大剂量胰岛素对多囊卵巢综合征患者血浆皮质醇水平的影响

The effects of high insulin concentrations on cortisol levels in patients with polycystic ovarian syndrome

目的:了解多囊卵巢综合征患者空腹血浆皮质醇浓度变化及其影响因素,以及短期高糖或高胰岛素本身对患者皮质醇水平的影响。方法:84例PCOS患者分为超重组和正常体质量组,20例年龄匹配的健康妇女作为对照组。受试者均接受高糖刺激后,进行高胰岛素-正糖钳夹试验。结果:与对照组相比,超重PCOS患者的空腹血浆皮质醇水平明显下降,而正常体质量P-COS组无变化。多元回归分析提示,PCOS患者空腹皮质醇与体质量指数、胰岛素敏感性、空腹胰岛素呈负相关。高糖刺激不影响PCOS患者的皮质醇水平。但是高胰岛素刺激后,超重PCOS患者血浆皮质醇升高。结论:PCOS患者空腹皮质醇水平不仅与体质量有关,还与胰岛素敏感性和空腹胰岛素水平有关。短期高剂量胰岛素可能会激活超重PCOS患者的HPA轴。

OBJECTIVEE To measure the basal levels of cortisol in patients with Polycystic Ovarian Syndrome （PCOS）, analyze correlative factors, and investigate the effects of short-term hyperglycemia or hyperinsulinemia per se on their plasma eortisol concentrations. METHODS 84 PCOS patients divided into two groups （overweight group, BMI≥23. 0 kg·m^-2, n = 34; normal weight group, 18. 5≤BMI〈23. 0 kg·m^-2, n = 50） and 21 age-matched healthy women were involved. An acute glucose stimulation was given followed by euglyeemie hyperinsulinemie clamp in all subjects. RESULTS Basal eortisol levels in the overweight patients with PCOS were lower than in normal weight PCOS and control groups. Multiple linear regression analysis showed that basal eortisol correlated negatively with body mass index, insulin sensitivity and fasting insulin level. Although no changes in eortisol levels were observed after short-term hyperglycemic challenges, the eortisol levels increased in the overweight patients with PCOS after short-term hyperinsulinemie challenges. CONCLUSION Basal level of eortisol correlates not only with body weight, but also with insulin sensitivity and fasting insulin level in PCOS patients. An acute rise in plasma insulin appears to moderately stimulate the HPA axis of overweight patients with PCOS.