Rotterdam标准诊断不同表型多囊卵巢综合征中国患者糖代谢的差异评估

Glucose Metabolism in Polycystic Ovary Syndrome Diagnosed With Rotterdam Criteria Among Chinese Females.

目的研究不同表型多囊卵巢综合征(polycystic ovary syndrom,PCOS)患者糖代谢差异,从糖代谢角度探讨多囊卵巢综合征Rotterdam标准不同诊断指标对我国患者是否适用。方法将2004年1月至2004年12月在南京大学医学院附属医院妇科门诊就诊的52例患者(病例组)中,诊断为多囊卵巢综合征的17例患者纳入PCOS组(组),诊断为雄激素过高症的14例患者纳入雄激素过高症组(组),既有多囊卵巢综合征又有雄激素过高症的21例患者纳入复合组(组)。所有入选对象血清硫酸脱氢表雄酮(DHEA-S)水平正常(<5μmol/L),近2个月未服用避孕药。同期就诊,月经周期规律,经直肠超声检查显示卵巢形态学正常,诊断为单纯输卵管性不孕的8例患者纳入对照组。月经周期第2～第5天行口服75 g葡萄糖耐量试验(OGTT),测量血糖(Glu)、胰高血糖素(GLY)、胰岛素(INS)和C-肽(C-P)的血浓度变化,并计算胰岛素抵抗(insulin resistance,IR)参数[胰岛素浓度/血糖浓度(I/G)]、[IR=C-肽浓度/胰岛素浓度(C/I)]。结果病例组基本情况及基础激素水平与对照组相似,糖代谢表现为高胰岛素血症和胰岛素抵抗,且程度相似。结论病例组患者胰岛素抵抗程度相似,说明糖代谢异常相似。因此,就糖代谢的角度而言,Rotterdam标准的不同诊断指标对我国多囊卵巢综合征患者适用。

Objective Rotterdam criteria in polycystic ovary syndrome （PCOS） diagnosing is adopted in china and the glucose metabolic abnormality is commonly found in Chinese women. Therefore, a method was designed to assess the overlap between the glucose metabolism abnormality and Rotterdam criteria in polyeystic ovary syndrom diagnosis. Methods From January 2004 to December 2004,fifty-two polycystic ovary syndrome cases （the patients group） based on the Rotterdam criteria were subdivided into polycystic ovary （the group Ⅰ , n=17）, hyperandrogenism （the group Ⅱ , n=14）and both （the group Ⅲ , n=22） according to their major features. All the participants had the normal DHEA-S （〈5 μmol/L） and did not take contraceptive pills in recent two months. Eight cases with the simple tubal infertility were admitted as the control group. The oral glucose （75 g） tolerance test （OGTT） was carried out to measure serum glucose （GLU）, insulin（INS） and c peptide （C-P） at the indicated time points at the 2 nd-5 th day of menstrual cycles. The peripheral insulin resistance（IR） and hepatic insulin clearance were evaluated by insulin to glucose ratio and c-peptide to insulin ratio respectively. Natural logarithm transformed the data to meet the Gaussian distribution. Results The patients group and control group had the comparable basal metabolism level. The patient group had hyperinsulinemia and insulin resistance at the comparable level. Conclusion Glucose metabolisms are abnormal in the patient group diagnosed by Rotterdam criteria. From the angle of glucose metabolism, Rotterdam criteria can be applied to the Chinese women with polycystic ovary syndrom.