饮食疗法对多囊卵巢综合征患者人体测量学和胰岛素敏感性的影响

Effects of dietary intervention on body weight and insulin sensitivity of patients with polycystic ovary syndrome

目的探讨饮食干预对多囊卵巢综合征患者体质量及胰岛素敏感性的影响。方法2009年6月至2010年2月在复旦大学附属妇产科医院内分泌专科门诊入选31例多囊卵巢综合征患者（年龄19～30岁），根据体质指数将其分至肥胖多囊卵巢综合征组（n=17，体质指数≥25kg／m^2）和非肥胖多囊卵巢综合征组（n=14，体质指数〈25kg／m^2），测定身高、体质量、腰围、臀围、黄体生成素、卵泡刺激素、总睾酮、空腹血浆葡萄糖和空腹血浆胰岛素水平。2组均予低热量饮食，1、3个月后比较各组体质量、空腹血浆葡萄糖、空腹血浆胰岛素、胰岛素抵抗指数改善情况。采用配对样本￡检验进行统计学分析。结果肥胖多囊卵巢综合征组十预1个月后体质量、体质指数及腰围明显低于干预前（t值分别为4．82、4．79、3．32，均P〈0．05），空腹血浆胰岛素水平[（13±6）mU／LVS（21±7）mU／L]及胰岛素抵抗指数（0．9±0．5VS1．5±0．5）得以改善（t值分别为4．75、4．95，均P〈0．01）；干预3个月后体质量、体质指数及空腹血浆胰岛素仍保持下降（t值分别为4．41、4．27、5．92，均P〈0．05）。非肥胖多囊卵巢综合征组干预1个月后体质量、体质指数及腰围明显低于干预前（t值分别为4．41、4．28、5．92，均P〈0．01）；干预3个月后空腹血浆胰岛素[（7．1±2．5）mU／LVS（15．2±1．5）mU／L]及胰岛素抵抗指数（0．42±0．38vs1．16±0．09）得以改善（t值分别为4．44、3．27，均P〈0．05）。干预前后2组黄体生成素、卵泡刺激素、总睾酮水平无明显变化。结论饮食疗法可改善肥胖和非肥胖多囊卵巢综合征患者人体测量学指标及胰岛素抵抗。

Objective To investigate the effects of dietary intervention on body weight and metabolic profiles in patients with polycystic ovary syndrome （PCOS）. Methods A total of 31 PCOS patients aged 19 to 30 years were assigned to group A （n = 17, body mass index （BMI） /〉25 kg/m2） or group B （n = 14, BMI 〈 25 kg/m2 ）. Anthropometric measurements and hormonal and metabolic profiles were compared in each group before and after the intervention. Results Body weight, BMI and waist circumference of group A were significantly decreased at 1 month （ t values were 4. 82, 4. 79 and 3.32, respectively; all P 〈0. 05） , and fasting plasma insulin （ （ 13±6） mU/L vs （21±7） mU/L） and HOMA- IR （0. 9± 0. 5 vs 1.5 - 0. 5 ） were largely improved （ t values were 4. 75 and 5.92, respectively ; both P 〈 0. 01 ）. At 3 months, body weight, BMI and fasting plasma insulin were still decreased （t values were 4. 41, 4. 28 and 5.92, respectively; all P 〈 0. 05）. Body weight, BMI and waist circumference of group B were significantly decreased at 1 month （t values were 4.41, 4. 28 and 5.14, respectively; all P 〈0. 01 ） , and fasting plasma insulin （（7.1±2.5） mU/L vs （15.2 ± 1.5） mU/L） and HOMA-IR （0.42±0.38 vs 1.16± 0. 09） were improved （ t values were 4.44 and 3.27, respectively; both P 〈 0. 05 ） at 3 months. Conclusion Dietary intervention could improve anthropometric measurements and metabolic profiles in nonobese or obese women with PCOS.