,both P<0.01]. FINS and HOMA-IR values in OB-PCOS group were higher than those in the NOB-PCOS group (22.04± 18.01 vs 13.06± 12. 60) mIU/L,4. 62±3. 87 vs 2.38±2.26,both P<0.01]. In PCOS group,FINS of 75 cases(53.19% )and HOMA-IR of 67 patients(47.52% ) exceeded the physical upper limits. In 79 OB-PCOS patients, FINS of 56 cases (70. 89% ) and HOMA-IR of 52 patients (65.82% ) exceeded the physical upper limits while in 62 NOB-PCOS patients there were 19(30.65% ) and 15 (24. 19% )patients. In PCOS group,2(1.42% ) patients were diagnosed diabetes mellitus,and both FINS and HOMA-IR of these two cases increased. Meanwhile, 12 cases(8.51% ) were impaired glucose tolerance(ICT) ,of whom 11 patients FINS and HOMA-IR increased. Conclusion Pathological IR is prevalent in adolescent PCOS, more severe and popular in obese-PCOS, a part of them with abnormal glucose metabolism.