糖尿病家族青春期多囊卵巢综合征胰岛素抵抗的临床特征和治疗

Clinical investigation of insulin resistance in adolescence women with polycystic ovary syndrome from diabetic family.

目的:探讨糖尿病(DM)家族青春期多囊卵巢综合征(PCOS)胰岛素抵抗(IR)的程度及应用二甲双胍治疗的效果。方法:选择父亲或母亲被确诊患DM的7例青春期PCOS患者为实验组,以无DM家族史的28例青春期PCOS患者为对照组。测体重指数(BM I)、基础体温(BBT),抽血测FSH、LH、PRL、T、E2、P,行75g葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT)。计算空腹血糖胰岛素比率(FGIR)、糖负荷120m in血糖胰岛素比率(G120/I120)及稳态模型的胰岛素抵抗指数(HOMA-IR)。确诊IR患者进行包括二甲双胍在内的综合治疗,每3月重复检测1次上述指标。结果:实验组7例均超重(BM I≥25),其比率明显高于对照组(7/7vs12/28,P<0.01);实验组IR患病率亦明显高于对照组(7/7vs 9/21,P<0.01),且IR程度明显高于对照组IR患者(HOMA-IR为14.35vs 6.02,P<0.01)。两组接受二甲双胍综合治疗的IR患者治疗6月后空腹胰岛素(I0)比治疗前明显降低(32.47vs 40.36,P<0.05),胰岛素敏感性(IS)明显提高(FGIR为3.42 vs2.99,P<0.05),T降低,并有3例卵巢恢复排卵。结论:DM家族青春期PCOS患者可能存在较重IR,坚持二甲双胍综合治疗可减轻IR程度并恢复卵巢排卵功能。

Objective：To investigate the degree of insulin resistance （IR） in adolescence women with polycystic ovary syndrome （PCOS） from diabetic family and the effects of metformin treatment on them. Methods：Seven adolescence women with PCOS whose father or mother was diabetic （test group） and 28 cases of adolescence women with PCOS without diabetic family history （control group ） were investigated. Body mass index （BMI）, basal body temperature （BBT） ,sex hormone concentration,75g oral glucose tolerance tests （OGTT） and insulin release tests （IRT） were tested in all cases. Fasting glucose to insulin ratio（FGIR） ,2- hour glucose to insulin ratio（ G120/I120 ） and Homeostatic model assessment insulin resistance index（HOMA-IR） were calculated. Patients with IR received comprehensive therapy including metformin, and most tests above-mentioned were repeated every 3 months. Results：All cases in the test group had severe IR（ HOMA-IR was 14. 35 ） and high BMI（ ≥25 ） ;whereas in the control group only 9 cases had IR （HOMA-IR was 6.02 vs the test group, P 〈0. 01 ） and 12 cases had high BMI（P 〈0. 01 vs the test group）. Among 7 cases from two groups receiving the comprehensive therapy including metformin, their fasting insulin （I0 ） concentration was decreased significantly after 6 months treatment （40.36 vs 32.47, P 〈 0. 05 ） , and the insulin sensitivity （IS） was increased significantly （ FGIR was 2.99 vs 3.42 ,P 〈0. 05 ） ,in the same time T level was decreased significantly and 3 cases resumed their ovulation. Conclusion： Adolescence women with PCOS whose parents are suffering diabetes mellitus（DM） may all have severe IR which can be reduced by the comprehensive therapy including metformin.