藏族人群多囊卵巢综合征患者胰岛素抵抗与其体质量指数和血脂血糖的相关性(英文)

Association of insulin resistance with body mass index,blood lipids and plasma glucose in Tibetan patients with polycystic ovary syndrome

背景:胰岛素抵抗和胰岛素分泌异常是多囊卵巢综合征常见的并发症,胰岛素抵抗、糖耐量异常和糖尿病具有种族差异,决定了多囊卵巢综合征与胰岛素抵抗关系也存在种族差异。目的:分析藏族人群多囊卵巢综合征患者胰岛素抵抗与其体质量指数和血脂、血糖的关系。设计:病例分析。单位:解放军总医院心内科,西藏军区总医院内二科。对象:于2005-04/2006-04在西藏军区总医院内二科和妇科住院的藏族多囊卵巢综合征患者36名,年龄25～42岁,平均(32±5)岁。对照组36例,年龄24～35岁,平均(30±5)岁,为同时期同科住院的藏族非多囊卵巢综合征的患者。方法:采静脉血检测激素水平、空腹胰岛素、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇;超声检查卵巢。采集病史,记录一般情况,所有病例均接受75g口服葡萄糖耐量试验。禁食12h采静脉血检测空腹胰岛素、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇。胰岛素抵抗指标采用稳态模型计算,胰岛素抵抗指数=空腹胰岛素(mIU/L)×空腹血糖(mmol/L)/22.5。比较多囊卵巢综合征组与对照组观察对象的血压、体质量指数、血脂、血糖和胰岛素水平。主要观察指标:多囊卵巢综合征组与对照组观察对象血压、体质量指数、血脂、血糖和胰岛素水平。结果:36名多囊卵巢综合征患者和36名对照观察对象全部完成实验,中途无脱落。①多囊卵巢综合征患者的体质量指数、收缩压、舒张压高于对照组(t=3.4265,2.4484,2.2125,P<0.05～0.01)。②多囊卵巢综合征患者的总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平高于对照组(t=2.1049,t=2.3047,2.4000,P<0.05～0.01),高密度脂蛋白胆固醇低于对照组(t=4.8000,P<0.01)。③多囊卵巢综合征组患者的空腹胰岛素、服糖后2h血糖和胰岛素抵抗指数高于对照组(t=7.8095,12.3650,2.7899,P<0.01)。结论:藏族多囊卵巢综合征患者呈现动脉粥样硬化危险因素聚集,如肥胖、血脂异常、高血压、高血糖等。

BACKGROUND： Insulin resistance and impaired insulin secretion are the key complications of polycystic ovary syndrome （PCOS）. The incidences of insulin resistance syndrome （IRS）, impaired glucose tolerance （IGT） and diabetes mellitus have been clearly shown to be race-related, thus the association between polycystic ovary syndrome and insulin resistance was race-related.OBJECTIVE： To analyze the correlation of insulin resistance with body mass index （BMI）, blood lipids and plasma glucose in Tibetan patients with PCOS.DESIGN： A prospective study based on Tibetan population.SETTING： Department of Cardiology, General Hospital of Chinese PLA; Second Department of Internal Medicine,General Hospital of Tibetan Military Area Command of Chinese PLA.PARTICIPANTS： Thirty-six Tibetan PCOS patients, aged 25-42 years with a mean age of （32±5） years were selected from the Second Department of Internal Medicine and Department of Gynecology, General Hospital of Tibetan Military Area Command of Chinese PLA. Another 36 female inpatients were selected as the controls （control group）, aged 24-35 years with a mean age of （30±5） years.METHODS： The disease histories were collected and general conditions were recorded. Oral glucose tolerance test （OGTT, 75 g） was conducted for all the subjects. All the subjects werefasted for 12 hours to collect venous blood samples to detect the levels of hormone, fasting insulin, total cholesterol, triglyceride, high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C）. Ovary was detected with echocardiography. The insulin resistance index was calculated by the homeostasis model assessment （HOMA-IR） was calculated by the formula：fasting insulin （mlU/L）×FPG （mmol/L）/22.5. The blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were compared between the PCOS group and control group.MAIN OUTCOME MEASURES： Blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were observed in both groups.RESULTS： All the 36 PCOS patients and 36 controls were involved in the analysis of final results. ① The BMI, systolic blood pressure and diastolic blood pressure in the PCOS group were higher than those in the control group （t =3.426 5,2.448 4, 2.212 5, P 〈 0.05-0.01）. ② The levels of total cholesterol, triglyceride and LDL-C in the PCOS group were higher than those in the control group （t=2.104 9, t =2.304 7, 2.400 0, P〈 0.05-0.01）, whereas the level of HDL-C was lower that in the control group （t =4.800 0, P〈 0.01）. ③ The levels of fasting insulin and 2-hour plasma glucose and HOM in the PCOS group were higher than those in the control group （t =7.809 5, 12.365 0, 2.789 9, P〈 0.01）.CONCLUSION： Tibetan PCOS patients present a clustering of atherosclerotic risk factors, including obesity, adverse lipid profile, hypertension, hyperglycemia, etc.